Several symptoms of hyperprolactinemia that are easily misdiagnosed

Since there are many causes of hyperprolactinemia, it is necessary to distinguish hyperprolactinemia caused by function, pituitary tumors, and other tumors. Hyperprolactinemia caused by lactation, stress, drugs, chest wall stimulation, hypothyroidism, adrenal failure, ectopic secretory tumors, polycystic ovary syndrome, etc. should be excluded. If it is a pituitary tumor, it is necessary to clarify whether it is a tumor that secretes PRL or another tumor.

1. Polycystic ovary syndrome Thirty percent of PCOS is accompanied by elevated prolactin, which is due to long-term estrogen stimulation of the pituitary gland, causing prolactin cells to secrete PRL. Some PCOS patients will have infrequent menstruation or even amenorrhea, but almost no lactation. Pelvic ultrasound suggests that the ovaries have polycystic changes. Endocrine tests show that LH is elevated, estrogen is elevated, and PRL is not high or slightly elevated. In hyperprolactinemia, in addition to the typical clinical manifestations, PRL is significantly elevated, and FSH and LH are suppressed. 2. Long-term use of the following drugs may cause lactation sedation drugs include chlorpromazine, phenothiazine, and perphenazine. Antiemetic metoclopramide. Gastrokinetic drug domperidone. Antihypertensive drugs reserpine methyldopa, verapamil. In addition, cocaine, monoamine oxidase inhibitors, and protease inhibitors can all cause high PRL blood disease. 3. Kidney disease Seventy-three to ninety percent of women with end-stage renal disease have high PRL levels, which are caused by decreased PRL clearance and increased autonomous production. Bromocriptine can reduce PRL. 4. Cirrhosis Some cirrhotic patients have increased PRL levels, and 50% of patients with hepatic encephalopathy have high PRL levels, which is speculated to be related to insufficient hypothalamic dopamine production. 5. Hypothyroidism When the thyroid gland is hypothyroid, TRH production increases, and prolactin cells are sensitive to TRH stimulation, resulting in increased PRL levels. Taking thyroxine tablets reduces PRL to normal. 6. Adrenal insufficiency Glucocorticoids have an inhibitory effect on PRL gene transcription and PRL release. A small number of patients have high PRL levels, and PRL levels return to normal after glucocorticoid supplementation. 7. Neurogenic stimulation Breast stimulation and sucking reflex have been reported to cause PRL release. Similar persistent increases in PRL may occur in mastectomy, nipple puncture, thoracotomy, and chronic spinal cord injury. 8. Ectopic PRL secretion is extremely rare, however, there have been reports of PRL originating from one renal cell, one gonadotropin cell tumor, and two ovarian teratomas with ectopic pituitary tissue. 9. Hypothalamic pituitary stalk disease. This type of lesion is caused by a disorder of the neuroendocrine mechanism that controls PRL secretion and is related to dopamine disinhibition. Craniopharyngioma is common. 10. Idiopathic hyperPRLemia. When no other specific cause is found for hyperPRLemia, it is defined as idiopathic hyperPRLemia. In many of these cases, small PRL tumors that cannot be detected by current imaging technology may be included. Other causes may include hypothalamic regulation disorders. Long-term follow-up found that PRL returned to normal in 1/3 of the patients, and PRL levels were elevated or exceeded in 10-15% of the patients. A 2-6 year follow-up of patients with pituitary disease found that 23 cases developed microadenomas. 11. Other pituitary tumors When other pituitary tumors are suspected, growth hormone, cortisol, FSH, LH, TSH, etc. should be measured to rule out tumors that secrete TSH and gonadotropin, acromegaly, and Cushing's syndrome.