Introduction to the causes of hyperprolactinemia

Hyperprolactinemia is a disease caused by abnormal hormones. The related symptoms include irregular menstruation, abnormal ovulation, and osteoporosis. It is a disease that affects women's fertility. What are the causes of hyperprolactinemia? There are three main types: one is caused by physiological reasons, the second is caused by pathological and rational reasons, and the third is abnormal pituitary lesions.

What is the cause of hyperprolactinemia?

1. Physiological hyperprolactinemia Many physiological factors can affect the patient's serum PRL level, which changes in different physiological periods, even every day and every hour. Many daily activities, such as physical exercise, mental trauma, hypoglycemia, night, sleep, eating, stress stimulation, sexual intercourse, and physiological phenomena, such as the late follicular and luteal phases, pregnancy, lactation, puerperium, nipple stimulation, neonatal period, etc., can lead to a temporary increase in PRL, but the increase will not be too large, the duration will not be too long, and it will not cause relevant pathological symptoms.

2. Pharmacological hyperprolactinemia Any drug that affects dopamine (DA) metabolism may reduce the effect of DA at the DA receptor level by antagonizing prolactin inhibitory factor (PIF) and enhancing prolactin releasing factor (PRF), thereby promoting PRL secretion and leading to hyperprolactinemia, but it is generally below 100ng/ml.

3. Pathological hyperprolactinemia Common pathological causes of hyperprolactinemia are:

(1) Hypothalamic PIF deficiency or obstruction of the pathway to the pituitary gland causes the normal inhibitory regulation of pituitary PRI cells to be released. This is common in hypothalamic or pituitary stalk lesions, especially in pan-adenohypophysis or when the pituitary stalk is damaged due to trauma or surgery, such as skull base meningitis, tuberculosis, syphilis, actinomycosis, craniopharyngioma, sarcoidosis, glioma, empty sella syndrome, injury, surgery, arteriovenous malformation, Parkinson's disease, and mental trauma.

(2) Primary and/or secondary hypoparathyroidism: such as pseudohypoparathyroidism and Hashimoto's thyroiditis.

(3) Obtaining autonomous high-function PRL-secreting cell monoclonal lines: seen in pituitary PRL adenomas, GH adenomas, ACTH adenomas, etc., as well as heterologous PRL secretion in cancers, such as undifferentiated bronchial lung cancer, adrenal adenomas, embryonal carcinomas, endometriosis, etc.

(4) Afferent nerves can enhance the effect of PRF through enhanced stimulation: this is seen in various chest wall inflammatory diseases, such as papillitis, chapped skin, chest wall trauma, herpes zoster, tuberculosis, traumatic and neoplastic diseases, etc.

(5) Abnormal degradation of PRL in the kidney: This occurs in chronic renal failure, cirrhosis, or hepatic encephalopathy, where pseudo-neurotransmitters are formed, thereby weakening the effect of PIF.

(6) Gynecological and obstetric surgery: such as artificial abortion, induced labor, stillbirth, hysterectomy, tubal ligation, oophorectomy, etc.

4. Idiopathic hyperprolactinemia. This type of patient has nothing to do with pregnancy, medication, pituitary tumors or other organic lesions. It is mostly due to hypothalamic-pituitary dysfunction, which leads to increased PRL secretion. Most of them have mildly elevated PRL and a long course of disease, but can return to normal. When there is no medical reason and the cranial MRI fails to find adenoma, the diagnosis of idiopathic hyperprolactinemia can be confirmed. However, for some patients with menstrual disorders and PRL>100tiglL, it is necessary to be alert to the possibility of latent pituitary microadenoma and should be followed up closely.

The above article introduces the causes of hyperprolactinemia, which seems very complicated and may not be understood by many patients. If you suffer from this disease, it is best to consult a doctor to understand it clearly. Different patients have different specific causes, so the treatment methods are also different. It is necessary to determine the exact cause based on the relevant examination results before implementing the subsequent treatment plan.