Difference between hyperprolactinemia and macroprolactinemia

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.

Hyperprolactinemia refers to a syndrome caused by internal and external environmental factors, characterized by elevated prolactin (PRL) (>25ng/ml), amenorrhea, galactorrhea, anovulation and infertility. From the perspective of pathological changes, it can be divided into tumor hyperprolactinemia, postpartum hyperprolactinemia, idiopathic hyperprolactinemia and iatrogenic hyperprolactinemia. The main clinical features are amenorrhea, infertility and galactorrhea.

The most prominent manifestation of hyperprolactinemia is hypogonadism, which is caused by elevated PRL levels and is called hyperprolactinemic hypogonadism. Female patients may have decreased libido and loss of sexual desire, which will be relieved after treatment as PRL levels decrease. In women of childbearing age, hyperprolactinemic hypogonadism is mainly manifested by decreased menstruation or even amenorrhea, but it can also be manifested as menorrhagia or normal menstruation with infertility. Galactorrhea is another common symptom, seen in 30% to 80% of female patients. Most patients have well-developed breasts, which is in sharp contrast to the breast atrophy of natural menopausal women. Spontaneous galactorrhea is rare, and milk can only be seen when the nipples are squeezed. People with excessively high blood PRL levels do not have galactorrhea, which may be because excessively high PRL strongly inhibits the function of the gonads and significantly reduces estrogen levels. Patients with this disease have true galactorrhea, with fluid flowing out of both nipples. It is a milky or turbid white fluid that is rich in casein, whey protein and lactose, and should be differentiated from pseudogalactorrhea.