Transient hyperprolactinemia. Hyperprolactinemia syndrome - etiology, clinical picture, diagnosis, treatment

Prolactin, together with luteinizing (LH) and follicle-stimulating (FSH) hormones, ensures sexual desire and the process of procreation. In women, thanks to them, estrogens are formed, eggs mature, and lactation begins. In men, these hormones are responsible for sperm motility and testosterone production.

As the name suggests, hyperprolactinemia is characterized by too much a large number the hormone prolactin, caused by its excessive production by the pituitary gland. The level of this hormone is clearly established in men, but for women at different stages menstrual cycle, when carrying a child, shortly after its birth and during lactation, the indicators differ. Hyperprolactinemia in children and adolescents is detected in only 5% of cases.

Physiological hyperprolactinemia

In healthy women, under certain circumstances, a blood test may show increased level prolactin. He is called by a number physiological factors:

• Increased physical activity
• Stressful situations,
• Pregnancy,
• Postnatal condition,
• Breastfeeding,
• Sexual intercourse.

Pathological hyperprolactinemia

There is an idiopathic form of increased function of pituitary cells - this is a type of hyperprolactinemia, in which there are no visible factors causing an increase in hormone levels - the size of the pituitary gland is only slightly larger than normal or is not changed at all.

In other cases, there is an organic or functional factor that causes the development of hyperprolactinemia.

Reasons

Organic hyperprolactinemia occurs with the appearance of a tumor (benign neoplasm) of the pituitary gland. This structure independently produces prolactin.

Significant doses of drugs can cause an increase in prolactin production:

• Contains estrogen
• For hypertension
• Prostaglandins
• Neuroleptic,
• Antidepressants,
• Oral contraception.

The functional form of this syndrome is also often associated with one of the diseases:

• liver cirrhosis,
• Hypothyroidism,
• Polycystic ovary syndrome.

Or it develops as a result of surgical interventions in the chest area, curettage of the uterus.

Symptoms

In males, an excess of prolactin will manifest itself in a decrease in libido, impotence and even infertility. Such symptoms are associated with a drop in testosterone production.

Female representatives also experience infertility. It occurs against the background of irregular or absent ovulation, insufficiency of phase II, cycle failure or cessation of menstruation. Milk or colostrum may be leaked (galactorrhea) in non-pregnant and nulliparous women.

Diagnostics

The primary way to detect hyperprolactinemia is a laboratory test of the patient's blood. It should be submitted in the morning. For men, as a rule, a two-time procedure is sufficient, with the necessary interval to exclude an increase in prolactin from physiological factors. Women need to donate blood according to their menstrual cycle, from the fifth to the eighth day.

Modern hardware techniques allow us to identify or exclude the organic cause of hyperprolactinemia: computer (X-ray) and magnetic resonance imaging. Less accurate and visual results are obtained by using craniography (an X-ray image of the skull in 2 projections).

It is important to know that the amount of prolactin can be increased for physiological reasons, which can be easily detected by analyzing it 2-3 times; this is a type of normal. If pathological hyperprolactinemia is confirmed, it is necessary to identify its cause and carry out correction.

Hyperprolactinemia: code according to ICD-10

According to the international classification of diseases, the code for hyperprolactinemia according to ICD-10 is E 22.1

Causes of hyperprolactinemia

The causes of hyperprolactinemia are:

• physiological;
• pharmacological;
• pathological.

Prolactinemia of the physiological type develops due to the activation of prolactin production. This process develops after prolonged physical exercise and when eating protein-rich foods. It can provoke increased production of prolactin sound sleep, stress or sexual contact.

The use of certain medications negatively affects metabolism and increases the volume of prolactin. These medications include:

• Butyrofen;
• Methyldop;
• Decarboxylase;
• Phenothiazine;
• Pimozide;
• Reserpine.

If pathologies develop in the female body, the volume of prolactin in the blood also increases, and hyperprolactinemia occurs. This happens with the following diseases:

• pituitary adenoma (benign neoplasm);
• tuberculosis;
• sarcoidosis;
• tumors in the hypothalamus;
• gliomas.

The consequence of their development is the cutting of the pituitary stalk. Irradiation helps to cope with the problem, which activates the production of prolactin.

Functional hyperprolactinemia occurs when:

• disrupted work thyroid gland;
• liver cirrhosis;
• polycystic ovary syndrome;
• chronic kidney failure.

The development of prolactinemia is facilitated by frequent surgeries or constant chest injuries. Pathology appears in women who have undergone uterine curettage.

What symptoms occur with hyperprolactinemia?

A pathological condition of the female body called hyperprolactinemia can form a variety of clinical picture. Symptoms of the disease vary depending on the gender of the patient. Sometimes the disease is diagnosed during a random examination, but sometimes it is different. The signs of hyperprolactinemia in some women are quite well expressed, in the form of disorders at the sexual, reproductive, emotional, personal and metabolic levels.

Signs of hyperprolactinemia in women:

• about 90% of patients who have hyperprolactinemia suffer from menstrual irregularities due to amenorrhea, oligomenorrhea or opsomenorrhea. Such disorders manifest themselves especially strongly after stress, the beginning of sexual intercourse, abortion, the birth of a child, or discontinuation of use. oral contraceptives;
• frigidity, low sexual activity;
• the patient has a history of frequent abortions with hyperprolactinemia that occurred spontaneously in the early stages of pregnancy, as well as infertility that develops against the background of absent ovulation cycles;
• galactorrhea (a pathology in which in women who are not breastfeeding mothers, milk or colostrum oozes from the nipples), which can be primary (a few drops of milk appear from the nipples when pressing on the breasts), secondary (with minimal squeezing of the nipples, milk flows out copiously, multiple droplets or stream), tertiary (milk flows out of the nipples spontaneously, without any pressure);
• migraine attacks, headaches, dizziness, PMS;
• acne on the surface of the skin of the face and body, increased hair growth around the nipples, on the face, arms, legs and abdomen;
• swelling, pain, increased sensitivity breasts;
• pain in the joints and bones, provoked by a prolonged lack of medical procedures, leaching of calcium from the bones, the occurrence of osteoporosis and friability of bone tissue;
• insulin resistance, excess weight;
• decreased visual acuity and limited viewing angle due to macroprolactinoma (a tumor that compresses the optic nerves);
• moderate restoration of the external genitalia after surgery;
• disorders at the psycho-emotional level, depression, disturbed sleep, pain of unknown origin in the heart, weakness, weakened memory.

The symptoms of hyperprolactinemia in women and the treatment of this pathology depend on how early the problem is detected. At the slightest sign of pathology, a woman should go to the hospital. Timely therapy will help avoid serious complications.

Hyperprolactinemia in men, the symptoms of which appear much less frequently than in females, has the following symptoms:

• libido and potency decrease in 50-85% of cases;
• reduction in the severity of secondary sexual characteristics (from 3% to 20%);
• infertility, which develops due to a decrease in sperm quality by 3.5-14% or a decrease in its quantitative indicators;
• hyperprolactinemia galactorrhea (0.5-8% of cases);
• acne and moderate hair growth on the face, nipple area, upper and lower extremities;
• severe migraine attacks, headaches, dizziness;
• deterioration of visual functions, decreased visual acuity, macroprolactinoma;
• insulin resistance, excess weight;
• psycho-emotional disorders, subjective symptoms (the appearance of general weakness, memory problems, depressive states, unexplained pain in the heart);
• tissue enlargement mammary glands(gynecomastia), developing in 6-22% of cases, having 3 stages (proliferating, intermediate and fibrous).

