Hyperprolactinemia

Especially with childless couples who dearly want a child, you should contact one Hyperprolactinemia be thought. This increase in the prolactin value leads to infertility in women and men in addition to other complaints.

What is hyperprolactinemia?

A Hyperprolactinemia describes an excess of prolactin in the blood. The hormone ensures breast growth during pregnancy and is then involved in milk production.

At the same time, it suppresses ovulation during this period. An increased prolactin level is then by no means a disorder, but rather desirable. Outside of pregnancy and breastfeeding, however, hyperprolactinemia can also occur in men and women, which is associated with various symptoms.

In women there are menstrual disorders up to and including missed periods and a milk-like discharge from the breast. In men, the mammary gland tissue grows visibly while their libido decreases. As a result, they can also become infertile.

causes

The causes of a Hyperprolactinemia are very diverse. A benign tumor on the anterior lobe of the pituitary gland (pituitary gland) can be responsible for the increased release of prolactin.

This lump is also known as a prolactinoma. However, drugs that counteract the natural dopamine production are often the cause of the symptoms. These include certain antihypertensive agents as well as antidepressants and pain relievers with morphine-like ingredients as well as anti-seizure drugs from the group of dopamine antagonists and the female hormone estrogen. While dopamine inhibits prolactin production, these drugs suppress this mechanism.

Less often, the cause is an accident or fall in which the pituitary stalk is damaged or torn off. In this case, the messenger substance dopamine can no longer reach the anterior pituitary gland in order to regulate the production of prolactin. An underactive thyroid or liver weakness can also be the cause of hyperprolactinemia.

Symptoms, ailments & signs

In hyperprolactinemia, a distinction must be made between the symptoms of the actual disorder and the symptoms of the underlying disease. Hyperprolactinemia is a hormonal disorder characterized by the presence of too high a concentration of the hormone prolactin. In women, hyperprolactinemia is associated with secondary amenorrhea.

In about ten to 40 percent of cases, secondary amenorrhea is also a possible cause of hyperprolactinemia. Half of women with hyperprolactinemia develop galactorrhea. Galactorrhea is characterized by spontaneous milk production even outside of pregnancy and breastfeeding. Edema (water retention in the tissue) can also develop.

Often there is also a decrease in bone density (osteoporosis) with the increasing risk of spontaneous bone fractures. Men can also be affected by excessively high prolactin concentrations. As a result, testosterone production decreases. The affected men suffer from a decrease in potency and libido. In addition, the beard growth is reduced and the mammary gland enlarged (gynecomastia).

The other symptoms depend on the respective cause of the hyperprolactinemia. Often the trigger is a benign tumor of the pituitary gland, which stimulates prolactin production. With a certain size of the tumor, headaches, restrictions of the field of vision and fatigue can occur. Other possible causes include kidney failure, liver disease, hypothyroidism, or chest wall injuries with their own symptoms.

Diagnosis & course

To diagnose a Hyperprolactinemia the doctor will have a detailed discussion about the patient's complaints. Then a blood sample is taken. Magnetic resonance imaging (MRI) can show a possible tumor of the anterior pituitary gland.

This tumor, known as a prolactinoma, is benign and should not be confused with a brain tumor. Changes in the pituitary style are also visible through the MRI scan. If a prolactinoma is the cause of the prolactin excess, the person concerned will be referred to an ophthalmologist to clarify possible visual disturbances and visual field restrictions. It must also be determined whether the tumor is pressing on the optic nerve, as the treatment of hyperprolactinemia must be tailored accordingly.

Complications

Since hyperprolactinemia means that there is too much of the hormone prolactin in the body, numerous complications can arise. The hormone prolactin promotes milk secretion and the growth of the mammary glands during pregnancy. If there is no pregnancy, but the mammary glands still deposit a milky-whitish liquid, ovulation is suppressed and the menstrual cycle is disturbed. In the long run, this can damage the sexual organs and lead to premature osteoporosis.

Too high a prolactin level also promotes breast cancer. Since prolactin is produced in the pituitary gland, too high a level can also be caused by a tumor, a so-called prolactinoma. The use of certain psychotropic drugs or cannabis consumption is often the cause of an increased prolactin level. An underactive thyroid is also conceivable. A pathologically elevated prolactin level must be treated urgently. Otherwise there is a risk of long-term health damage.

The prolactin level is measured using a blood analysis. Various drugs such as bromocriptine can be administered to lower it. They should ensure that the concentration in the blood returns to normal. A prolactinoma can often be positively influenced in this way. Then an operation becomes superfluous. If medication does not work, additional hormones are administered so that ovulation and the menstrual cycle return to normal and the flow of milk is stopped. In the case of a therapy-resistant prolactinoma, surgery must be performed.

When should you go to the doctor?

