What are the more effective tests for hyperprolactinemia?

Hyperprolactinemia refers to a syndrome caused by internal and external environmental factors, characterized by elevated PRL, amenorrhea, galactorrhea, anovulation and infertility. Traditional Chinese medicine believes that the etiology and pathogenesis of this disease are relatively complex, but in principle it can be divided into two categories: deficiency and excess. Deficiency is caused by liver and kidney deficiency, insufficient blood, and an empty blood sea. If there is no blood to go down, then there will be amenorrhea; if qi and blood are weak, and kidney qi is not solid, then milk will overflow. So, what are the more effective tests for hyperprolactinemia?

There are several main methods for testing for hyperprolactinemia:

1. Sella section: In normal women, the anterior-posterior diameter of the sella turcica is <17mm, the depth is <13mm, the area is <130mm2, and the volume is <1100mm3. CT scan should be performed if the following phenomena occur: ① sailboat-like enlargement; ② double sella bottom or double edge; ③ high/low density area or inhomogeneity in the sella turcica; ④ plate deformation; ⑤ calcification foci above the sella turcica; ⑥ osteoporosis of the anterior and posterior clinoid processes or cavitation in the sella turcica; ⑦ bone destruction.

2. Computed tomography and magnetic resonance imaging: precise positioning and radiometric measurement of intracranial lesions.

3. Contrast examination: How to check hyperprolactinemia? Contrast examination includes: sponge sinus angiography, pneumoencephalography and cerebral angiography.

4. Endocrine function examination

1. Pituitary function: FSH and LH decrease, and the LH/FSH ratio increases. PRL increases ≥25ng/ml. It is generally believed that <100ng/ml is mostly functional. ≥100mg/ml should be careful to exclude PRL adenoma. The larger the tumor, the higher the PRL. For example, if the tumor diameter d≤5mm, PRL is 171±38ng/ml; d=5～10mm206±29ng/ml; ≥10mm485±158ng/ml. PRL may not increase when giant adenoma bleeds and necrotizes.

2. Ovarian function test: E2 and P decreased, T increased.

3. Thyroid function test: When HPRL is combined with hypothyroidism, TSH increases, while T3, T4, and PBI decrease.

4. Adrenal function test: When HPEL is combined with Cushing's disease and virilization symptoms, T, △4dione, DHT, DHEA, 17KS and plasma cortisol are elevated.

5. Pancreatic function examination: When HPRL is combined with diabetes and acromegaly, insulin, blood sugar, glucagon and glucose tolerance test should be measured.

5. Prolactin function test

1. Prolactin stimulation test

1) Thyrotropin-releasing hormone test: How to check for hyperprolactinemia? In normal women, 100-400 μg of TRH is injected intravenously once. Within 15-30 minutes, PRL increases 5-10 times and TSH increases 2 times compared with before injection. It does not increase in case of pituitary tumor.

2) Chlorpromazine test: Chlorpromazine inhibits the absorption of norepinephrine and the conversion of dopamine through receptor mechanism, and promotes PRL secretion. In normal women, blood PRL increases 1 to 2 times compared with before injection 60 to 90 minutes after intramuscular injection of 25 to 50 mg, and lasts for 3 hours. It does not increase in pituitary tumors.

3) Metoclopramide test: This drug is a dopamine receptor antagonist that promotes the synthesis and release of PRL. In normal women, 30 to 60 minutes after intravenous injection of 10 mg, PRL increased by more than 3 times compared with before injection. It does not increase in pituitary tumors.

2. Prolactin suppression test

1) Levodopa test: This drug is a dopamine precursor, which generates DA through the action of dehydroxylase and inhibits PRL secretion. In normal women, PRL is significantly reduced 2 to 3 hours after oral administration of 500 mg. It does not decrease in pituitary tumors.

2) Bromocriptine test: This drug is a dopamine receptor agonist that strongly inhibits PRL synthesis and release. In normal women, PRL decreases by ≥50% 2 to 4 hours after oral administration of 2.5 to 5.0 mm, and lasts for 20 to 30 hours. In functional adenomas, HPRL and PRL decrease significantly, while GH and ACTH decrease less than the former two.

6. Ophthalmological examination: including visual acuity, visual field, intraocular pressure, and fundus examination to determine whether there are any signs of compression caused by intracranial tumors.