Hyper prolactinemia

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Overview

Prolactin (PRL) plays a central role in a variety of reproductive functions. Initially, even though this hormone was recognized in relation to lactation in women, lately immense interest has been focused on prolactin with respect to its effect on reproduction. Hyperprolactinemia is a condition of elevated prolactin levels in blood which could be physiological, pathological, or idiopathic in origin. Similarly elevated prolactin levels could be associated with severe clinical manifestations on one side of the spectrum or be completely asymptomatic on the other side.


Unlike other tropic hormones secreted by the anterior pituitary gland, prolactin secretion is controlled primarily by inhibition from the hypothalamus and it is not subject to negative feedback directly or indirectly by peripheral hormones. It exercises self-inhibition by a counter-current flow in the hypophyseal pituitary portal system which initiates secretion of hypothalamic dopamine, as well as causes inhibition of pulsatile secretion of gonadotropin releasing hormone (GnRH). This negatively modulates the secretion of pituitary hormones responsible for gonadal function.

Symptoms

Milky nipple discharge.

Milk production when not pregnant or breastfeeding.

Menstrual irregularities.

Vaginal dryness, causing painful intercourse.

Fertility problems.

Headaches and visual problems (both of these are less common)


Causes

Several factors and conditions can cause hyperprolactinemia, including:


Prolactinoma (most common cause).

Certain medications.

Certain health conditions.

Other pituitary gland tumors.

Sometimes, no cause of hyperprolactinemia can be found. This is known as idiopathic hyperprolactinemia. It usually goes away without treatment after several months.

Risk factors

More prolactinomas occur in females than males. The disorder is rare in children.

Rarely, an inherited disorder such as multiple endocrine neoplasia, type 1 — a disorder that causes tumors in hormone-producing glands — may increase the risk of a prolactinoma.

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Complications

Complications of prolactinoma may include:


Infertility. A prolactinoma can interfere with reproduction. Too much prolactin reduces the production of the hormones estrogen and testosterone. Too much prolactin also can prevent the release of an egg during the menstrual cycle (anovulation) in females. In males, too much prolactin also can lead to decreased sperm production.

Bone loss (osteoporosis). Reduced estrogen and testosterone also cause decreased bone strength. This results in weak and brittle bones that can break easily.

Pregnancy complications. During a typical pregnancy, the production of estrogen increases. This may cause tumor growth. This can result in signs and symptoms such as headaches and changes in vision in pregnant females who have large prolactinomas.

Vision loss. Left untreated, a prolactinoma may grow large enough to press on your optic nerve. This nerve sits near the pituitary gland. The nerve sends images from your eye to your brain so that you can see. The first sign of pressure on the optic nerve is a loss of your side (peripheral) vision.

Low levels of other pituitary gland hormones. Larger prolactinomas can put pressure on the healthy part of the pituitary gland. This can lead to lower levels of other hormones controlled by the pituitary gland. These include thyroid hormones and cortisol. Cortisol is a stress-response hormone.

Prevention

Unfortunately, there’s nothing you can do to prevent hyperprolactinemia.

The only known risk factor for developing a prolactinoma, the most common cause of hyperprolactinemia, is having an inherited (passed through the family) condition called multiple endocrine neoplasia (MEN) type 1.

If you have a first-degree relative (sibling or parent) who has this condition, you may want to go through genetic testing to check to see if you have it as well. This may help screen for and catch a prolactinoma in its early phases.