Specific manifestations 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. So, what are the specific manifestations of this disease?

1. Abnormal menstruation: The incidence of amenorrhea in patients with high PRL blood is about 70%, rare menstruation is 9%, anovulatory menstruation and corpus luteum dysfunction are about 5% each. Eight percent have normal menstrual cycles. The proportion of each cause of disease: the incidence of amenorrhea in pituitary adenoma is up to 90%, and the incidence of amenorrhea in patients with primary hypothyroidism and drug-induced high PRL blood is less, about 60%. The PRL value in the blood is closely related to the incidence of amenorrhea. When it is 25-100ng/ml, it is 58%, when it is 101300ng/m1, it is 80%, and when it is above 30lng/m1, it is 95%. It can be seen that the incidence of amenorrhea increases with the increase of PRL value. In terms of the type of amenorrhea, 96% is secondary amenorrhea, and primary amenorrhea accounts for only 4%.

2. Infertility: HyperPRLemia reduces or even eliminates the LH pulse secretion of the pituitary gland, and the positive feedback mechanism of estrogen inducing the LH peak before ovulation is impaired. The GnRH secreted by the thalamus is inhibited, thus affecting the function of the gonadal axis, causing ovulation disorders and infertility.

2. Infertility: HyperPRLemia reduces or even eliminates the LH pulse secretion of the pituitary gland, and the positive feedback mechanism of estrogen inducing the LH peak before ovulation is impaired. The GnRH secreted by the thalamus is inhibited, thus affecting the function of the gonadal axis, causing ovulation disorders and infertility.

3. Milk secretion: 70% of patients with high PRL blood have milk secretion during breast examination. This indicates the importance of breast examination. The milk secretion rate caused by other diseases is the highest in Chiari-Frommel syndrome, up to 97%, followed by pituitary adenoma, 83%, Argonz-delcastillo syndrome, 74%, and primary hypothyroidism, only 26%.

The incidence of lactation has nothing to do with the level of PRL in the blood. A high PRL level may not necessarily result in milk secretion, whereas a slightly high PRL level may result in milk secretion.

4. Other disorders: 1/3 of patients with primary hypothyroidism will have thyroid enlargement. Tumors near the hypothalamus and pituitary gland may cause symptoms such as hemianopsia and low vision. PRL stimulates the adrenal cortex to produce excessive dehydroepiandrosterone (DHEA), resulting in hirsutism.