Hyperprolactinemia Introduction

Hyperprolactinemia is a very common disease in women, which can lead to infertility, oligomenorrhea, amenorrhea and other symptoms, causing a lot of trouble to the normal life and psychology of patients. Next, let's take a look at the introduction of hyperprolactinemia.

Hyperprolactinemia is the most common pituitary disease, with galactorrhea and hypogonadism as prominent manifestations. Female patients may have decreased libido and loss of sexual function, which will be relieved after treatment as PRL levels decrease. PRL mainly affects the function of the gonads at the hypothalamic level. PRL can stimulate the production of endogenous opioids, and opioids can strongly inhibit the pulsatile release of GnRH, thereby reducing LH secretion. Male patients mainly show decreased libido and impotence. In severe cases, body hair loss, testicular atrophy, reduced sperm count and even azoospermia may occur. Hyperprolactinemia (HPPL) refers to a syndrome caused by internal and external environmental factors, characterized by elevated prolactin (PRL) (≥25ng/ml), amenorrhea, galactorrhea, anovulation and infertility.

Normal PRL pulsatile release and its circadian rhythm play an important role in regulating breast development, lactation and ovarian function. PRL secretion is regulated by both hypothalamic PRL-RH and PRL-IH. In the normal ovulatory menstrual cycle, PRL is always under the tonic inhibitory regulation of CNS hypothalamic dopaminergic neurotransmitters and PRL-IH. Once this regulation is unbalanced, HPPL is caused. HPRL can be caused by physiological and pathological factors.

1. Physiological hyperprolactinemia

(a) Nighttime and sleep (2-6 Am).

(ii) Late ovarian and luteal phases.

(III) Pregnancy: ≥10 times higher than non-pregnancy.

(iv) Lactation: Massage and nipple sucking can cause acute, short-term or persistent increase in secretion.

(V) Postpartum period: 3 to 4 weeks.

(6) Hypoglycemia.

(VII) Exercise and stress stimulation.

(8) Sexual intercourse: It increases significantly during orgasm.

(IX) Fetuses and newborns (≥28 weeks of gestation to 2 to 3 weeks after birth).

2. Pathological hyperprolactinemia

1. Hypothalamic-pituitary lesions

1. Tumors:

Non-functional - craniopharyngioma, sarcoid glioma.

Functional-PRL adenoma 46%; GH adenoma 22-31%. PRL-GH adenoma 5-7%; ACTH adenoma & Nelson's syndrome 4-15%. Multifunctional adenoma 10%; Undifferentiated adenoma 19-27%.

2. Inflammation: skull base meningitis, tuberculosis, syphilis, and actinomycosis.

3. Destruction: injury, surgery, arteriovenous malformation, granulomatosis (Hand-Schüller-Christian's syndrome).

4. Empty sella syndrome.

5. Pituitary stalk lesions, damage or tumor compression.

6. Psychological trauma and stress.

7. Parkinson's disease.

(ii) Primary and/or secondary hypothyroidism.

1. Pseudo-parathyroidism.

2. Hashimoto's thyroiditis.

(III) Ectopic PRL secretion syndrome: undifferentiated bronchogenic carcinoma, adrenal carcinoma, and embryonal carcinoma.

(iv) Adrenal gland and kidney diseases: Addison's disease, chronic renal failure.

(V) Polycystic ovary syndrome.

(VI) Liver cirrhosis

(VII) Gynecological and obstetric surgery: artificial abortion, induced labor, stillbirth, hysterectomy, tubal ligation, and oophorectomy.

(8) Local irritation: papillitis, chapped skin, chest wall trauma, herpes zoster, tuberculosis, and surgery.

(IX) Medical and drug factors:

1. Insulin hypoglycemia.

2. Sex hormones (estrogen-progestin contraceptives).

3. Synthesize TSH-RH.

4. Anesthetics: morphine, methadone, and methionine enkephalin.

5. Dopamine receptor blockers: Phenothiazones, Haloperidol, Metoclprimide, Domperidone, Pimozide, Sulpiride.

6. Dopamine reabsorption blocker: Nomifensine.

7. CNS dopamine degraders: Reserpine, amethyl-Dopa.

8. Dopamine conversion inhibitor: APTIDE.

9. Monoamine oxidase inhibitors.

10. Diphenylamine derivatives: diphenylamine, carbamyl nitrogen, imipramine, amitriptyline, phenytoin, diazepam and clonazepam.

11. Histamine and histamine H1, H2, receptor antagonists: serotonin, amphetamines, hallucinogens, H1 receptor antagonists (meclizine, pyribenzamine, pyribenzamine), H2 receptor antagonists (cimitidine).

(10) Idiopathic.

Pathological changes

1. Tumor-type hyperprolactinemia

2. Postpartum hyperprolactinemia

3. Idiopathic hyperprolactinemia

4. Iatrogenic hyperprolactinemia