Comprehensive understanding of the causes of hyperprolactinemia in women

Hyperprolactinemia is the most common pituitary disease, with galactorrhea and hypogonadism as prominent manifestations. Female patients may experience decreased libido and loss of sexual desire, which will be relieved after treatment as PRL levels decrease. Male patients mainly experience decreased libido and impotence, and in severe cases, body hair loss, testicular atrophy, reduced sperm count, and even azoospermia may occur.

Causes: ① Pituitary or sellar region tumors; ② Hypothyroidism; ③ Drug-induced, including dopamine receptor antagonists and estrogen; ④ Chronic renal failure; ⑤ PRL is the largest stress hormone in the human body, and any physical stress state can cause a sharp increase in PRL.

Triggering factors 1. Nerve stimulation: Stimulation of certain parts of the skin, especially the chest, including severe pain caused by damage to the peripheral nerves, can be transmitted to the hypothalamus through nerves and cause an increase in prolactin. 2. Pituitary disorders: Pituitary disorders mainly refer to various tumors in the pituitary area. In addition, some vacuolar sella syndrome, hyperpituitarism, etc. can also cause galactorrhea and amenorrhea. 3. Drug factors: The secretion of high prolactin is affected by many factors. For example, acute conditions such as intense physical activity, some drugs, and trauma can cause increased secretion of prolactin. 4. Primary hypothyroidism: When the thyroid function is hypothyroid, the information of insufficient thyroid secretion is fed back to the hypothalamus, causing the hypothalamus to produce a large amount of thyroid-stimulating hormone-releasing factor. This factor can stimulate the pituitary to secrete thyroid-stimulating hormone while stimulating the excessive secretion of pituitary prolactin and causing galactorrhea. 5. Hypothalamic disorders: Diseases of the hypothalamus and adjacent parts of women can cause a decrease in the prolactin-inhibiting factor produced by the hypothalamus, or an increase in prolactin-releasing factor and thyroid-stimulating hormone-releasing factor.

Clinical features

Main symptoms 1. Menstrual disorders include various menstrual disorders, ranging from oligomenorrhea, sparse menstruation to amenorrhea, among which amenorrhea is the most common. Primary amenorrhea occurs before puberty or during puberty, and secondary amenorrhea occurs after the reproductive period. 2. Infertility Abnormally elevated PRL inhibits ovulation, leading to infertility, and mildly elevated PRL causes luteal insufficiency, leading to miscarriage. 3. Galactorrhea is usually manifested as non-bloody, milky or transparent fluid flowing out of or being squeezed out of both breasts, with varying amounts.

Minor symptoms include 1. Headache, dizziness and visual disturbances due to compression of surrounding brain tissue and optic chiasm caused by enlarged pituitary adenoma, as well as cerebrospinal fluid reflux obstruction. 2. Low estrogen status due to suppression of ovarian function, resulting in vasomotor symptoms such as hot flashes and sweating, breast shrinkage, vaginal dryness, sexual dysfunction and other changes. 3. Other symptoms 20%-30% of patients with hyperprolactinemia are accompanied by hirsutism and acne, and a few patients may also be obese.

Signs: 1. Galactorrhea. 2. Headache, dizziness and visual disturbance. 3. Hirsutism and acne. 4. Obesity.