What is hyperprolactinemia?

What exactly is hyperprolactinemia? Hyperprolactinemia is the most common pituitary disease. The main predisposing factors are changes in the internal and external environment. It is mainly manifested in high prolactin, generally greater than 25ng/ml. It is a syndrome characterized by amenorrhea, galactorrhea, anovulation and infertility. Hyperprolactinemia is characterized by galactorrhea and hypogonadism. If a woman suffers from hyperprolactinemia, she will show decreased libido and loss of sex drive, which will be relieved after treatment as the PRL level decreases.

Causes

1. Physiological hyperprolactinemia

Normal healthy women have elevated plasma prolactin levels at night and during sleep (2-6am), in the late follicular phase, and in the luteal phase. Plasma prolactin levels increase 5-10 times during pregnancy. Prolactin concentrations in amniotic fluid are higher than in plasma after the second trimester of pregnancy. In lactating women, plasma prolactin concentrations are 1 times higher than in the non-pregnant period. Plasma prolactin levels in fetuses and newborns (28 weeks of gestation to 2-3 weeks postpartum) are equivalent to maternal levels. Breast massage and nipple sucking reflexively promote prolactin secretion. Plasma prolactin levels remain high during the puerperium (within 4 weeks). Prolactin levels in non-lactating women drop to non-pregnant levels within 3 months. Prolactin levels increase significantly during fasting, insulin-induced hypoglycemia, exercise, stress, and sexual intercourse.

2. Pathological hyperprolactinemia

(1) Hypothalamic-pituitary lesions:

① Non-functional hypothalamic tumors: including craniopharyngioma, invasive hypothalamic lesions sarcoid disease, histiocytosis, glioma and leukemia.

② Functional pituitary tumors: including pituitary adenoma (80 percent secrete prolactin), prolactin adenoma, acromegaly (25 percent accompanied by hyperprolactinemia), Cushing's syndrome (adrenal ACTH adenoma, 10 percent accompanied by hyperprolactinemia), and prolactin cell hyperplasia (80 percent accompanied by hyperprolactinemia).

③ Functional hyperprolactinemia: caused by dopamine function inhibition, including primary vacuolar sella syndrome (5 with amenorrhea and galactorrhea syndrome) and secondary vacuolar sella syndrome (10 with hyperprolactinemia).

④ Inflammatory and destructive lesions: including meningitis, tuberculosis, syphilis, actinomycosis, injury, surgery, arteriovenous malformation, granulomatous disease; pituitary stalk lesions, injury or tumor compression.

⑤Mental trauma, stress and Parkinson's disease.

(2) Thyroid and adrenal gland diseases:

These include primary and secondary hypothyroidism, pseudohypoparathyroidism, and Hashimoto's thyroiditis. Adrenal diseases, including chronic kidney disease, Addison's disease, and chronic renal failure, can cause hyperprolactinemia.

(3) Ectopic prolactin secretion syndrome:

These include undifferentiated bronchogenic carcinoma, adrenal carcinoma, and embryonal carcinoma.

(4) Polycystic ovary syndrome.

(5) Gynecological surgery and local irritation:

Including artificial abortion, invasive mole or stillbirth after induction of labor, hysterectomy, tubal ligation, oophorectomy. Local stimulation of the breast, including papillitis, fissures, chest wall trauma, herpes zoster, tuberculosis and chest wall surgery can also reflexively cause hyperprolactinemia.

(6) Drugs that promote prolactin secretion:

① Anesthetic drugs: including morphine, methadone, and methionine enkephalin.

② Psychotropic drugs: including phenothiazines, including haloperidol, fluphenazine, chlorpromazine, etc., tricyclic antidepressants, artetide, chlordiazepoxide, amphetamine and diazepam.

③ Hormone drugs: including estrogen, oral contraceptives, and thyroid-stimulating hormone-releasing hormone (TSH-RH).

④ Antihypertensive drugs: including methyldopa, reserpine, and verapamil (Isapamil).

⑤ Drugs that affect dopamine metabolism and function: including: A. Dopamine receptor antagonists, including phenothiazines, haloperidol, metoclopramide, metoclopramide, and pimozide (pimozide); B. Dopamine reabsorption blockers: nomifensine (benzoquinamide); C. Dopamine degraders, including reserpine and methyldopa; D. Dopamine conversion inhibitors: aptamer.

⑥Monoamine oxidase inhibitors.

⑦ Benzodiazepine derivatives: including dibenzodiazepines, carbamyl nitrogen, phenytoin, imipramine, amitriptyline, phenytoin, diazepam, and clonazepam.

⑧Histamine and histamine H1, H2 receptor antagonists: including 5-hydroxytryptamine, amphetamine, etc. H1 receptor antagonists include chlorpheniramine and pyroxyproline. H2 receptor antagonist cyproconazole.

⑨ Antiemetic drugs: including sulpiride, promazine, and fluphenazine.

⑩Others: Cyproheptadine.