Types of hyperprolactinemia

The types of hyperprolactinemia directly depend on the nature of the underlying disease. This pathology can be of the following types:

• physiological;
• idiopathic;
• pathological;
• functional (secondary);
• organic;
• pharmacological (medicinal).

Each type of hyperprolactinemia occurs individually, with its own characteristics and nuances.

Physiological or transient hyperprolactinemia has the following mechanism of development. The protein hormone prolactin is produced in the body of every woman and stimulates lactation (the appearance breast milk after the birth of the child). The process of production of this hormone is controlled by the glands internal secretion, hypothalamus and pituitary gland. Sometimes prolactin is produced in too much quantity, and this condition is medically called hyperprolactinemia. At the physiological level, this pathology is formed due to the influence of the following unfavorable factors:

• severe stress;
• excessive physical activity;
• sexual contact;
• oversaturation of the diet with protein foods;
• low blood sugar;
• deep sleep.

It should be noted that prolactin is a stress hormone, so it is not surprising that in tense emotional situations its amount in the blood increases. The person experiences severe weakness and may even faint due to a sharp decrease in blood pressure.

A feature of idiopathic hyperprolactinemia is the absence of obvious causes and pronounced signs of pathology. There is a sudden activation of cell activity human body, and the release of large doses of prolactin into the blood. This process is sometimes facilitated by a nervous environment in which for a long time there is a patient. Idiopathic hyperprolactinemia and stress are strongly associated with each other. The hormone prolactin, which provokes the development of pathology, is essentially stressful. Sometimes the disease occurs together with polycystic ovary syndrome, and idiopathic hyperprolactinemia in men develops against the background of a chronic inflammatory process in the prostate gland. A man complains of a lack of sexual desire and high fatigue when performing complex physical work or exercise.

The development of hyperprolactinemia syndrome in men and women often occurs due to various concomitant diseases. In this case, an increase in the hormone prolactin leads to the development of 2 types of conditions.

1. Organic. Most often, the pathology develops as a result of prolactinoma (pituitary adenoma). Sometimes the neoplasm is microscopic in size (no more than 1 cm). There are other cases when the parameters of the adenoma exceed 1 cm. And here doctors are already talking about macroprolactinoma.
2. Secondary hyperprolactinemia (functional) is a condition that occurs against the background of serious diseases (injuries in the chest area, cirrhosis of the liver, polycystic ovary syndrome, chronic renal failure, lack of thyroid hormones in the body).

In addition, functional hyperprolactinemia in women is formed due to repeated procedures for curettage of the uterine cavity.

Drug-induced hyperprolactinemia (also called pharmacological) occurs in patients taking medications, which lead to metabolic and hormonal imbalances. Under the influence of certain drugs, the production of dopamine is disrupted, and the body's cells can no longer absorb it. If the concentration of this hormone in the blood sharply increases, then the production of prolactin, which is under the control of dopamine, decreases. Drug-induced or iatrogenic hyperprolactinemia is possible while taking the following drugs:

• Butyrofen;
• Decarboxylase;
• Pimozide;
• Reserpine;
• Methyldol;
• Domperidone.

There are other categories of medications that help increase the amount of prolactin in the blood. They necessarily contain estrogens. They are the reason for the increase in lactogenic hormones and the simultaneous suppression of the synthesis of luteinizing and follicle-stimulating hormones. In such cases, infertility often develops against the background of hyperprolactinemia.

Diagnosis of hyperprolactinemia

To diagnose a patient with hyperprolactinemia, the doctor performs a comprehensive examination. First of all, a visual inspection and conversation are carried out. Based on the results of these procedures, the specialist prescribes additional studies, which include:

• blood samples to determine prolactin levels;
• determination of thyroid hormone levels;
• examination by an ophthalmologist (a specialist examines the fundus of the eye to exclude the possibility of developing a tumor in the pituitary gland);
• magnetic resonance therapy;
• computed tomography;
• X-ray of the head in 2 projections, namely craniography and craniogram (helps to find out what condition the sella turcica is in).

If a doctor suspects that his patient has hyperprolactinemia, the diagnosis is carried out taking into account the patient’s gender. Biomaterial is collected from women 5-8 days after the start of the menstrual cycle. Men can take tests for research on any convenient day.

For hyperprolactinemia, examination involves taking blood on an empty stomach. It is recommended to stop sexual contact one day before the test. If the results research work show high level prolactin, they are repeated 2 more times. This will help eliminate the slightest possibility of inaccuracies. In general, blood is taken three times to determine prolactin levels, in the morning (from 9 to 11 o’clock). It is after a night's sleep that prolactin levels are at their most accurate level.

Determination of thyroid hormone levels if hyperprolactinemia is suspected is of great importance for correct diagnosis. The data obtained help confirm the pathology of the pituitary gland (which produces prolactin), or refute the assumptions of doctors. Such tests are also necessary to identify hypothyroidism, which becomes the cause of the development of spontaneous galactorrhea.

The course of treatment for prolactinemia is developed based on the results of diagnostic procedures.

Treatment of hyperprolactinemia

How to treat hyperprolactinemia? Treatment of such a pathological condition as galactorrhea-amenorrhea syndrome is carried out with the help of drug therapy. The doctor who treats this pathology is an endocrinologist. But observation by a gynecologist is also necessary.

Drugs used to treat hyperprolactinemia

The most effective means Parlodel is used in the fight against this disease. It is prescribed both in the presence of pituitary adenoma and in its absence in hyperprolactinemia. In any case, treatment with this remedy is effective. Parlodel is aimed at inhibiting the growth of prolactin and preventing its entry into the bloodstream, as well as inhibiting the processes of its synthesis.

Parlodel for galactorrhea-amenorrhea syndrome normalizes the secretion of prolactin. And this in turn gives the following consequences:

• restoration of activity of the sexual centers of the hypothalamus;
• an increase in the production of gonadotropic hormones several times;
• normalization of the menstrual cycle;
• restoration of reproductive function.

The effectiveness of this drug in the fight against illness has been confirmed by many examples of recovery. To treat a severe form of the disease, an additional drug may be added to Parlodel.

Usually the drug is prescribed in the following dosage: 2.5 - 5 mg per day. In case of severe condition of the patient, the dose can be increased to 10 - 20 mg.

The drug is usually not prescribed to pregnant women. But during pregnancy and lactation, prolactin synthesis increases several times. This fact forced doctors to reconsider their decision to take the drug.

If a woman was treated with Parlodel before pregnancy, the tumor did not grow. But if it is discontinued, a relapse of the disease may occur. This once again confirms the need to take the drug for pregnant women with galactorrhea-amenorrhea syndrome. Moreover, it has no effect on the fetus, and children born to women taking Parlodel are absolutely healthy.

