Hyperprolactinemia should be considered especially in childless couples who long for a child. This increase in prolactin levels leads to infertility in both men and women, along with other symptoms.
What is hyperprolactinemia?
To diagnose hyperprolactinemia, the doctor will conduct a detailed discussion of the patient’s symptoms. Then a blood sample is taken.
Hyperprolactinemia is an excess of prolactin in the blood. The hormone ensures breast growth during pregnancy and is then involved in milk production. See AbbreviationFinder for abbreviations related to hyperprolactinemia.
At the same time, it suppresses ovulation during this period. An increased prolactin level is then by no means a disorder but desired. However, outside of pregnancy and lactation, hyperprolactinemia can also occur in men and women, which is associated with various symptoms.
Women experience menstrual irregularities, including missed periods and milk-like discharge from the breasts. In men, the mammary gland tissue grows visibly while their libido decreases. As a result, they can also become infertile.
The causes of hyperprolactinemia are very diverse. A benign tumor in the anterior lobe of the pituitary gland (hypophysis) may be responsible for the increased prolactin release.
This tumor is also known as a prolactinoma. However, drugs that counteract natural dopamine production are often the cause of the symptoms. These include certain antihypertensive drugs, antidepressants and painkillers with morphine-like ingredients, as well as drugs against seizures from the group of dopamine antagonists and the female hormone estrogen. While dopamine inhibits prolactin production, the drugs mentioned suppress this mechanism.
Rarely, an accident or fall is the cause, in which the pituitary stalk is damaged or torn off. In this case, the messenger substance dopamine can no longer reach the anterior lobe of the pituitary gland to regulate the production of prolactin. Hypothyroidism or liver weakness can also be the cause of hyperprolactinemia.
Symptoms, Ailments & Signs
In the case of 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 excessive levels of the hormone prolactin. In women, hyperprolactinemia is associated with secondary amenorrhea.
In about ten to 40 percent of cases, secondary amenorrhea can also be the cause of hyperprolactinemia. Half of women with hyperprolactinemia develop galactorrhea. Galactorrhea is characterized by spontaneous milk production outside of pregnancy and lactation. Edema (water retention in the tissue) can also develop.
Often there is also a reduction in bone density (osteoporosis) with the increasing risk of spontaneous fractures. Men can also be affected by too high a prolactin concentration. As a result, testosterone production decreases. The affected men suffer from a reduction in potency and libido. In addition, beard growth is reduced and the mammary glands are enlarged (gynaecomastia).
The other symptoms depend on the particular cause of the hyperprolactinemia. The trigger is often a benign tumor in the pituitary gland, which stimulates prolactin production. If the tumor is of a certain size, it can lead to headaches, restricted vision and fatigue. Other possible causes include renal insufficiency, liver disease, hypothyroidism, or chest wall injuries with their own symptoms.
Diagnosis & History
To diagnose hyperprolactinemia, the doctor will conduct a detailed discussion of the patient’s symptoms. Then a blood sample is taken. Magnetic resonance imaging (MRI) can show a possible tumor of the anterior pituitary gland.
This growth, 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 examination. If a prolactinoma is the cause of the prolactin excess, the person concerned is 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, since the treatment of hyperprolactinemia must be directed accordingly.
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 secrete a milky-whitish fluid, ovulation is suppressed and the menstrual cycle is disrupted. Over time, this can damage the genitals 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 due to a tumor, a so-called prolactinoma. The intake of certain psychotropic drugs or cannabis consumption is often the cause of an increased prolactin level. Hypothyroidism is also possible. A pathologically elevated prolactin level requires urgent treatment. Otherwise there is a risk of long-term damage to health.
The prolactin level is measured by means of 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 doesn’t work, hormones are also administered so that ovulation and the menstrual cycle return to normal and the flow of milk is stopped. Treatment-resistant prolactinoma requires surgery.
When should you go to the doctor?
Individuals with sexual dysfunction should be evaluated for hyperprolactinemia. An excess of prolactin in the body is usually harmless, but should be clarified if symptoms arise. Men who seem to have low levels of sexual activity for no reason should speak to their family doctor or a urologist. Other warning signs are reduced sperm production, a decrease in facial hair and a reduction in the field of vision. If one or more of these symptoms appear, a doctor must be contacted.
