Does hyperprolactinemia affect pregnancy?

Prolactin is a protein hormone secreted by the pituitary gland. Its main function is to stimulate the growth of breast tissue and the production of milk. In the menstrual cycle, the secretion of PRL in the follicular phase is lower than that in the luteal phase, and is more synchronized with the changes in LH. Dopamine and γ-aminobutyric acid can inhibit the secretion of PRL, thyrotropin-releasing hormone can stimulate the synthesis of PRL, and vasodilatory intestinal peptide can promote the release of PRL. The effect of normal levels of PRL on the secretion of gonadotropin is not very clear, but excessive PRL can cause dysfunction of the gonadal axis.

1. Causes

Common causes of primary hyperprolactinemia include pituitary prolactin tumors, empty sella syndrome, hypothalamic-pituitary diseases, idiopathic PRL elevation, etc.; common causes of secondary hyperprolactinemia include drug-induced PRL elevation, primary hypothyroidism, PCOS, adrenal insufficiency, cirrhosis, chronic renal failure, etc.

2. Clinical manifestations

(1) Menstrual changes: The typical manifestation of HPRL is amenorrhea, and it can also manifest as irregular menstruation (such as infrequent menstruation, scanty menstruation, etc.), ovulation disorders, luteal insufficiency, infertility, etc.

(2) Lactation: Milk can be seen during spontaneous lactation or when squeezing both breasts. There is no absolute positive correlation between the level of PRL and the level of PRL, which may be related to factors such as the heteromorphism of PRL and its immune activity, biological activity, and receptor binding rate.

(3) Other manifestations: If left untreated for a long time, estrogen deficiency may lead to osteoporosis, or the progression of pituitary tumors may cause headaches and visual impairment.

(III) Diagnosis

1. Medical history

Pay attention to menstrual changes, history of chronic diseases, history of taking chlorpromazine, reserpine or birth control pills, history of surgery and history of postpartum blood loss.

2. Physical examination

Pay attention to the presence of thyroid enlargement, obesity, hirsutism, lactation, etc.

(1) Auxiliary examination

① Serum PRL determination is the main diagnostic method. Since the secretion of PRL is affected by many factors, such as sleep, rest, eating, tension, depression, hunger, sexual intercourse, etc., it is best to draw blood on an empty stomach at 9 to 10 a.m. for PRL determination. >35ng, ​​ml or >liu/l is considered elevated, and the result is reliable if the determination is repeated 2 to 3 times.

②Measure serum TSH, free T3 and T4 to rule out hypothyroidism.

③Measure ovarian function, such as FSH, LH, and measure blood E2 and P when necessary.

(2) X-ray, CT, and MRI examination of the sella turcica and pituitary gland to exclude pituitary tumors. If necessary, the visual field can be checked to understand the compression of the tumor on the optic chiasm. (IV) Treatment

Secondary hyperprolactinemia should be treated with medication discontinuation or the primary disease. Patients with pituitary tumors can be treated with medication, surgery, or radiotherapy.

Bromocriptine is currently the drug of choice for the treatment of hyperprolactinemia and pituitary adenomas. Due to its central DA effect, it excites dopamine receptors, can directly inhibit the synthesis and secretion of PRL, and inhibit the growth of adenomas. The dosage starts at 1.25 mg/day and can be gradually increased to 7.5 mg/day. Adverse reactions include nausea, vomiting, headache, dizziness, etc. Taking it in divided doses and during meals can reduce gastrointestinal side effects. PRL should be reviewed monthly after medication. After it drops to normal levels, the minimum maintenance dose should be used to prevent rebound after discontinuation of the drug. For infertile patients, ovulation can be monitored or ovulation induction treatment can be performed, and bromocriptine should be discontinued after pregnancy.