prolactin. Typically, the prolactin level in the blood increases in
Pregnancy and breast-feeding, which leads to the development of
milk. As soon as a woman stops to feed the baby, the level of
prolactin is reduced to normal. If prolactin levels increase not
during pregnancy or is not reduced to normal after discontinuation
breast feeding, then this condition is known as hyperprolactinemia.
One symptom of hyperprolactinemia is
irregular menstruation (infrequent menstruation or complete their
absence), because elevated levels of prolactin violates the synthesis
follicle stimulating hormone (FSH) and luteinizing hormone (LH),
regulating the menstrual cycle. This is largely the cause
infertility in women with hyperprolactinemia. Patients with
hyperprolactinemia also may suffer from headaches, they can
observed decreased libido.
30% of women with elevated prolactin
meets galactorrhoea (release of milk from the mammary glands).
Occurrence galactorrhea depends on the level of the hormone. It does not
is a manifestation of a breast disease, for example,
cancer, and occurs because of the physiological effect of prolactin.
(Increase the level of male sex hormones) and acne to occur in 20-25%
patients with hyperprolactinemia.
There are many causes of pathological
increasing blood levels of prolactin. Even a minimal stress
before blood samples for the study as a pelvic examination or
study of mammary glands may cause a momentary
hormone level may be increased due to the reception
certain drugs, such as antiemetics,
antipsychotics, estrogens, opiates, birth control pills. If
when you study found increased blood levels of prolactin,
be sure to tell your doctor about these drugs.
hyperprolactinemia reason may be transferred
radiation exposure, surgeries on the breast and
the organs of the chest, a syndrome of "empty" sella (Turkish
saddle - a bone formation at the base of the skull, in which
It is the pituitary gland).
The cause of elevated levels of prolactin can be
and chronic liver failure and kidney failure
thyroid function (hypothyroidism), and a number of other endocrine
diseases (Cushing's disease, polycystic ovary syndrome).
In addition to a variety of endocrine and not endocrine
disease, hyperprolactinemia can be caused by benign
tumors of the hypothalamic-pituitary region - pituitary adenoma,
generating prolactin (prolactinoma). Adenomas grow very slowly
or do not grow at all. What exactly is their education, yet to
It is not clear.
Mikroprolaktinomy (10 mm in diameter) and
macroprolactinoma (10 mm in diameter) are a common cause
hyperprolactinemia. Elevated prolactin levels are detected in 20-25%
patients with infertility and various disorders of the menstrual cycle,
and at 40-45% due to the presence of tumor hyperprolactinemia
It should be noted that quite often increased
prolactin levels found in the absence of the above
pathologies. This so-called "idiopathic" or "functional"
form of hyperprolactinemia. Its reason lies in the increased function
cells secreting prolactin.
How is the diagnosis of hyperprolactinemia
Hyperprolactinemia Diagnostics includes:
determining the level of prolactin and other hormones in the blood plasma;
kraniogramme (x-ray of the head);
X-ray computed tomography or nuclear magnetic resonance (NMR) imaging of the head;
research fundus and visual fields.
If it turns out the results of a blood test that
elevated prolactin levels, and other manifestations of hyperprolactinemia not,
it is necessary to repeat the analysis to exclude errors. Blood sampling for
prolactin content analysis should be carried out from 9 to 12 am
on an empty stomach. A woman should have a good rest, the day before to refrain from
hyperprolactinemia Diagnosis can be made at
double detected elevated levels of prolactin. For most
Laboratory standards hormone upper limit - 500 mU / l or 25 ng / ml.
Prolactin in some degree may indicate the reason
hyperprolactinemia: the prolactin level greater than 200 ng / ml (4.000
mU / l), there is usually a macroadenoma pituitary; in prolactin level
less than 200 ng / ml (4000 IU / L) is the most likely diagnosis - microadenoma
pituitary or idiopathic hyperprolactinemia.
In addition to determining the level of prolactin, you must
be sure to check the function of the thyroid gland, as well as to determine the
levels of other hormones.
It should also be made to render kraniogramme
sella. In 20% of patients at increased kraniogramme determined
saddle, "double" floor, the entrance expansion in the Turkish saddle, which is
signs of the presence of prolactinoma (macroadenoma) pituitary. Where
kraniogramme when there are no changes, we recommend holding
X-ray CT or MRI imaging to detect
mikroprolaktinom pituitary size less than 10 mm.
If confirmed by the presence of macroadenoma, held
examination of the fundus and visual fields to determine the spread of
tumor outside the Turkish saddle - on the optic chiasm.
How is the treatment of hyperprolactinemia
Methods of treatment of hyperprolactinemia include medications, radiation therapy and surgery.
When hyperprolactinemia caused microadenomas
functional pituitary or increased levels of prolactin, the main
is the use of dopamine agonists, reduces
prolactin level in the blood is often reduced to normal
a few weeks after starting treatment.
These drugs are prescribed in cycles of 6-24 months. At the time of their admission control prolactin levels and measure the basal temperature.
menstrual cycle is restored As the normalization of prolactin and
ovulation (in 80% of cases), 70% of pregnancy occurs.
While taking drugs almost all prolactinomas
decrease in size. When macroadenomas pituitary question of method
the treatment is decided jointly by a gynecologist and a neurosurgeon. In connection with
effectiveness of drug treatment with prolactinomas are rarely
resorting to surgery and radiation therapy. Only a small proportion of patients with
macroprolactinoma whose tumor size is reduced by the background
medical treatment, surgery may be necessary. This operation
currently underway through a small incision near the sinuses.
Sometimes the experts recommend to carry out radiation therapy, which allows
stop taking the medication. However, it is possible to develop
As treatment may also be administered
Some hormones: glucocorticoids if
adrenal insufficiency, L-thyroxine in the presence of failure
thyroid (hypothyroidism), and sex hormones (estrogens) in
as replacement therapy.
Patients with hyperprolactinemia should be constantly observed by specialists.