What are the sequelae of hyperprolactinemia?

Hyperprolactinemia (HP) is an endocrine disease caused by hypothalamic pituitary disorders, the most common cause of which is excessive secretion of prolactin (PRL) by pituitary prolactinoma. Since elevated serum PRL causes ovarian dysfunction in women, resulting in amenorrhea, galactorrhea, and infertility, HP is now a difficult disease that gynecologists pay attention to. Hyperprolactinemia can also cause significant osteoporosis, which may be due to the decrease in estrogen levels, but some people also believe that PRL itself has a negative impact on bone density.

Common symptoms: non-lactating period, breast milk secretion during pregnancy, irregular menstruation 1. General manifestations

(1) Menstrual disorders: primary amenorrhea accounts for 4%, secondary amenorrhea accounts for 89%, oligomenorrhea accounts for 7%, dysfunctional bleeding and luteal insufficiency account for 23% to 77%.

(2) Galactorrhea The incidence of typical amenorrhea-galactorrhea syndrome in non-tumor hyperprolactinemia is 28.4%, in tumor-type hyperprolactinemia it is 70.6%, and in simple galactorrhea it is 63% to 83.5%. Galactorrhea is overt or occurs when the breast is squeezed and is watery, serous, or milky. The breasts are usually normal.

(3) The incidence of infertility is 70%, which can be primary or secondary infertility and is related to anovulation, luteal insufficiency or luteinized unruptured follicle syndrome (LUFS).

(4) Hypoestrogenemia and hyperandrogenism: Decreased estrogen levels cause hot flashes, palpitations, spontaneous sweating, vaginal dryness, dyspareunia, decreased libido, etc. Increased androgen levels cause moderate obesity, seborrheic dermatitis, acne, and hirsutism.

(5) Changes in vision and visual field: When pituitary tumors involve the optic chiasm, they can cause decreased vision, headaches, dizziness, hemianopsia and blindness, as well as functional impairment of cranial nerves II, III and IV, and fundus edema and exudation.

(6) Acromegaly: seen in PRL-GH adenoma, myxedema seen in combined hypothyroidism, some patients have type 2 diabetes and osteoporosis.

2. Clinical classification

(1) Tumor-type hyperprolactinemia: It accounts for 71% of hyperprolactinemia, of which prolactin adenomas account for 46%, microadenomas account for 66%, and macroadenomas account for 34%. A small number of them are prolactin-growth hormone adenomas and chromosomal cell tumors. Most pituitary adenomas have PRL ≥ 200ng/ml, and some pituitary adenomas can regress naturally.

(2) Postpartum hyperprolactinemia: It accounts for 30% of hyperprolactinemia and occurs within 3 years after pregnancy, delivery, miscarriage, or induced labor. Plasma prolactin is slightly elevated, and patients have oligomenorrhea, menstrual disorders, and galactorrhea. The prognosis is good with treatment.

(3) Idiopathic hyperprolactinemia: rare, mostly related to psychological trauma and stress factors, and some are extremely small adenomas.

(4) Iatrogenic hyperprolactinemia is caused by iatrogenic factors or drugs, mostly due to other diseases (such as hypothyroidism), and can recover naturally after the cause is eliminated.

(5) Latent hyperprolactinemia (OHP) is also called latent hyperprolactinemia.