Hyperprolactinemia: manifestations, symptoms and treatment of a disease
Hyperprolactinaemia is a condition in which the blood contains increased levels of the prolactin hormone. Normally prolactin is produced in the pituitary gland and participates in a hormonal background. More often the disease occurs in young women aged 25-35 years, much less often - in men.
The syndrome of hyperprolactinemia in women is accompanied by the release of milk from the mammary glands, which can be without pregnancy. In this case, they talk about galactorrhea. In addition to this symptom, patients are concerned about menstrual dysfunction and infertility.
In men, this syndrome is accompanied by a decrease or a complete absence of sexual desire, as well as being separated from the mammary glands. In some cases, men change the nature of the hair, there is excessive hair growth and acne.
Causes of hyperprolactinemia
Causes that cause this disease, because they are otherwise associated with the function of the endocrine system. Hyperprotectinemia most often appears due to hypothalamic-pituitary hormonal shift. Moreover, the disease can be both independent and be a sign of another disease, also associated with endocrinopathy.
So, the causes of hyperprolactinemia:
- Diseases of the hypothalamus. Any pathological process localized in the hypothalamus can cause the disease. It can be a tumor, damage to the leg of the hypothalamus, radiation training.
- Pathology of the pituitary gland. More often, with pathology of the pituitary gland, there are such diseases as the Itenko-Cushing syndrome, acromegaly, Nelson's syndrome. Practically in 50% of these patients there is a symptom of a hyperprolactinemia. In the pituitary gland, there may also appear microscopic benign tumors that can cause disruption of the production of the hormone prolactin.
- Hypothyroidism or decreased thyroid function.
- Disturbance of ovarian function in polycystic syndrome.
- Prolonged intake of drugs that affect the hormonal background. These include anti-emetics( cerucal), contraceptives, antidepressants( amitriptyline).
- Diseases of the brain and growth of tumors. Such diseases as encephalitis and meningitis can cause a disruption of the endocrine system.
- Cirrhosis of the liver and chronic hepatitis.
- Syndrome of chronic renal failure, in which the adrenal cortex is involved.
In rare cases, it is not possible to find out the cause of the disease, and this condition is called idiopathic hyperprolactinaemia. At the same time, all signs of the disease are observed, but there are no changes on X-rays and examination that could cause the disease. This may be minor damage to the hypothalamus or pituitary gland that are not visible to the common eye. This type of hyperprolactinemia is also called functional hyperprolactinemia.
Symptoms of hyperprolactinemia may occur during pregnancy, but this is not considered a disease, as during pregnancy serious hormonal changes and preparations for childbirth and feeding occur.
Usually normal after childbirth and the natural period of breastfeeding, hyperprolactinemia traces off without a trace, without causing trouble.
The diagnosis of hyperprolactinaemia is based on patient complaints, examination data and clinical data, as well as laboratory and instrumental studies. In the collection of complaints should pay special attention to the onset of the disease. The onset can be acute, against a background of complete health, and also gradual, and this picture is more like a picture of tumors.
Transient hyperprolactinemia is also diagnosed as a disease, with a symptom of milk separation observed during primary infertility for several years.
Previously used a method of diagnosis, such as X-ray craniography, but in such pictures visible only visible to the eye of the tumor. Micro-tumors are determined using magnetic resonance imaging, which has been used successfully in recent years.
The level of the hormone prolactin in the blood plays an important role in the diagnosis. With functional hyperprolactinemia, its value does not exceed 3000 mIU / l. If the level of prolactin is doubled and is from 3500 to 8000 mIU / l, the probability of a pituitary tumor is 80%.
Treatment of hyperprolactinemia
In the diagnosis of hyperprolactinemia, treatment should be directed, first of all, to the causes that could cause the disease.
If the cause of the disease is hypothyroidism, then therapy with thyroid medications is performed. In general, dopamine agonists( Parlodel, Serocryptin, Brompretin) are used in the treatment. A particularly positive shift and a good effect is observed when these preparations are treated with the microadenomas of the pituitary gland. Therapy with medications is performed only under the supervision of an endocrinologist and should not be carried out independently!
With primary infertility, the task of treatment becomes a normal menstrual function, and in this case hormone therapy with female sex hormones is performed.
If the cause of the disease is a large pituitary tumor( size 1 cm or more), then in these cases, surgery and removal of the tumor. In extreme cases, the method of radiation therapy is used.
Treatment of the disease in men should begin with the establishment of the cause of the disease and restore the hormonal background. Since tumors of the pituitary gland can be observed in men, they are subjected to the same diagnosis as in women. One of the reasons for the disease of men is the independent or uncontrolled intake of anabolic drugs for muscle building. Usually, when anabolic steroids are abolished, the release of milk from the mammary glands ceases.