What is Hyperprolactinemia?
Hyperprolactinemia is a condition wherein there is a high level of prolactin in the blood. This is an abnormal condition because the normal levels of prolactin in women are at 500mIU/L and 450mIU/L or less in men. The prolactin is an important hormone in women because this aids them in lactation during childbirth. This can be a normal condition especially during pregnancy and breastfeeding. Naturally, the pituitary gland will secrete or produce more prolactin when breastfeeding. But hyperprolactenemia may also be pathologic when there is an injury or disease on the pituitary gland or the hypothalamus.
Symptoms in women
- This condition affects women more than men and it can lead to amenorrhea or skipping menstruation. Sometimes, the menstrual flow may also be irregular.
- In other cases, even though the woman is not pregnant, she will produce breast milk which should not happen.
- It may also affect the vagina causing it to dry and when there is sexual intercourse, it becomes painful.
- Some women experiences low sex drive or decreased libido and some breast pain.
Even though this problem is common in women, men may also experience hyperprolactinemia.
Symptoms in men
- Some recognizable symptoms would include gynecomastia or sudden enlargement of the breast.
- Their sex drive is also lessened or there is decrease in libido.
- Later on, it can lead to infertility and even
- erectile dysfunction.
There are different causes that can lead to hyperprolactinemia. This can be due to the
- Physiologic changes such as
- mental stress
- overproduction of prolactin
Another probably cause of the problem is due to certain diseases. A known disease that can lead to hyperprolactinemia is the
- Cushing’s syndrome or acromegaly
- chronic renal failure
- bronchogenic carcinoma.
- Seizure may also be linked with the disease because it alters the normal electrical conduction in the brain.
- Tumors in the pituitary gland may also cause overproduction of prolactin.
Drugs may also be the cause of hyperprolactinemia. There are drugs that will block the dopamine secretion. Dopamine is an important chemical in the brain and once it is suppressed, the pituitary gland will secrete more prolactin. Example of drug that causes this condition is the tranquilizers like
- domperidone and others
Hyperprolactinemia Diagnosis, Treatment
After consulting the doctor, the health care team will conduct a series of tests to ensure the right diagnosis of the problem. Checking of the prolactin levels through blood samples will explain the symptoms of the prolactin levels are high. Then the physicians will also check for thyroid tests to see if the problem is due to hypothyroidism. This is one of the most common causes especially if the physician reviews the medications and found no relationship between the drugs taken and the high levels of prolactin.
Imaging studies like plain x-ray will check for big macro-adenoma, or presence of tumors in the head. Sometimes, MRI and CT scans are also ordered to have a better view of the pituitary gland and its nodule.
Reduction of size of tumour
If tumors are found, the main goal of the treatment is to reduce the size of the tumor.
Surgery may be done but it is risky since the pituitary gland is a small gland and adjacent to it is the hypothalamus.
Other options would include doing radiation therapy to effectively decrease the size of the tumor.
Medications like dopamine agonists are the drug of choice to treat hyperprolactinemia. There should be enough dopamine in the system so that the pituitary gland will not over secrete prolactin hormones.
The drug is called bromocriptine mesylate. This is drug is taken in order to shrink the prolactonimas and it is proven to be effective in reducing the prolactin level of the patients from 70 to 100%. Another drug is the cabergoline. This drug has the same effects with bromocriptine but the side effects are lesser yet the price is higher.