If the disease is caused by macro- and microprolactinomas that are resistant to parlodel, surgical intervention will be required. If a woman is not planning a pregnancy, she can take her time with the operation and monitor the course of the disease. Surgery will only be required if the tumor is clearly growing. Radiation therapy, which was previously often prescribed for the treatment of galactorrhea-amenorrhea syndrome, does not guarantee complete recovery.

Parlodel treatment may not work positive result if the patient has severe hyperprolactinemia and very low concentrations of gonadotropic hormones and estrogens in the blood. To treat such patients, the drug clostilbegit is used, which stimulates the release of FSH and LH into the blood. Also effective is the introduction of gonadotropic hormones into the blood, which contain FSH and LH in a 1:1 ratio.

Galactorrhea-amenorrhea syndrome: prognosis

With proper and timely treatment of galactorrhea-amenorrhea syndrome, the patient has a good chance of healthy life and preservation of reproductive function.

Galactorrhea - amenorrhea syndrome: treatment and prognosis

Hyperprolactinemia syndrome is a hormonal disease that can affect both female and male bodies. In women, the level of prolactin in the blood changes much more often. This is due to changes in hormonal levels during menstruation, pregnancy or breastfeeding a newborn baby. In fact, prolactin is a sex hormone, so successful conception, a favorable course of pregnancy, childbirth and breastfeeding of a newborn depend on it. Ovulation disorders, absence of menstruation, difficulties conceiving a child and infertility - this is what a high level of prolactin in a woman’s blood leads to.

The problem of hyperprolactinemia and pregnancy

During pregnancy, in many women the amount of prolactin in the blood exceeds medical indicators. Doctors call this the physiological norm. An increase in the concentration of this hormone occurs from the 2nd to the 6th months of pregnancy. Then the level of prolactin decreases somewhat, and the new levels are maintained until childbirth. There are cases when, against the background of pathology of the pituitary gland (for example, the development of an adenoma in this gland), the amount of prolactin remains high. This leads to an unfavorable course of pregnancy later. The task of medical specialists in such a situation is to identify the reasons for the increased concentration of lactation hormone and adequate treatment (which will help stabilize the condition of the expectant mother).

It should be noted that drug therapy at high concentrations of prolactin in the blood of a pregnant woman is contraindicated. Hormonal medications cannot be taken, because they will cause a malfunction of the hormonal system, and the consequence of this will be spontaneous termination of pregnancy. If the cause of the pathology is a pituitary adenoma, therapy using antitumor drugs is also prohibited. Medicines against tumors are highly toxic, so taking them during pregnancy often leads to disruption of the baby’s intrauterine development. The only way to help reduce prolactin is folk remedies with a general strengthening and calming effect, which are used for symptomatic therapy.

Hyperprolactinemia: treatment with folk remedies

Treatment of hyperprolactinemia folk remedies well suited for those whose increase in prolactin is not associated with a somatic disease and occurs due to stress or physical overload. The main herbs that are used for this pathology are sage and elecampane. An effective course of herbal medicine made from several herbs is also common: motherwort, peony root, hops, adonis, mint, and mother liquor.

Planning pregnancy with hyperprolactinemia

Hyperprolactinemia and pregnancy are concepts that are interconnected. After conceiving a child, the level of the hormone prolactin increases, and as a result hyperprolactinemia develops. The pathology, in which the activity of eggs is suppressed and sexual desire is significantly reduced, occurs due to the “blocking” of the production of progesterone (pregnancy hormone). An unfavorable situation develops due to excess prolactin in the body and is often accompanied by the following symptoms:

• there is insufficiency of the 2nd menstrual phase;
• no ovulation;
• The endometrium (uterine lining) grows very slowly, so problems arise with conceiving a baby and carrying a fetus.

If a woman is diagnosed with hyperprolactinemia and pregnancy planning is in jeopardy, the doctor carries out a set of research activities. Diagnostic procedures help to quickly detect the cause of excess prolactin levels and direct efforts to eliminate the problem. A woman should:

• consult with an ophthalmologist (visual fields and fundus are examined);
• do an MRI of the pituitary gland;
• a blood test that needs to be taken several times, at different periods of the menstrual cycle, over several months (this allows you to track changes in prolactin levels over time).

In 80% of cases, after drug therapy, the level of prolactin in the blood stabilizes, and the woman has every chance of becoming pregnant, carrying a baby and giving birth.

Hyperprolactinemia after childbirth becomes the main cause of menstrual irregularities. Lactational amenorrhea develops due to excess levels of prolactin, which stimulates the production of breast milk. During breastfeeding, high prolactin levels are considered normal. But if a woman stops breastfeeding her baby, and prolactin remains at the same level, it is necessary to begin treatment for hyperprolactinemia. Perhaps the pathology developed due to prolactinoma (benign tumor of the pituitary gland) or hypothyroidism (thyroid disease).

Women with postpartum hyperprolactinemia complain not only about the absence of menstruation. They develop additional symptoms such as headaches and the presence of milk in the breast (although feeding the newborn has already stopped). Fortunately, hyperprolactinemia is now easily corrected. Women with this problem are prescribed medications that help reduce the amount of prolactin:

• Cabergoline;
• Metergoline.

If the cause of hyperprolactinemia is hypothyroidism, the patient is recommended to take a course of L-thyroxine. To stop breast milk production, you need to take the following medications:

• Parlodel;
• Abergeen;
• Lisenil;
• Bromocriptine.

When a woman has hyperprolactinemia,
infertility is an accompanying and unpleasant factor of this pathology. According to medical statistics, about 40% of cases of infertility are caused by pathological processes in the endocrine system. Hyperprolactinemia is one of the most common causes of endocrine infertility. Often women turn to a gynecologist because they cannot conceive a child, and during the examination a high level of prolactin is discovered in their blood. Typically, pregnancy does not occur with such indicators, but there are cases where conception occurred with elevated prolactin levels. Such patients are prescribed the drug Parlodel, which helps regulate hormone levels and reduce the risk of developing prolactinoma. It does not harm the fetus and helps to carry the baby without complications. Pregnant women with hyperprolactinemia syndrome should periodically consult an ophthalmologist and neurologist.

The human body produces many different hormones produced by internal organs and glands. Both a deficiency and an excess of any hormone always indicate the occurrence of some pathological process. Men and women contain the same hormones, the only difference is their concentration.

Prolactinemia, or more precisely hyperprolactinemia, is an excess level of the hormone prolactin in the blood.IN lately the frequency of symptoms of hyperprolactinemia in women is observed.

Hyperprolactinemia in the body

Hyperprolactinemia in women is produced by the endocrine gland of the pituitary gland, which is responsible for the full functioning of the entire human endocrine system.

The thyroid gland, ovaries and testes, adrenal glands - all these organs are able to function correctly only with the proper guidance of the pituitary gland.

There are also known pathological conditions and symptoms such as hypoprolactinemia (decrease in prolactin levels) And macroprolactinemia (this is the case when the blood contains prolactin, which has a high molecular weight).

