Treatment of hyperprolactinaemia

Treatment of hyperprolactinaemia is different depending on what causes too high levels of prolactin in the blood. If hyperprolactinaemia is caused by a benign and hormonally inactive tumor, treatment may not be necessary, unless symptoms are severe. In the event that hypogonadotrophic hypogonadism develops, oral contraceptives are used in women and testosterone in men. Hyperprolactinemia in men and women must be monitored regularly, even if it does not cause any symptoms.

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1. What is the diagnosis of hyperprolactinaemia?

Hyperprolactinaemia is a state of elevated levels of prolactin in the blood - in women above 20 ng / ml, and in men 15 ng / ml. The first test should therefore be to test the level of prolactin. It is also worth paying attention to the symptoms. Prolactin is a hormone that, in excess, can induce in women:

  • menstrual disorders (amenorrhea as well as irregular or heavy bleeding),
  • sterility,
  • galactorrhea,
  • osteopenia,
  • osteoporosis,
  • hirsutism,
  • decrease in libido.

However, hyperprolactinaemia in men causes:

  • fertility disorders,
  • decrease in libido,
  • erection problems,
  • gynecomastia,
  • osteopenia,
  • osteoporosis,
  • in rare cases, galactorrhea.

In children, hyperprolactinaemia may delay growth and sexual maturation.

If hyperprolactinaemia is caused by a large tumor in the hypothalamic-pituitary region, visual field disturbances may occur due to pressure on the optic chiasm. The field of view may be limited to the right and left. In order to identify such a disorder, an ophthalmological examination is necessary to examine the field of view. The tumor can also cause headaches.

Contrast-enhanced MRI is necessary to rule out a brain tumor as the cause of hyperprolactinaemia. If a tumor is detected, its size and nature are assessed. Most of the brain tumors that cause these symptoms are benign prolactin-secreting adenomas.

Also, dysfunction of the dopamine-producing hypothalamus can cause an increase in prolactin levels. Dopamine inhibits the secretion of prolactin. Its reduced amount may be associated with the appearance of tumors in the hypothalamus or the use of certain drugs and substances (opioids, large amounts of estrogens, neuroleptics, tricyclic antidepressants).

2. How is hyperprolactinemia treated?

In many cases, treatment of hyperprolactinaemia is merely pharmacological lowering of prolactin and amelioration of hypogonadotrophic hypogonadism. In women, the treatment focuses on restoring fertility, while in men, the symptoms of hypogonadism are relieved (male fertility is not completely impaired, but there are problems with erection and libido). D2 receptor antagonists, as well as estrogen in women and testosterone in men.

If the cause of hyperprolactinaemia is a pituitary tumor that grows in size, inhibition of pituitary growth becomes the goal of treatment. In some cases, it is necessary to remove the tumor. If prolactin levels rise as a result of drug treatment, such as depression, both the advantages and disadvantages of drug withdrawal and alteration must be considered.

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