Hyperprolactinemia in women

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.

Examination items: endocrine function test, lateral sella turcica film, follicle-stimulating hormone (FSH), luteinizing hormone (LH), ovarian function test, breast inspection, prolactin (PRL) stimulation test, prolactin (PRL) secretion inhibition test, placental lactogen (PL), bromocriptine (BCT) inhibition PRL test, TRH stimulation TSH, PRL test, prolactin (P

1. Sella fault

In normal women, the anterior-posterior diameter of the sella turcica is <17mm, the depth is <13mm, the area is <130mm2, and the volume is <1100mm3. CT scans should be performed if the following images are present: sailboat-shaped enlargement; double sella turcica bottoms or double edges; high/low density areas or inhomogeneity in the sella turcica; plate deformation; suprasellar calcifications; osteoporosis of the anterior and posterior clinoid processes or cavitation in the sella turcica; and bone destruction.

2.Computed tomography (CT) and magnetic resonance imaging (MRI)

Precise localization and radiometric measurement of intracranial lesions.

3. Angiography

Includes: cavernous sinus angiography, pneumoencephalography and cerebral angiography.

4. Endocrine function test

Pituitary function: FSH and LH decreased, LH/FSH ratio increased. PRL increased ≥ 25ng/ml.

5. Prolactin function test

(1) Prolactin stimulation test ① Thyrotropin-releasing hormone test: Normal women are given a single intravenous injection of TRH 100-400 μg. Within 15-30 minutes, PRL increases 5-10 times and TSH increases 2 times compared to before injection. It does not increase in case of pituitary tumors. ② Chlorpromazine test: Chlorpromazine inhibits the absorption and conversion of norepinephrine into dopamine through receptor mechanism, and promotes PRL secretion. Within 60-90 minutes after intramuscular injection of 25-50 mg in normal women, blood PRL increases 1-2 times compared to before injection, and lasts for 3 hours. It does not increase in case of pituitary tumors. ③ Metoclopramide test: This drug is a dopamine receptor antagonist that promotes PRL synthesis and release. Within 30-60 minutes after intravenous injection of 10 mg in normal women, PRL increases more than 3 times compared to before injection. It does not increase in case of pituitary tumors.

(2) Prolactin inhibition test ① L-Dopa test (L-Dopatest): This drug is a dopamine precursor, which inhibits PRL secretion by generating DA through the action of dehydroxylase. In normal women, PRL is significantly reduced 2 to 3 hours after oral administration of 500 mg. It does not decrease in pituitary tumors. ② Bromocriptine test: This drug is a dopamine receptor agonist that strongly inhibits PRL synthesis and release. In normal women, PRL is reduced by ≥50% 2 to 4 hours after oral administration of 2.5 to 5.0 mm, and lasts for 20 to 30 hours. Functional HPRL and PRL adenomas decrease significantly, while the decrease in GH and ACTH is less than the former two.

Secondary examinations 1. Visual field examination. Pituitary tumors may invade or compress the optic chiasm, resulting in visual field defects. Visual field defects may range from classic, complete bitemporal hemianopsia to small partial quadrant defects or dark spots. 2. Gynecological ultrasound to observe the uterine shape, size and ovarian abnormalities.

Inspection Notes 1. If PRL is slightly elevated, a blood sample needs to be collected and repeated to confirm the result. 2. MRL is suitable for patients with elevated PRL, even if it is slightly elevated. 3. Since MEL can help make an early diagnosis, visual field examination does not need to be a routine. 4. If the breast milk is bloody, the patient should be referred to the breast department for treatment.