Prolactin in a woman is one of the most important hormones. It is synthesized in the human brain, namely in the anterior lobe of the pituitary gland. Hyperprolactinemia in women- this is an increase in the main hormone that directly affects its reproductive function. The same hormone in the body of men is also related to reproductive function.

Sexual activity, sperm quality and the severity of secondary sexual characteristics all depend on the concentration of the hormone in the blood.

However, it cannot be said that the only function of the hormone is reproductive function. Prolactin in women is a multifunctional hormone and it is also responsible for metabolism, the functioning of the immune system, psychological behavior, the formation of new blood vessels in organs and tissues, so you need to know its symptoms.

The presence of hyperprolactinemia can be detected already in an embryo at the age of 5-7 weeks and, starting from the 20th week, the concentration of the hormone in the fetal blood is constantly increasing. After the birth of the child, at approximately 1-1.5 months, the establishment of normal indicators prolactin in the baby's blood.

As already mentioned, the hormone plays a very important role in a woman’s body. There are several main functions of prolactin in a woman:

• direct participation in the formation and growth mammary glands;
• full development of female reproductive cells;
• aging follicles V ovaries;
• proper functioning of the corpus luteum;
• coherence of the mechanism ovulation and maturation of follicles;
• maintaining a balance between peptide receptors (luteinizing) hormone and receptors estrogen;
• preparing the mammary glands for breastfeeding and milk production itself after childbirth;
• influence on composition and quality amniotic fluid (amniotic fluid).

In the case when an excess of the hormone level is observed in the body, hyperprolactinemia occurs, the following processes occur in the woman’s body:

• hypothalamus becomes less susceptible to estrogens;
• production decreases gonadotropin-releasing hormone (GnRH) due to hyperprolactinemia;
• synthesis decreases luteinizing hormone (LG);
• blocking luteinizing hormone receptors due to hyperprolactinemia;
• ovarian enzyme production is suppressed aromatase;
• decrease in output estrogen– as a result of previous disorders due to hyperprolactinemia.

Reasons for the development of pathology

There are many reasons that can lead to the development of a condition such as hyperprolactinemia, so you need to know the symptoms. These include:

Physiological causes of hyperprolactinemia:

• sudden drop in blood sugar levels (hypoglycemic conditions);
• eating foods high in protein;
• the period of bearing a child, as well as for 2-3 weeks after birth;
• breast-feeding baby (directly the sucking process itself);
• carrying out various medical procedures;
• physical activity and overexertion;
• periods sleep;
• state of stress in which the body is (and stress, both physical and mental);
• during sex, irritation of the breast nipples;
• second phase of the menstrual cycle.

Pathological causes of hyperprolactinemia in women:

• lesions of the hypothalamus: neoplasms of various nature, metastasis of others internal organs, surgical interventions, radiation injuries, vascular diseases, pathological processes of infiltrative nature.
• pathologies of the pituitary gland with hyperprolactinemia: adenomas, cysts, tumors, trauma and surgery on the skull and others.
• mastitis, injuries and surgeries on the chest, lichen, herpes and burns in this area.
• polycystic ovary syndrome and tumors that produce huge amounts of hormones, thereby disrupting the functioning of the endocrine system.
• and various uterine fibroids with hyperprolactinemia.
• liver diseases.
• Much less common is lung, bronchial or kidney cancer.
• epileptic seizures.
• improper functioning of the adrenal cortex and its insufficiency (congenital) at the time of hyperprolactinemia.
• hyper- or hypothyroidism.
• prostatitis, lupus erythematosus.

Symptoms of hyperprolactinemia

Symptoms of hyperprolactinemia in women depend on which organs and systems are affected by this process.

Galactorrhea- secretion of milk from the mammary glands.

This symptom of hyperprolactinemia has three stages:

• Stage 1 symptoms: secretion of milk, if palpated. The intensity of discharge is low - insignificant drops of milk from the nipple.
• Stage 2 symptoms hyperprolactinemia: the appearance of streams of milk upon palpation.
• Stage 3 symptoms: spontaneous release of milk, without any irritating factors.

However, symptoms of lactorrhea may not always be observed with hyperprolactinemia. In 67% of all cases, such a symptom may be absent altogether, despite the fact that the woman’s prolactin concentration will remain significantly higher than normal. The reverse process of hyperprolactinemia is also possible - with a slight increase in the hormone in the blood, signs of galactorrhea may be observed.

It has been noted that milk discharge is most often observed in cases where menstrual cycles occur with the absence of ovulation and the development phase of the corpus luteum (anovulatory menstrual cycles), although normal uterine bleeding persists. Because of this, it was concluded that pathology such as hyperprolactinemia is closely related to pregnancy.

Moreover, an excessive level of prolactin in a woman’s blood can be associated with both the end of pregnancy and infertility. It has also been proven that excessive prolactin synthesis reduces the likelihood of ovulation. Conception becomes impossible and infertility develops, which is called secondary infertility.

Galactorrhea, as a symptom of hyperprolactinemia, is most often observed in patients who complain of various menstrual irregularities.

Other symptoms:

Diagnosis of hyperprolactinemia

Diagnosis and treatment of a disease such as hyperprolactinemia in a woman is carried out by an endocrinologist or gynecologist-endocrinologist. First of all, the doctor collects a complete medical history of the patient. After this, a series of medical studies are prescribed to confirm or refute the preliminary diagnosis of hyperprolactinemia.

These include:

Types of hyperprolactinemia

The main types of hyperprolactinemia:

1. Functional hyperprolactinemia in women. This condition occurs due to such serious pathological processes as tuberculosis, cirrhosis of the liver, chest trauma, as well as frequent curettage of the uterine cavity or polycystic ovaries. In such cases, hypothyroidism is added to the described pathology.
2. Iatrogenic hyperprolactinemia in a woman is a consequence of the use of any medicines. These can be oral contraceptives containing estrogen, drugs that affect dopamine levels, as well as amphetamines and hallucinogens.
3. Organic hyperprolactinemia in women, as a rule, this is a consequence of the development of a pituitary adenoma (prolactinoma). If this tumor is less than one centimeter in size, then it is a microplactinoma, if more, then it is a macroplactinoma. Malignant neoplasm can also cause increased levels of prolactin in the body. Pituitary microadenoma is the cause of hyperprolactinemia in 90% of all cases.
4. Idiopathic hyperprolactinemia in a woman, this is the case when there is no exact cause for the manifestation of the condition.
5. Transient hyperprolactinemia in women it often accompanies infertility.

Treatment

Treatment of hyperprolactinemia in a woman involves, first of all, reducing the level of prolactin in the blood and eliminating symptoms.

Therapy is also aimed at:

Compliance with the daily regimen, a full night's sleep and rest, moderate physical activity are mandatory additional measures to treat hyperprolactinemia in a woman and its symptoms.

Consequences of hyperprolactinemia

Like any disease, hyperprolactinemia in a woman has a number of negative consequences, especially when improper treatment symptoms.

Complications include:

• Failure various organs of the endocrine system (including the pituitary gland). If such a complication manifests itself, then mandatory medication maintenance of the activity of the thyroid gland or adrenal glands is necessary;
• Compression of the optic nerve. If vision quickly decreases, then in such cases removal of the compressing tumor is indicated.
• Osteoporosis, as a complication, occurs in the absence of adequate treatment for hyperprolactinemia in a woman and its symptoms;
• Transformation of a benign tumor into a malignant one requires urgent hospitalization of the patient and the appointment of radiation therapy or surgery.

