Hyperprolaktemia: diagnosis and treatment


  • Diagnosis of hyperprolactiakiyia
  • Treatment of hyperprolactiakiyia

  • Increased level of prolactin
    diagnosed in 20-25% of patients with infertility and various
    disorders of the menstrual cycle, and 40-45% of them are the reason in
    The presence of macro and microcholas pituitary.

    Definition of the level of prolactin - a mandatory method of study from this contingent of patients.

    Blood fence to analyze the prolactin content should
    produced from 9 to 12 am on an empty stomach. Woman should be fine
    relax on the eve of abstainment from sexual intercourse.

    Gynecological examination and inspection of the mammary glands before taking blood.

    Diagnosis of hyperprolactiakiyia

    The diagnosis of hyperprolactinemia can be delivered at twofold
    Definition of increased level prolactin. For most laboratories
    Upper border of the rate of hormone - 500 mm / l or 25 ng / ml.

    Hyperprolaktemia: diagnosis and treatmentThere are two types of hyperprolactinemia: physiological and
    Pathological. Physiological hyperprolactinemics manifests itself during
    pregnancy, in the process of breastfeeding, during deep sleep, and
    Also after physical stress load and in the stressful situation.

    Hyperprolactiania also cause sexual contact and reception
    Protein food. Pathological increase in the level of prolactin arises when
    Tumors of the hypothalamic-pituitary area, after radioactive
    irradiation or surgical damage to the pituitary legs, during syndrome «empty» Turkish saddle, craniophangioma. In addition, it is possible
    The emergence of pathologies under a number of endocrine diseases (hypothyroidism,
    Incenko-Cushing disease, polycystic ovarian syndrome), chronic
    deficiency of the kidneys and liver, as well as after operations on dairy
    glands and chest organs.

    Section of prolactin is disturbed when taking drugs, such as neuroleptics, reserpine, opiates, estrogens.

    The clinical picture of the disease is manifested in violation
    menstrual cycle (rare menstruation or their complete absence),
    infertility, decline in sexual entry (libido).

    Galactere (release from the mammary glands) was revealed in 30-70%
    Patients with elevated prolactin content. The frequency of its occurrence
    depends on the level of hormone content and severity of the menstrual disorders

    Violations such as Girsutism (Men's Summary) and
    Hyperandrogenation (raising the level of men's genital hormones) and acne
    (acne, if in a simple) can occur in 20-25% of patients with

    Diagnosis of hyperprolactinemia includes:

    • determining the level of the blood plasma;
    • craniogram;
    • Computer tomography (CT) or nuclear magnetic resonance (NMR);
    • Inspection of the eyeboard and fields of view;
    • Functional tests.

    Raising the level of prolactin in the blood plasma - a sign of the disease
    and indication of the X-ray Survey of the pituitary.

    In 20% of patients on the craniogram, an enlarged saddle is determined, «Double» bottom, expanding the entrance to the Turkish saddle, which is
    Signs of presence of prolactinoma (macroenomes) pituitary. In those cases,
    When there are no changes on the craniogram, it is shown by CT (computed tomography) or NMR (nuclear magnetic resonance) for
    Detecting the microprolactin of the pituitary size of less than 10 mm.

    Survey of the eye doves and fields of view on white and colored
    Tags shown in patients with macroenomes to detect distribution
    Tumors beyond the Turkish saddle - on the crossroads of optic nerves.

    Functional samples with TRG (thyrotropic release-hormone) or
    Metoklopramide allow the differential diagnosis between
    organic hyperprolactineia due to micropoffy microense,
    and functional not related to the tumor process.

    Hyperprolactinemia can be combined with diseases such as
    Polycystic ovarian syndrome (SPKI). One of the hormonal parameters
    SPKA is to increase the ratio of Hormones LH / FSH, in combination with
    Violations of the menstrual cycle by type of oligo-amenoria with
    hyperagratenia or without the last. Final diagnosis
    confirmed ultrasound, laparoscopy with ovarian biopsy and subsequent
    Patomorphological research.

    Treatment of hyperprolactiakiyia

    The treatment of hyperprolactinemia is carried out with the help of medicines, radiation therapy and surgical intervention.

    In the macroenoma of the pituitary, the question of the treatment method is solved
    jointly with a gynecologist and neurosurgeon. With hyperprolactinov
    states caused by microenomes of pituitary or functional
    Increased hormone, leading is the use of dopamine agonists
    (Yes): Parlodela, Bromocriptic, Seroktyptin.

    In recent years, dosage forms have been actively used
    prolonged action: norprolac and reaches. Domestic
    Preparation - serbergin - successfully tested in clinics and can be
    Recommended for the treatment of all types of hyperprolactinemia.

    Prescribed drugs with cycles for 6-12-24 months. During them
    Reception by experts are controlled by the level of prolactin and measurement
    rectal temperature. The establishment of ovulation and menstruation is planned
    In 80% of cases, pregnancy occurs in 65-72% of cases.

    Patients with hyperprolactinemia should know that they
    represent a group «Risk» for the possible development of tumors
    pituitary or their recurrence after treatment, pregnancy and childbirth. Them
    should be observed with specialists all life.

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