Comprehensive understanding of the symptoms of hyperprolactinemia in women

How can we fully understand the symptoms of female hyperprolactinemia? Clinically, there is a type of female hyperprolactinemia that can cause multiple symptoms, making many women suffer. In order to give everyone a comprehensive understanding of female hyperprolactinemia, today we will answer related questions for you.

Definition of HyperPRLemia

The state of continuous increase in peripheral blood PRL level caused by various reasons is called hyperprolactinemia, that is, high PRLemia. Standardized blood sample collection and stable and accurate laboratory measurements are crucial to the diagnosis of high PRLemia. Each laboratory should define the normal range of serum PRL levels based on its own laboratory data.

Causes of high PRL levels

High PRLemia is a clinical pathophysiological state rather than a disease and can be caused by a variety of physiological, pharmacological, and pathological conditions.

1. Physiological

The hypothalamus of the central nervous system has a bidirectional regulatory effect on PRL through PRL inhibitory factor (PIF) and PRL releasing factor (PRF). Thyrotropin-releasing hormone (TRH) promotes PRL secretion, but it is not yet certain whether it has physiological significance. Other PRFs include gonadotropin-releasing hormone (GnRH), serotonin, opium peptide μ receptors, etc. Estrogen can directly stimulate PRL cell proliferation and hypertrophy, promoting PRL release. Progesterone can also increase PRL secretion.

2. Pharmacology

Drugs induce hyperPRLemia by antagonizing hypothalamic dopamine or enhancing PRF stimulation.

3. Pathological

Diseases of the hypothalamus or adjacent parts; pituitary diseases; primary hypothyroidism; chronic renal insufficiency; cirrhosis, hepatic encephalopathy; ectopic PRL secretion; chest wall disease or chronic breast irritation; multiple endocrine neoplasia type I; patients with polycystic ovary syndrome (PCOS), patients with endometriosis, etc.

4. Idiopathic

It refers to a mild increase in blood PRL levels accompanied by symptoms, but no cause for the increase in blood PRL levels has been found. It may be caused by diffuse proliferation of PRL-secreting cells.

Clinical features of hyperPRLemia

1. Clinical manifestations

1. Menstrual disorders and infertility: Menstrual disorders are mostly secondary amenorrhea, but can also be scanty, infrequent or anovulatory menstruation. Ovarian function changes are most common with anovulation, but can also be caused by luteal insufficiency, leading to infertility or miscarriage.

2. Abnormal lactation: refers to the continued secretion of milk even when the woman is not pregnant or has stopped breastfeeding for more than 6 months after giving birth.

3. Tumor compression symptoms: (1) Decreased secretion of growth hormone (GH) causes growth retardation in childhood; decreased secretion of gonadotropin (Gn) causes amenorrhea and delayed puberty; decreased secretion of antidiuretic hormone causes diabetes insipidus; decreased secretion of thyroid stimulating hormone (TSH) or adrenocorticotropic hormone (ACTH) leads to decreased thyroid or adrenal cortex function, etc. (2) Headache, bilateral temporal visual field defect, obesity, drowsiness, abnormal appetite and symptoms of cranial nerve compression, etc.

4. Others: low estrogen levels, hirsutism, and hypersecretion of other pituitary hormones.