Prevention

There are no special preventive measures to prevent symptoms of hyperprolactinemia in women. There is also no need to establish any diets. Rather, it is necessary to balance emotional and physical stress.

Absolute contraindications include the use of oral contraceptives with estrogens - they can serve as a factor in increasing the level of the hormone in a woman’s blood.

Application intrauterine devices as a contraceptive can also cause hyperprolactinemia in a woman, as well as the appearance of symptoms. This is due to excessive and constant impact on the endometrium, which entails negative consequences in the form of an increase in the level of hormone concentration in a woman’s blood.

Conclusion

The prognosis for the treatment of hyperprolactinemia in women is extremely favorable. After passing full course treatment, a woman can lead a normal life and plan a pregnancy.

Women with pituitary prolactinoma should be monitored by an endocrinologist to prevent relapses of the disease.

Hello everyone, Olga Ryshkova is with you. Why does the hormone prolactin increase? What is it - hyperprolactinemia syndrome in women and men? We'll discuss this today. Prolactin is a hormone, that is, it belongs to the endocrine system. Prolactin is produced by the pituitary gland, the main endocrine gland, which is located in the brain. The purpose of prolactin is the production of milk by the mammary glands. The mammary glands of both women and men respond to the action of prolactin.

Hyperprolactinemia is an increase in the level of prolactin in the blood. Hyperprolactinemia can be a normal phenomenon and then it is called physiological, or it can be a consequence of a disease and then it is called pathological.

When does physiological hyperprolactinemia occur?

It can occur in women in the second half of the menstrual cycle. The body never knows how the menstrual cycle will end and always adjusts to future pregnancy. In the second phase of the cycle, a woman’s body always adjusts to pregnancy and therefore prolactin increases.

A woman’s prolactin level also increases during pregnancy and lactation, that is, when she is breastfeeding. This hyperprolactinemia is a physiologically normal condition.

And when else?

Prolactin also increases in both women and men under stress, during heavy physical activity, during abundant intake protein foods and after sexual intercourse. I want to say that if your prolactin level is slightly increased, literally a few units above normal, and this worries you, and you don’t know what to do about it, then it is recommended to measure this indicator several times in a calm state. Not when you left the gym, having exercised with protein foods, not after sexual intercourse, not after stress, not when recovering from an illness, after a respiratory infection. viral infection, and in a calm state in the morning on an empty stomach, come several times and donate blood for prolactin.

Pathological hyperprolactinemia.

Now about the pathological increase in prolactin in the blood or pathological hyperprolactinemia. The main causes associated with the pituitary gland are pituitary tumors, adenomas, traumatic lesions of the pituitary gland and lesions associated with vascular disorders in the brain, such as infarctions. But these are rare causes of hyperprolactinemia in both women and men. As a rule, they are accompanied by other clinical symptoms, which are visible and indicative to the doctor, and the doctor will quickly differentiate such pathologies and send such a patient to his destination.

More pathological reasons.

And when does prolactin increase, when we don’t even think that it could be increased? The first and very important thing is renal and liver failure, especially liver failure in alcoholic cirrhosis. That is, if you don’t take care of your body and your prolactin levels increase, then these are links in the same chain.

Hormonal causes of hyperprolactinemia.

The next moment is hormonal. In women, it is polycystic ovary syndrome (PCOS). In PCOS, the pituitary-ovarian system is deregulated in such a way that prolactin increases.

In men, this is chronic prostatitis, this is a proven cause of increased prolactin.

Idiopathic hyperprolactinemia.

There is also such a concept - idiopathic hyperprolactinemia. This diagnosis is made when everything is fine with the head, that is, no structural pathological changes were found in the endocrine part of the brain; they are not the cause of the increase in prolactin. Nevertheless, prolactin increases and then this diagnosis is made. “Idiopathic” translated from medical to universal means “for an unknown reason.”

Why does prolactin increase?

And even after taking potent substances, which include all antidepressants, because they affect dopamine receptors, and blockade of dopamine receptors causes an increase in prolactin.

The next point is antihypertensive therapy, that is, patients with a high risk of arterial hypertension who constantly take drugs that reduce blood pressure, are at risk for increased prolactin levels.

This also includes opiates and antiemetics central action and, most interestingly, estrogens. Women who take estrogens as prescribed by a gynecologist or endocrinologist, which is associated with some specific gynecological condition, are at risk for increased prolactin.

Men who improperly exit anabolic steroid therapy for bulking muscle mass, are also at risk for hyperprolactinemia. Their blood estrogens also increase and this leads to an increase in prolactin. That is, in both men and women, in addition to disorders associated with the hormonal part of the brain, there are many reasons for increased prolactin in the blood.

What are the symptoms of hyperprolactinemia?

The symptoms of hyperprolactinemia are as follows. In men it will be gynecomastia. Who doesn’t know what gynecomastia is - this is swelling of the mammary glands in men, that is, an anatomical defect visible to the eye. There was an even body and suddenly there was a resemblance to such female mammary glands. There is also a decrease in sexual function and a decrease in fertility, that is, infertility, since prolactin affects the formation of sperm in men (spermatogenesis) and increased prolactin reduces the properties of sperm in such a way that a man becomes infertile.

In women, the range of disorders is much wider. This is a shortening of the second phase of the menstrual cycle, up to complete amenorrhea (cessation of menstrual function altogether). If menstrual function is preserved, then most menstrual cycles become anovulatory, that is, ovulation is suppressed and the woman suffers from infertility.

Infertility is the primary complaint with hyperprolactinemia in both men and women. And I’ll tell you even more, it is believed that every third woman and every sixth man suffers from infertility due to hyperprolactinemia. That is, about 30% of women and 15% of men suffering from infertility require prolactin-lowering therapy.

Another symptom of hyperprolactinemia.

And another symptom is galactorrhea, that is, the leakage of milk from the mammary glands. This can occur in both women and men with severe hyperprolactinemia.

And what else?

In women and men, this can be osteoporosis, depression, sleep disturbance. Well, symptoms associated with central causes, when there are tumor disorders in the pituitary gland, then there may be a narrowing of visual fields, headaches and other symptoms associated with a tumor in the pituitary gland.

What to do?

Therefore, if you have been diagnosed with an increase in prolactin in the blood, you should not despair, but retake the test several times. If you are a woman, then you do this on days 3-5 of the menstrual cycle for about 3 months. In the morning on an empty stomach on days 3-4-5, the level of prolactin is measured in a calm state. And if all 3 times you see a persistent increase in prolactin, consult a doctor.

If you are a man, then you also choose a time when you are not after stress, not after physical activity and measure your prolactin level several times. If your prolactin level is persistently elevated, then you should see a doctor.

Which doctor?

To an endocrinologist. What will the endocrinologist tell you? It is imperative to undergo an MRI of the brain in order to exclude a tumor or pituitary adenoma. And if neither a tumor nor an adenoma is found there, then the doctor will prescribe you drugs that affect dopamine receptors and reduce the level of prolactin in the blood.

