Uncovering the true face of hyperprolactinemia

Hyperprolactinemia is a very destructive disease and is a type of pituitary disease. Hyperprolactinemia is relatively common. Patients with hyperprolactinemia will have symptoms of galactorrhea and varying degrees of hypogonadism. Female patients with hyperprolactinemia will have symptoms of decreased libido and even loss of sexual desire, but it can be treated and will be relieved as the level of hyperprolactinemia decreases after treatment.

Main symptoms

1. Menstrual disorders include various menstrual disorders, ranging from oligomenorrhea, sparse menstruation to amenorrhea, among which amenorrhea is the most common. Primary amenorrhea occurs before or during puberty, and secondary amenorrhea occurs after the reproductive period. 2. Infertility Abnormally elevated PRL inhibits ovulation, leading to infertility, and mildly elevated PRL causes luteal insufficiency, leading to miscarriage. 3. Galactorrhea is usually manifested as non-bloody, milky or transparent fluid flowing out of or being squeezed out of both breasts, with varying amounts.

Minor symptoms include 1. Headache, dizziness and visual disturbances due to compression of surrounding brain tissue and optic chiasm caused by enlarged pituitary adenoma, as well as cerebrospinal fluid reflux obstruction. 2. Low estrogen status due to suppression of ovarian function, resulting in vasomotor symptoms such as hot flashes and sweating, breast shrinkage, vaginal dryness, sexual dysfunction and other changes. 3. Other symptoms 20%-30% of patients with hyperprolactinemia are accompanied by hirsutism and acne, and a few patients may also be obese.

Signs: 1. Galactorrhea. 2. Headache, dizziness and visual disturbance. 3. Hirsutism and acne. 4. Obesity.

Misdiagnosis analysis Since there are many causes of hyperprolactinemia, it is necessary to distinguish hyperprolactinemia caused by function, pituitary tumors and other tumors. Hyperprolactinemia caused by lactation, stress, drugs, chest wall stimulation, hypothyroidism, adrenal failure, ectopic secretory tumors, polycystic ovary syndrome, etc. should be excluded. If it is a pituitary tumor, it is necessary to clarify whether it is a tumor that secretes PRL or other tumors. 1. Polycystic ovary syndrome Thirty percent of PCOS is accompanied by elevated prolactin, which is due to long-term and continuous estrogen stimulation of the pituitary gland, causing lactotroph cells to secrete PRL. Some PCOS patients will have oligomenorrhea or even amenorrhea, but almost no lactation. Pelvic ultrasound suggests that the ovaries have polycystic changes. Endocrine tests show that LH is elevated, estrogen is elevated, and PRL is not high or slightly elevated. In addition to the typical clinical manifestations, PRL is significantly elevated in hyperprolactinemia, and FSH and LH are suppressed. 2. Long-term use of the following drugs may cause lactation sedation drugs include chlorpromazine, phenothiazine, and perphenazine. Antiemetic metoclopramide. Gastrokinetic drug domperidone. Antihypertensive drugs reserpine methyldopa, verapamil. In addition, cocaine, monoamine oxidase inhibitors, and protease inhibitors can all cause high PRL blood levels. 3. Kidney disease Seventy-three percent to ninety percent of women with end-stage renal disease have high PRL blood levels. The reason is that PRL clearance decreases and autonomous production increases. Bromocriptine can reduce PRL. 4. Cirrhosis Some cirrhotic patients have increased PRL levels. Fifty percent of patients with hepatic encephalopathy have high PRL blood levels, which are speculated to be related to insufficient hypothalamic dopamine production. 5. Hypothyroidism When the thyroid gland is hypothyroid, TRH production increases, and prolactin cells are sensitive to TRH stimulation, resulting in increased PRL levels. Taking thyroxine tablets reduces PRL to normal. 6. Adrenal insufficiency Glucocorticoids have an inhibitory effect on PRL gene transcription and PRL release. A small number of patients have high PRL blood levels, and PRL levels return to normal after glucocorticoid supplementation. 7. Neurogenic stimulation Breast stimulation and sucking reflex have been reported to cause PRL release. Similar persistent PRL elevation may occur after mastectomy, nipple puncture, thoracotomy, and chronic spinal cord injury. 8. Ectopic PRL secretion is extremely rare, but there have been reports that PRL originated from one renal cell, one gonadotropin cell tumor, and two ovarian teratomas with ectopic pituitary tissue. 9. Hypothalamic pituitary stalk disease This type of lesion is caused by a disorder of the neuroendocrine mechanism that controls PRL secretion and is related to dopamine disinhibition. Craniopharyngioma is common. 10. Idiopathic hyperPRLemia When hyperPRLemia is not found for other specific reasons, it is defined as idiopathic hyperPRLemia. In many such cases, small PRL tumors that cannot be detected by current imaging technology may be included. Other causes may be hypothalamic regulation disorders. Long-term follow-up found that PRL returned to normal in 1/3 of the patients, and PRL levels were elevated or exceeded in 10-15% of the patients. A 2-6 year follow-up of patients with pituitary disease found that 23 cases developed microadenomas. 11. Other pituitary tumors When other pituitary tumors are suspected, growth hormone, cortisol, FSH, LH, TSH, etc. should be measured to rule out tumors that secrete TSH and gonadotropin, acromegaly, and Cushing's syndrome.