Tests for symptomatic hyperprolactinemia

Hyperprolactinemia is a common hypothalamic-pituitary-gonadal axis disease. Excessive prolactin can interfere with the function of the gonads and is one of the causes of sexual dysfunction and infertility in both men and women. The examination of hyperprolactinemia is of great reference significance for the accurate treatment of the disease. So, what are the examinations for symptomatic hyperprolactinemia?

1. Can a single high blood prolactin test diagnose hyperprolactinemia?

If the prolactin level is between 25 and 40 ng/ml, the answer is no. Because a single blood test shows that the prolactin level is higher than normal, it is not enough to diagnose hyperprolactinemia. Because prolactin is secreted in a pulsed manner, and stress can increase the secretion of prolactin. Hyperprolactinemia can only be diagnosed after other causes of elevated prolactin are excluded by taking a medical history (especially medication history), a pregnancy test, and checking thyroid and kidney function.

2. What tests need to be done after hyperprolactinemia is diagnosed:

After excluding other causes of elevated prolactin, patients with hyperprolactinemia should undergo sellar enhanced MRI examination. Generally, dynamic sellar enhanced MRI is used. This examination method can detect pituitary adenomas of 2 to 3 mm in size. According to the size of the tumor, pituitary adenomas are divided into microadenomas with a diameter of <1 cm and macroadenomas between 1 and 3 cm. For patients whose tumors are higher than the pituitary fossa, visual field examinations and anterior pituitary function examinations are also required. Anterior pituitary function includes adrenal function (blood F, 24UFC, ACTH), thyroid function (thyroid function 1 to 3) and gonadal function (FSH, LH, E2 and T).

The blood prolactin level is proportional to the size of the tumor. The prolactin level of a large adenoma is generally more than 250ng/ml. In special cases, the tumor is very large, but the prolactin level is slightly elevated. There are two reasons for this. First, the tumor is not a prolactin adenoma, but the tumor compresses the pituitary stalk, causing a secondary increase in prolactin; second, it is a hook phenomenon. That is, the blood prolactin level is