This is the main treatment of choice for hyperprolactinemia - the prescription of such drugs.

What to do if medications don't help?

They are prescribed surgical correction or radiation correction. Treatment methods for hyperprolactinemia have been developed.

Last question.

Well, the last question is how long should you take medications that regulate prolactin levels? If you are a man, then you take the course prescribed by your doctor, then laboratory control, then, if necessary, again a course of correction.

If you are a woman and you are being treated for infertility, you take prolactin-lowering medications until you become pregnant. This shouldn’t happen - you’ve been drinking for three months and that’s enough. You take the drug until the desired pregnancy occurs. Then you go to the doctor, the doctor confirms the pregnancy and with his own hand stops the drug for you. Under no circumstances should you cancel treatment for hyperprolactinemia yourself because you are pregnant and because all medications are harmful to your child. The doctor prescribed the drug, the doctor cancels it.

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Hyperprolactinemia is an increase in the concentration of prolactin in the blood, which can be both physiological and pathological in nature.

Prolactin is a peptide hormone produced by the anterior pituitary gland, belonging to the family of prolactin-like proteins. It is a single-chain polypeptide that consists of 199 amino acids. The main isoforms of the hormone circulating in the blood are small, large and very large, as well as glycosylated prolactin. Small has high biological activity, and large and very large have low; these forms of prolactin are characteristic of patients with adenomas, although they can also be found in healthy people. Due to the loss of disulfide bonds, large prolactin is able to turn into small prolactin.

Prolactin is produced by lactotrophic cells of the pituitary gland. The secretion of the hormone is influenced by the hypothalamus; the central nervous system, immune system, mammary glands, and placenta also take part in the production of prolactin. Dopamine, a neurotransmitter produced primarily by the adrenal glands, and its agonists block the secretion of prolactin; prolactin, in turn, inhibits the production of dopamine. In addition, the secretion of prolactin in the pituitary gland is reduced under the influence of the hormones progesterone and somatostatin. These properties are used in the treatment of hyperprolactinemia.

In a woman’s body, prolactin stimulates the maturation of the egg, helps prolong the luteal phase of the menstrual cycle, and has an effect on the developing fetus. The main target organs of the hormone are the mammary glands. Prolactin stimulates the growth and development of the mammary glands, affects the lactation process, and promotes the transformation of colostrum into mature milk. In turn, irritation of the nipples according to the principle feedback stimulates the production of prolactin.

In the male body, prolactin affects sexual function, the release of sex hormones, and sperm motility. In addition, this hormone is an activator of new growth. blood vessels. In addition to the mammary glands, prolactin receptors are found in the uterus, ovaries, testicles, skeletal muscle tissue, heart, lungs, liver, pancreas, spleen, kidneys, adrenal glands, skin, and some parts nervous system, however, its effect on these organs has not been studied enough.

The production of prolactin depends on the emotional and physical state, sexual life, and lactation. The level of the hormone in the blood increases with injury and stress, as well as with the use of alcohol, narcotic and psychotropic drugs.

Violation of prolactin secretion is one of the most common reasons changes in menstrual function and concomitant infertility. In women, levels of prolactin in the blood change throughout the menstrual cycle. In addition, prolactin is characterized by daily fluctuations, with the most low content hormone in the blood is observed immediately after waking up, and peak production occurs between 5 and 7 am.

An increase in hormone levels is most often diagnosed in women aged 25–40 years. Hyperprolactinemia develops much less frequently in men.

Lack of adequate timely treatment pathological conditions, which caused the development of hyperprolactinemia, leads to further endocrine disorders.

Causes of hyperprolactinemia

The causes of hyperprolactinemia are divided into physiological and pathological. Physiological reasons for increased concentrations of prolactin in the blood, in addition to pregnancy and breastfeeding, include:

deep sleep;

sexual intercourse;

consumption of certain foods (including alcoholic beverages);

stressful situations.

These factors cause a short-term increase in the level of prolactin in the blood.

The following conditions contribute to the development of pathological hyperprolactinemia:

• diseases associated with disruption of the hypothalamus (tuberculosis, neurosyphilis, malignant neoplasms, severe injuries, etc.);
• prolactin-secreting pituitary adenomas (prolactinomas) are the most common type of pituitary tumors;
• hyperfunction of the pituitary gland;
• systemic diseases (rheumatoid arthritis, systemic lupus erythematosus);
• ovarian dysfunction;
• chronic renal failure, hemodialysis;
• injuries (extensive burns, surgical interventions in the chest area);
• artificial termination of pregnancy;
• lack of vitamin B 6 in the body;
• receiving a series medicines (hormonal drugs, antidepressants, neuroleptics, adrenergic blockers); etc.

Hyperprolactinemia in women often accompanies amenorrhea and infertility, and is also observed in 50% of women with galactorrhea.

Violation of prolactin secretion is one of the most common causes of changes in menstrual function and concomitant infertility.

Forms of hyperprolactinemia

Depending on the cause, hyperprolactinemia occurs:

• primary– caused by pathological processes in the hypothalamus or pituitary gland;
• secondary– develops against the background of other diseases;
• idiopathic– the mechanism of development cannot be elucidated.

In addition, according to origin they distinguish following forms pathologies:

• asymptomatic hyperprolactinemia;
• hyperprolactinemic hypogonadism (prolactin-secreting pituitary adenomas, idiopathic forms);
• symptomatic hyperprolactinemia (alcohol, drug, psychogenic, neuro-reflex);
• extrapituitary secretion of prolactin;
• hyperprolactinemia due to other hypothalamic-pituitary diseases (empty sella syndrome, hormonally inactive sellar and parasellar neoplasms, cerebrovascular accident, syphilis, tuberculosis);
• combined forms of hyperprolactinemia.

Symptoms of hyperprolactinemia

In some cases clinical manifestations There is no hyperprolactinemia, and an increased level of prolactin in the blood is an incidental diagnostic finding for another reason.

Source: prolactin-info.ru

In women, hyperprolactinemia usually begins to manifest clinically with the onset of sexual activity, the use of intrauterine contraceptives, the abolition of oral contraceptives, after childbirth, artificial or spontaneous termination of pregnancy, and also at the end of breastfeeding.

Symptoms of hyperprolactinemia in women include menstrual irregularities (irregular menstruation, amenorrhea, oligomenorrhea, hypomenorrhea, bradymenorrhea, opsomenorrhea, spaniomenorrhea), discharge of milk or colostrum from the mammary glands in the absence of pregnancy and lactation (galactorrhea). The severity of galactorrhea in women with hyperprolactinemia varies from single drops that are released with strong pressure on the mammary glands to copious spontaneous discharge. The color of the discharge may be white, yellowish, or opalescent. In addition, adenomas or cysts can form in the mammary glands.

Hyperprolactinemia in women often accompanies amenorrhea and infertility, and is also observed in 50% of women with galactorrhea.

Patients with hyperprolactinemia often develop acne, hirsutism (excessive body hair growth). male type), seborrhea of ​​the scalp, hypersalivation (increased salivation).