Women should see a gynecologist if they notice menstrual cramps, acne, and excessive hair growth. If depression, anxiety and personality changes set in, a doctor must be consulted immediately. People who regularly take antihypertensive drugs, antidepressants or pain medication are particularly susceptible to hyperprolactinemia. Hypothyroidism or liver weakness are also possible triggers. Anyone who belongs to this risk group should see their family doctor at the first sign. An internist can also be consulted. In the case of psychological complaints, therapeutic advice is required.
Treatment & Therapy
The treatment of hyperprolactinemia depends on its cause. Drugs should be reduced in dosage or replaced. Treatment for a prolactinoma depends on the size of the lump. Small tumors are often treated with drugs that have a similar effect to dopamine. As a result, the production of prolactin is inhibited and the blood value normalizes.
The tumor also shrinks. However, the drug treatment has numerous side effects such as nausea with nausea, tiredness and constipation, so that the medication always has to be started gradually. If the preparations are not well tolerated, even small tumors can be surgically removed. This procedure is used for large tumors, more than a centimeter in size, when there is damage to the optic nerve and the person does not tolerate drugs that suppress prolactin secretion well.
In general, however, in such a case, irradiation of the tumor is preferred to surgical removal. It leads to damage and death of the tumor cells, which brings the prolactin concentration in the blood back to normal. After radiation, the function of the pituitary gland can be severely restricted, so that the person affected has to replace other hormones with medication even after the hyperprolactinemia.
Outlook & Forecast
The underlying cause is decisive for making a prognosis. In some cases, a cure is possible. For other causes of hyperprolactinemia, no recovery can be documented. If the disease is diagnosed as a side effect of medication taken, the treatment plan is usually optimized and changed. Once the offending drugs are discontinued, symptoms improve and hyperprolactinemia resolves. New preparations are given to cure the existing underlying disease so that there is an overall improvement in health.
In the case of a tumor disease, the stage of the tumor is decisive for the course of recovery. In an advanced stage, the treatment is usually changed. The focus is then on pain relief rather than healing. In the case of initial cancer, the tumor is removed and follow-up treatment is initiated. If this was successfully completed and the cancer is considered cured, the symptoms of hyperprolactinemia also disappear.
In rare cases, falls or accidents are responsible for hyperprolactinemia. Damage to the pituitary gland is compensated for in long-term therapy by the administration of medication. This also occurs in the case of organ damage to the liver or hypothyroidism. This alleviates the symptoms, but a cure is not possible. After stopping the drug, the symptoms immediately recur.
There is no way to prevent hyperprolactinemia. If there is increased breast growth and a decrease in libido in men and no menstrual period in women without pregnancy, the doctor should be consulted in order to diagnose or rule out hyperprolactinemia as early as possible.
In the case of hyperprolactinemia, the measures or the direct options for aftercare are severely limited in most cases, so that the person affected is primarily reliant on rapid diagnosis and treatment to prevent further complications or further symptoms. The earlier the hyperprolactinemia is recognized and treated, the better the further course of this disease will be in most cases.
As a rule, the life expectancy of those affected is not negatively affected by this disease. In many cases, this disease requires surgery to remove the tumor. The person concerned should definitely rest after such an operation and protect his body. Efforts or stressful activities should be avoided so as not to unnecessarily burden the body.
You also have to take medication. It is important to ensure that it is taken regularly and that the correct dosage is used in order to alleviate the symptoms. In the case of hyperprolactinemia, those affected also depend on the help and support of their own families. This can also prevent psychological upsets or even depression.
You can do that yourself
As a rule, the options for self-help in the case of hyperprolactinemia are severely limited. If the disease is triggered by taking certain medications, the medication should be discontinued or replaced by another after consultation with a doctor. In the case of a tumour, medical treatment is essential. However, patients should always take care of their bodies and not expose 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 lack of hormones after an operation, the patients are dependent on substitution therapy. The regular intake of hormone preparations should be observed.
Serious symptoms or complications from hyperprolactinemia can be avoided if those affected take part in regular examinations. Early examinations in women can diagnose hyperprolactinemia, especially if menstrual bleeding is disrupted or if the desire to have children is unfulfilled. Early diagnosis increases the probability of a positive course of the disease.
Furthermore, contact with other affected people can be very helpful and contribute to the exchange of information. In the case of psychological problems, talking to close friends or relatives can also help.