The causes of hyperprolactinemia
Hyperprolactinemia is a fairly common endocrine disorder in both women and men. The main symptoms of hyperprolactinaemia may suggest hypogonadotrophic hypogonadism, as they are expressed by impaired fertility, decreased libido and menstrual disorders in women. Hyperprolactinemia is most often of drug or organic origin. Organic etiological factors are usually pituitary tumors (prolactinomas). Differentiating the causes of hyperprolactinaemia is important in terms of therapeutic decisions.
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1. Physiological causes of prolactinemia
Hyperprolactinaemia is increased blood prolactin levels.Prolactin is a hormone secreted by the anterior pituitary gland that stimulates the breast glands to produce milk. Hyperprolactinaemia is defined as the concentration of prolactin in the blood higher than 20 ng / ml in women (except pregnant and breastfeeding women) and 15 ng / ml in men. Hyperprolactinemia can appear in physiological states which include:
- breastfeeding (the first six months)
- stress and emotional tension,
- night rest, sleep,
- nipple irritation
- sexual relations,
- eating meals,
- hypoglycemia, i.e. a drop in blood glucose levels.
2. Pharmacological and pathological causes of hyperprolactinaemia
The cause of hyperprolactinaemia may be the use of drugs that directly or indirectly modify dopamine secretion. Drugs that can influence high blood prolactin levels include dopamine blockers, dopamine receptor antagonists, multiple hormones, cimetidine, opiates, and verapamil.
Diseases that negatively affect the pituitary and hypothalamus are considered pathological causes of hyperprolactinaemia. Organic changes in the pituitary gland include:
- benign tumors - adenomas - secreting prolactin or inhibiting the action of dopamine,
- tumors in the hypothalamic-pituitary region, which compress the pituitary gland,
- Empty Sella Syndrome (ESS) consisting in chronic invagination of the subarachnoid space.
Diseases that may be the causative agent of increased prolactin levels also include: primary hypothyroidism, shingles, seizures, liver cirrhosis, polycystic ovary syndrome, and chronic renal failure. Ectopic secretion of prolactin can be caused by lung cancer or kidney cancer. Sometimes hyperprolactinemia results from chest injuries, including surgical interventions.
Differentiating the causes of hyperprolactinaemia is important in making management decisions. Neurosurgical procedures are used in the presence of pituitary tumors in the absence of positive results of pharmacological treatment (drug intolerance or drug resistance) or if prolactinomas are characterized by rapid growth dynamics and cause pressure symptoms caused by the large size of the tumor. Surgical treatment is also recommended in women with macroprolactinoma who plan to become pregnant.