People with sexual disorders should be screened for hyperprolactinemia. An excess of prolactin in the body is usually harmless, but should be clarified if symptoms arise. Men who experience low levels of sexual activity for no apparent reason should speak to their family doctor or urologist. Other warning signs are decreased sperm production, decreased beard growth and a reduction in the field of vision. If any of these symptoms occur, a doctor should be contacted.

Women should see a gynecologist if they notice menstrual cramps, acne, and excessively thick hair. If depression, fears and personality changes develop, a doctor must be consulted immediately. People who regularly take antihypertensive drugs, antidepressants, or pain medication are particularly susceptible to hyperprolactinemia. An underactive thyroid or liver weakness are also possible triggers. Anyone who belongs to these risk groups should see their family doctor at the first sign. An internist can also be called in. Therapeutic advice is required for psychological complaints.

Doctors & therapists in your area

Treatment & Therapy

Treatment of the Hyperprolactinemia depends on the cause. Medicines should be reduced in dosage or replaced. For prolactinoma, treatment depends on the size of the tumor. In the case of small tumors, drugs are often used for therapy, which have an effect similar to dopamine. This inhibits the production of prolactin and normalizes the blood value.

The tumor also shrinks. However, drug treatment has numerous side effects such as nausea with nausea as well as fatigue and constipation, so that the drug must always be started gradually. If the preparations are not well tolerated, even small tumors can be surgically removed. This procedure is used for large tumors over one centimeter in size, when the optic nerve is impaired and the person concerned does not tolerate the drugs that inhibit prolactin release well.

In such a case, however, radiation of the tumor is generally preferred to surgical removal. It leads to damage and death of the tumor cells, which normalizes the prolactin concentration in the blood again. After radiation therapy, the function of the pituitary gland can be severely restricted, so that the person affected has to replace other hormones with medication even after hyperprolactinemia.

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Outlook & forecast

The underlying cause is decisive for making a prognosis. Cure is possible in some cases. For other reasons for hyperprolactinemia, recovery cannot be documented. If the disease is diagnosed as a side effect of the medication taken, the treatment plan is usually optimized and changed. As soon as the triggering drugs have been discontinued, the symptoms improve and the hyperprolactinemia recedes. New preparations for curing the existing underlying disease are being given so that overall health is improved.

In the case of a tumor, the stage of the tumor is decisive for the course of recovery. At an advanced stage, the treatment is usually changed. The focus is then on relieving pain instead of healing. In the case of an initial cancer, the tumor is removed and follow-up treatment initiated. If this has been successfully completed and the cancer is considered cured, the symptoms of hyperprolactinemia also disappear.

In rare cases, falls or accidents are responsible for hyperprolactinemia. In long-term therapy, damage to the pituitary gland is compensated for by the administration of medication. This is also the case with organ damage to the liver or an underactive thyroid. A relief of the symptoms is achieved, but a cure is not possible. After stopping the drug, the symptoms relapse immediately.

prevention

There are no ways one Hyperprolactinemia to prevent. If men have increased breast growth and a decrease in libido and women fail to have a menstrual period without a pregnancy, the doctor should be consulted in order to diagnose or rule out hyperprolactinemia as early as possible.

Aftercare

In the case of hyperprolactinemia, the measures or the direct options for follow-up care are in most cases severely limited, so that the person affected is primarily required to have a quick diagnosis and treatment so that there are no further complications or further complaints. The earlier the hyperprolactinemia is recognized and treated, the better, in most cases, the further course of this disease.

As a rule, the life expectancy of the person affected is not negatively affected by this disease. In many cases, this disease requires surgery to remove the tumor. The person affected should definitely rest after such an operation and take care of their body. Exertion or stressful activities should be avoided in order not to unnecessarily burden the body.

Medicines must also be taken. It is important to ensure that it is taken regularly and that the dosage is correct in order to alleviate the symptoms. With hyperprolactinemia, those affected are also dependent on the help and support of their own family. This can also prevent psychological upsets or even depression.

You can do that yourself

As a rule, the possibilities for self-help in hyperprolactinemia are severely limited. If the illness is triggered by taking certain medications, the medication should be discontinued or replaced by another after consulting a doctor. Medical treatment is essential for a tumor. However, patients should always take care of their bodies and not subject them to unnecessary stress. Since the treatment of a tumor is often associated with nausea, fatigue and vomiting, bed rest should also be observed.

If there is a deficiency in hormones after an operation, the patients are dependent on substitution therapy. The regular intake of the hormone preparations should be observed.

Serious symptoms or complications caused by hyperprolactinemia can be avoided by taking part in regular examinations. Early examinations can diagnose hyperprolactinemia in women, especially in the case of menstrual disorders or an unfulfilled desire to have children. An early diagnosis increases the probability of a positive course of the disease.

Furthermore, contact with other affected persons can also be very helpful and contribute to the exchange of information. In the case of psychological complaints, talking to close friends or relatives can also help.