Causes of Early Hyperprolactinemia

Hyperprolactinemia is also known as hyperprolactinemia. Patients may often present with amenorrhea, lactation, frequent menstruation, oligomenorrhea, infertility, sexual dysfunction, headache, obesity and other symptoms. Patients may seek medical advice from obstetrics and gynecology, reproductive medicine, andrology, breast medicine, neurology and neurosurgery. Hyperprolactinemia is still mainly treated with drugs, supplemented by surgery and radiotherapy, and treatment is selected based on the principle of individualization. The incidence rate reported in epidemiology varies greatly among the population, and it is most common in women of childbearing age.

reason

Under physiological conditions, inhibitory regulation is dominant in the regulation of prolactin. Any factors that interfere with the synthesis of dopamine in the hypothalamus and its transport to the pituitary gland, as well as the interaction between dopamine and its receptors, can weaken inhibitory regulation and cause hyperprolactinemia. Common causes can be summarized into four categories: physiological, pathological, pharmacological, and idiopathic. 1. Physiological prolactin is a stress hormone that is secreted in a pulsed manner, with higher secretion at night than during the day. It reaches a peak in the luteal phase of the female menstrual cycle and is at a low level in the follicular phase. It increases significantly at full term and after delivery. In addition, prolactin secretion increases significantly under stressful conditions, and high-protein diets, exercise, tension and sexual intercourse, breastfeeding, nipple stimulation, and sleep disorders can all lead to elevated serum prolactin levels. 2. Pharmacological Any drug that interferes with dopamine synthesis, metabolism, reabsorption, or blocks the binding of dopamine to receptors can cause hyperprolactinemia, but it is generally lower than 4.55nmol/L. Common drugs include estrogen, dopamine receptor blockers (such as antipsychotics, sedatives, antihypertensive drugs reserpine, monoamine oxidase inhibitors such as phenelzine, α-methyldopa), H2 receptor blockers (such as gastrokinetic drugs metoclopramide, metoclopramide and cimetidine, etc.), drugs that inhibit dopamine metabolism (such as opioid preparations), etc. 3. Pathological causes are mainly seen in hypothalamic-pituitary diseases, systemic diseases, ectopic prolactin production and other causes. ⑴ Hypothalamic lesions: such as craniopharyngioma, glioma, sarcoidosis, tuberculosis, etc. compressing the pituitary stalk; impaired hypothalamic function after cranial radiotherapy. ⑵ Pituitary diseases: prolactin-producing pituitary microadenomas; pituitary somatotropin adenomas, adrenocorticotropic hormone adenomas; empty sella syndrome, sarcoidosis, granulomatous disease, inflammatory lesions. ⑶ Systemic diseases: primary hypothyroidism; chronic renal failure; severe liver disease, cirrhosis, hepatic encephalopathy; certain tumors such as adrenal adenoma, bronchial carcinoma, ovarian cystic teratoma. ⑷ Neurogenic: chest wall lesions, herpes zoster neuritis and breast surgery, etc. ⑸ Others: polycystic ovary syndrome. 4. Idiopathic Idiopathic hyperprolactinemia refers to elevated serum prolactin, usually <4.55nmol/L, negative pituitary, central nervous and systemic examinations, and accompanied by symptoms such as lactation, oligomenorrhea, and amenorrhea. The onset may be related to the heteromorphic structure of the prolactin molecule, and the course of the disease is self-limited.