The development of neuroleptic hyperprolactinemia during pregnancy is dangerous due to its interruption in the early or late stages and slowdown of intrauterine growth and development of the fetus.

A manifestation of hyperprolactinemia can be hypoplasia of the genital organs (in particular, the ovaries), dryness of the mucous membrane of the vulva and vagina, which causes discomfort during sexual intercourse, thinning of hair under the arms and on the pubis, and reduction of the mammary glands.

Excessive production of prolactin in men causes a decrease in testosterone levels in the blood, which causes the development of gynecomastia, galactorrhea, and reproductive dysfunction (including erectile dysfunction, decreased libido). The number and motility of sperm decreases, pathological forms of sperm appear, which becomes the cause of infertility. In some cases, retrograde or painful ejaculation occurs.

Patients with hyperprolactinemia often have neurological disorders and psychoemotional disorders, disorders of bone tissue metabolism, lipid and carbohydrate metabolism. Psycho-emotional disorders that accompany hyperprolactinemia are usually manifested by asthenia, indifference, frequent mood swings, memory and attention disorders, psychonegative disorders, slowing of the associative process, increased irritability, a tendency to depressive states, reduced tolerance (even autism).

Patients may complain of persistent headaches, attacks of dizziness, decreased visual acuity, and narrowing of visual fields. Nonspecific complaints presented by patients with hyperprolactinemia also include weakness, increased fatigue, nagging chest pain without irradiation and clear localization. Such signs are especially often observed when an increase in prolactin concentration develops against the background of pituitary tumors. Such patients may experience liquorrhea, inflammatory processes in the sphenoid sinus, diplopia, ptosis, ophthalmoplegia.

An increase in hormone levels is most often diagnosed in women aged 25–40 years.

Hyperprolactinemia often causes increased appetite, which leads to weight gain. In addition, this condition may be accompanied by insulin resistance, changes in blood lipid composition with the development of hypercholesterolemia, increased levels of very low and low density lipoproteins and a decrease in high density lipoproteins. This causes an increased risk of developing coronary heart disease and/or arterial hypertension and type 2 diabetes.

With prolonged hyperprolactinemia, a decrease in bone mineral density occurs with the subsequent development of osteoporosis and osteopenia. Bone mineral density loss can reach 3.8% per year. Patients become susceptible to fractures, in particular fractures of the femoral neck, forearm, etc. While maintaining the menstrual cycle in women with hyperprolactinemia and normal estrogen levels, bone density does not change.

Manifestations of secondary hyperprolactinemia depend on the disease against which it developed. Irregular bursts of prolactin hypersecretion lead to swelling, enlargement and tenderness of the mammary glands.

Diagnostics

The main method for diagnosing hyperprolactinemia is to determine the level of prolactin and thyroid hormones in the patient's blood. Blood sampling to determine the concentration of prolactin should be carried out before 10 a.m., but not immediately after waking up and not after medical procedures.

Prolactin is characterized by daily fluctuations.

Patients should refrain from visiting the sauna and having sexual intercourse the day before the test. In women with a preserved menstrual cycle, blood sampling to determine prolactin levels is carried out between the 5th and 8th days of the cycle. To exclude a temporary increase in the level of this hormone, which is not pathological, repeated tests may be required. It should be taken into account that the stress associated with blood sampling can cause moderate hyperprolactinemia in emotionally labile patients.

In order to determine the cause of hyperprolactinemia, they resort to x-ray examination of the skull, computed tomography or magnetic resonance imaging, and an ophthalmological examination, including examination of the fundus and determination of visual fields. To diagnose the uterus and appendages, an ultrasound examination of the pelvic organs is performed. If necessary, other studies are also carried out: mammography in women, determination of the level of prostate-specific antigen in men, general and biochemical tests of urine and blood, etc.

Treatment of hyperprolactinemia

Treatment for physiological hyperprolactinemia is not required. Treatment tactics for hyperprolactinemia pathological forms depends on its root cause. The goals of therapy for hyperprolactinemia are to reduce prolactin levels to normal values, restore reproductive and other impaired body functions. The primary task is to eliminate the factor that caused the development of the pathological condition.

Drug-induced hyperprolactinemia requires discontinuation of the drug that caused hormonal disturbances. In the event that an increase in prolactin levels occurred under the influence of taking psychotropic drugs, it may be necessary to reduce the dose of the drug, transfer the patient to a drug that does not have a pronounced effect on prolactin levels, or add a dopamine receptor agonist to the drug taken.

Drug therapy for hyperprolactinemia includes the use of drugs that suppress prolactin production. In order to restore regular ovulatory menstrual cycles and the ability to conceive, dopamine receptor stimulants are prescribed, the use of which is indicated until the menstrual cycle normalizes. In some cases, to prevent relapses, it may be necessary to extend the course for several more menstrual cycles. Restoration of reproductive function during therapy that normalizes prolactin levels can occur quickly, so women who are not planning a pregnancy need to take care of contraception. In men, along with normalization of prolactin levels, testosterone levels are also normalized, and erectile function is restored.

In addition to dopamine receptor agonists, antidepressants and anticonvulsants can be used to treat increased anxiety, depressive states and psychovegetative disorders.

In the presence of prolactin-secreting pituitary adenomas, drug therapy is carried out. TO surgical interventions or radiation therapy for prolactinomas is rarely used, only for macroprolactinomas in case of ineffectiveness conservative therapy.

For hyperprolactinemia caused by hypothyroidism, it is prescribed replacement therapy thyroid hormones, this is enough to normalize prolactin levels in such patients.

Excessive prolactin production in patients with chronic renal failure is usually not corrected by hemodialysis, but on the contrary, may increase. In this case, the condition normalizes after kidney transplantation.

If the patient has tumors, cysts and other neoplasms, it may be advisable surgical treatment and/or radiation therapy. The main indications for hypophysectomy (removal of the pituitary gland) are the lack of a positive effect from conservative therapy and the development of complications from the visual system. IN postoperative period The issue of prescribing hormone replacement therapy is being considered, the need for which is determined by the results of a study of the state of the hypothalamic-pituitary system, determining the concentration of testosterone and free thyroxine in the blood.

During treatment mental disorders, occurring in some patients with hyperprolactinemia, there are difficulties with the use of psychopharmacological drugs, most of which help stimulate the production of prolactin. In this case, in addition to dopamine receptor agonists, antidepressants and anticonvulsants can be used to treat increased anxiety, depressive states and psychovegetative disorders.

Hyperprolactinemia in children

In newborns, a high level of prolactin is the physiological norm; by the end of the first month of life, its concentration in the blood corresponds to that of adults. Externally, this is manifested by enlargement (swelling) of the mammary glands. After a few months, the content of prolactin in the blood of children decreases.

Hyperprolactinemia in adolescents manifests itself in the form of delayed sexual development (hypogonadism, constitutional delayed sexual development, etc.). The cause of increased prolactin production in girls is often prolactinoma. Boys often exhibit an idiopathic form of hyperprolactinemia.

Prevention

There is no specific prevention of hyperprolactinemia, since it can be caused by various factors and diseases. Measures to prevent it consist of prevention, timely identification and elimination of the cause.

