Hyperprolactinemia treatment steps

Hyperprolactinemia is a common disease among women, which brings a lot of harm to women. Hyperprolactinemia should be treated actively. What are the steps for treating hyperprolactinemia? This is a problem that most women do not understand. Let's take a look at it together. I hope the following content can help you.

1. Antiprolactin drugs Antiprolactin drugs include bromocriptine, long-acting bromocriptine, tergoline, cabergoline, tergoline, methylergoline, quinagoline (nogonin) and lisuride.

(1) Bromocriptine therapy: Bromocriptine is a semi-synthetic ergot alkaloid derivative and a dopamine receptor agonist. Bromocriptine enhances dopamine receptor function, promotes the production and secretion of hypothalamic PRI-IH, and inhibits the production of pituitary PRI. Bromocriptine also directly inhibits the growth of pituitary tumors and the secretion of pituitary PRI, GH, TSH, and ACTH.

Bromocriptine therapy is suitable for various types of hyperprolactinemia and is also the first choice for the treatment of pituitary adenomas. The oral dose is 2.5-5.0 mg/d. The blood concentration of bromocriptine reaches its peak 1-3 hours after oral administration, and the inhibitory effect on prolactin secretion lasts for 14 hours. After taking 2.5 mg of bromocriptine orally once, prolactin levels in about 90% of patients decrease, and prolactin levels in 1/3 of patients decrease to normal. Vaginal medication can be used for those who cannot tolerate oral administration.

The purpose of bromocriptine treatment is to suppress galactorrhea, restore menstruation, and promote ovulation and pregnancy. The average treatment time for non-tumor hyperprolactinemia is 12 months, and the average treatment time for tumor hyperprolactinemia is 47 months. Univariate and multivariate analysis found that the treatment effect was correlated with age, gender, initial dose of bromocriptine, duration of treatment, tumor size, pregnancy during treatment, and previous radiotherapy.

After bromocriptine treatment of tumor hyperprolactinemia, 80-90% of pituitary microadenomas shrink and 10-20% permanently disappear, mostly within the first few weeks of treatment. After discontinuation of bromocriptine, the tumor recurrence rate is 35%. Although there is no evidence that bromocriptine has teratogenic effects and does not affect pregnancy outcomes, treatment should be stopped if pregnancy occurs during treatment.

After one year of bromocriptine treatment, 11% of women with microadenomas had their prolactin and menstrual function permanently restored to normal. After two years of treatment, the permanent regression rate of pituitary tumors was 22%. Although high-dose bromocriptine (10 mg/d) is more effective than low-dose, the side effect rate is higher and difficult to tolerate. Bromocriptine (5-12.5 mg/d) can cause 50% of pituitary macroadenomas to shrink, of which 2/3 occur within the first 6 weeks of treatment and 1/3 shrink after 6 months of treatment. For details on the ovulation rate, pregnancy rate, dosage and efficacy of bromocriptine treatment, please refer to the anti-prolactin section.