Nonspecific preventive measures are general health measures:

• giving up bad habits;
• regular physical activity;
• avoiding excessive physical and mental stress;
• normalization of sexual life, prevention of artificial termination of pregnancy, effective contraception;
• regular preventive examinations.

Consequences and complications

The lack of adequate timely treatment of pathological conditions that caused the development of hyperprolactinemia leads to further endocrine disorders (dysfunction of the thyroid gland, adrenal glands, ovaries, pituitary gland, etc.), infertility, anorgasmia, loss of vision, progression of neoplasms of the hypothalamus and pituitary gland, and the development of oncological pathologies of organs reproductive system, and in severe cases, even death.

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Hyperprolactinemia - an increase in the concentration of prolactin in the blood - can be an independent disease or be a symptom of some other pathology.

Sometimes prolactin levels increase for physiological reasons and return to normal on their own. Hyperprolactinemia occurs approximately 8 times more often in women than in men.

Prolactin is a hormone synthesized in the pituitary gland. Most often, hyperprolactinemia is caused by pathology of this organ, but it can also be physiological reasons. These include breastfeeding, excessive physical and emotional stress, and coitus. Normal is an increase in prolactin during sleep, which quickly returns to normal after waking up.

The reason may be surgical manipulations on chest. Prolactin levels increase when eating protein foods and when blood sugar levels decrease. Hyperprolactinemia occurs as a result of abortion and surgical interventions on the uterus.

Pathological causes of hyperprolactinemia in women are divided into the following groups:

• organic: prolactinoma, neoplasms in the pituitary gland (craniopharyngioma, glioma), trauma to the pituitary stalk, radiation, hypothalamic tumors;
• functional: hypothyroidism, acromegaly, Cushing's disease, infectious diseases brain and meninges, renal failure, liver disease;
• Iatrogenic: taking antiemetics, neuroleptics, female sex hormones, phenothiazines, reserpine, opioids, amphetamines, hallucinogens.

These reasons weaken the effect of dopamine, which normally blocks the synthesis of prolactin. This causes an increase in prolactin levels in the blood and its effect on the secretion of hormones that stimulate the growth and maturation of follicles in the ovaries. As a result, the growth of follicles and the synthesis of female sex hormones are inhibited, which causes disturbances in the reproductive system.

Hyperprolactinemia - symptoms in women

More than half of women with hyperprolactinemia complain of nipple discharge in the form of colostrum or milk. Most experience menstrual irregularities, which can be combined with infertility.

Most often they manifest themselves in the following forms:

• amenorrhea – a woman does not menstruate for six months or more;
• oligomenorrhea – small in volume and duration of menstruation once every 2-3 months;
• opsomenorea – delay of menstruation;
• cycles without ovulation;
• excessive bleeding.

The clinical picture of hyperprolactinemia is also manifested by decreased sexual desire, insufficient lubrication and pain during sexual intercourse. Often a woman cannot experience orgasm and does not receive pleasure from sexual relations. Hair loss, dandruff, and acne occur.

Serious consequences of the disease are represented by involution of the uterus and mammary glands, and the occurrence of malignant neoplasms. Hyperprolactinemia is especially dangerous for pregnant women, as it can cause miscarriage or negatively affect the development of the fetus.

Frequent symptoms are weight gain and decreased bone mineral density, which is manifested by frequent fractures. The risk of autoimmune diseases, depression, and insomnia increases. More general manifestations may be low mood, susceptibility to emotional swings, irritability, and impaired social adaptation.

When the tumor is localized in the pituitary gland, it causes damage to neighboring organs. Possible deterioration of vision, narrowing of visual fields. Violations are often irreversible. When the ventricles of the brain are involved, increased ICP occurs and the optic nerve swells. Possible leakage of cerebrospinal fluid from the nose, headache.

Often the disease is latent; an unstable increase in prolactin concentration is manifested by swelling and pain in the chest.

When to see a doctor?

It is difficult not to notice the flow of milk from the nipples, but such a manifestation of hyperprolactinemia does not occur in all cases. It is worth contacting a gynecologist if any menstrual cycle irregularities occur, if the cycle started late or dropped out altogether.

It is also worth paying attention to sudden changes in sexual behavior, decreased desire and the appearance of atrophic changes in the vagina. Engorgement and pain in the mammary glands, palpation of the formation is also a reason to consult a doctor.

Diagnostics

To establish a diagnosis, the doctor collects a detailed gynecological and life history, asks about the time of occurrence of menstrual irregularities, the duration and regularity of menstruation.

Conducts a general and vaginal examination to identify areas of mucosal atrophy.

The disease is confirmed by testing the level of prolactin in the blood. Normally, the concentration does not exceed 550 mcg per liter. The hormone is determined in the blood serum three times, preferably in the morning, in the first phase of the cycle. Prolactin levels correlate with the cause of the disease:

• more than 4000 mU per liter – pituitary macroadenoma;
• 3000-4000 mU – microadenoma;
• less than 3000 – craniopharyngioma or functional disorders.

An increase in prolactin is often combined with a decrease in follicle-stimulating and luteinizing hormones. Additionally, the level of thyroid-stimulating hormone is monitored to exclude hypothyroidism, which also increases the concentration of prolactin.

Additionally, an ophthalmological examination is performed to diagnose pituitary tumors, and the ovaries are visualized for polycystic syndrome. They carry out diagnostics of the mineral composition of the bone, X-rays, CT and MRI of the skull to confirm pituitary adenoma.

To identify the pharmacological cause of hyperprolactinemia, the drug should be discontinued for a while and the symptoms observed.

Treatment and prevention

Therapy should include correction of the conditions or diseases that were the cause.

Treatment of hyperprolactinemia in women can be medicinal and surgical.

Physiological conditions cannot be treated; in this case, lifestyle adjustments and the exclusion of stressful situations are necessary.

Drug treatment

Dopamine agonists are used - Bromocriptine. The initial dosage is 1.25 mg per day, increased to 10 mg. The goal is the occurrence of normal cycles with ovulation. Then maintenance therapy of 2.5 mg is carried out for 6-8 months. The drug Cabergoline, prescribed in the same dosage 1-2 times a week, is well tolerated and has a long-lasting effect.

Surgical treatment

Pituitary tumors are removed in various ways. When localized in the area of ​​the optic chiasm, a rhinoseptal approach is used - through the nasal cavity. When a tumor grows towards the temporal bone, a subfrontal approach is used, and for macroadenomas, a transsphenoidal approach is used. Tumor removal is possible using radiotherapy and ionizing radiation.

Prevention

Stress and increased physical activity should be avoided.

It is important to quit smoking, alcohol, proper nutrition without too fatty foods.

To eliminate the possibility of abortion, it is necessary to correctly select contraceptive methods and plan your pregnancy.

It is necessary to avoid casual sex and use a condom.

Every woman should visit a gynecologist twice a year for timely diagnosis of gynecological pathology.

With timely diagnosis and treatment, patients with hyperprolactinemia have a good prognosis. After treatment, it is recommended to perform an MRI of the head once a year, and to examine the level of prolactin in the blood twice a year.

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