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What is Hyperprolactinemia?
Hyperprolactinemia is defined as a condition of elevated serum prolactin which is the most common endocrine disorder involving hypothalamic-pituitary axis.
Prolactin is peptide hormone produced in the anterior pituitary gland particularly of the lactotroph cells. The function is vital in the development of breast during pregnancy by stimulation of epithelial cells to induce milk production and maintenance especially important in breastfeeding. Ovulation may be suppressed during lactation and breastfeeding as a result of suppression in gonadotropins by prolactin but may commence before menstruation begins.
Hyperprolactinemia in Men
Normal level of prolactin in blood for men is less than 450mIU/L. Increased level of prolactin in men is an abnormality unlike in women which is normally part of pregnancy. The abnormal occurrence in men is referred to as pituitary disorder. Hyperprolactinemia in men may induce testosterone pulsatility that may lead to spermatogenic arrest, impaired motility and sperm quality. Hypogonadism is also induced in hyperprolactinemia which will result to erectile dysfunction, impaired libido and a decreased in volume of ejaculate.
Hyperprolactinemia in males may be due pituitary tumor due to compress pituitary gland that may later on retard the function of Gonadotropin in releasing hormone vital for sperm production. Anxiety and mental stress also contribute for prolactin in male to increase their level.
The symptoms of hyperprolactinemia in males often manifest through erectile dysfunction, less interest in sex and an obvious development or enlargement of breast in males which is referred to as gynecomastia.
Hyperprolactinemia Causes
Various causes contribute to onset of hyperprolactinemia and these may include:
Medication
There are certain drugs that act by blocking dopamine effect or may deplete stored dopamine in the brain that causes prolactin secretion of the pituitary. Antipsychotic drugs are frequently responsible for drug induced hyperprolactinemia. Other drugs include the likes of tranquilizers, haloperidol and triflouperazine.
Diseases and Disorders
One common cause of hyperprolactinemia is pituitary tumors that may compress the pituitary gland suppressing its function of secreting hormone. Hypothyroidism is also considered to commonly cause hyperprolactinemia due to elevation in the level of thyroid-stimulating hormone as a result of thyrotropin-releasing hormone. Polycystic ovary syndrome causes mild elevation in prolactin level. Prolactin level is also said to increase shortly after epileptic seizure.
Hyperprolactinemia Symptoms
Hyperprolactinemia and Infertility
Infertility is the inability to conceive or carry pregnancy in women while in men it is the inability to contribute to conception.
Infertility to males as brought by hyperprolactinemia is due to the compression of the pituitary gland retarding the function of gonadotropin which is vital to sperm production. Testosterone pulsatility induced by hyperprolactinemia will lead to impaired motility of the sperm and affecting the sperm quality. The condition also affects males’ sexual interest and impairs erectile function and also cause a decrease in ejaculate volume.
Hyperprolactinemia is normally occurring in women during pregnancy and lactation however, an increased level of prolactin in the blood in the absence of pregnancy and breastfeeding may inhibit ovulation that is necessary in conception during the act of sexual intercourse.
Conceiving takes place when intercourse happens during the time of ovum being released from the ovary. Female hormones should be balance during this time and egg and sperm cell must be at their optimum level to achieved conception.
Hypothalamic-pituitary-ovarian axis is greatly affected by increased level of prolactin in females causing chronic anovulation and other disorder of the ovary impairing its function.
Hyperprolactinemia Symptoms in Women
Hyperprolactinemia is more common in women than in men. It is a normal part of pregnancy and breastfeeding where prolactin aids in lactation. Hyperprolactinemia is however bothersome when it affects women out of pregnancy and neither nursing a child. Hyperprolactinemia becomes pathologic when there is a presence of disease or any form of injury in pituitary gland or the hypothalamus. The condition of elevated prolactin I blood is sometimes asymptomatic. The symptoms may however manifest through the following:
- Woman experience an irregularity in their menstrual cycle
- Amenorrhea or the absence of menstrual period may occur
- Breast milk is produced to women who are neither pregnant nor nursing a child
- Dryness of vagina occurs resulting in painful intercourse
- Inability to conceive or infertility
Treatment of Hyperprolactinemia
Series of test may have to be done to confirm hyperprolactinemia and isolate the underlying condition prior to treatment and management. It is common for health professionals to require blood test to determine the level of prolactin in the blood especially in the absence of pregnancy and lactation women. Variety of treatment options is available for treating this condition depending on the medical history, condition, overall health and the age of the patient. Treatment can either surgical or drug therapy depending on the symptoms.
Treatment may include:
Drug therapy
Dopamine agonist such as bromocriptine mesylate is the drug of choice in reducing high level of prolactin in blood and is usually prescribed in high doses. There are patients who are unresponsive to bromocriptine treatment and cannot tolerate the adverse effect of bromocriptine that Cabergoline is prescribed. This drug is however, more expensive although it offers fewer adverse effect and is more effective.
Surgical Intervention
This type of treatment is especially indicated for patients who have persisting symptoms despite medical drug therapy. It is also especially recommended if the cause of hyperprolactinemia is cystic or tumor growth in the pituitary. Transspenoidal surgery may be done although the procedure is risky owing to the small size of the pituitary gland including its location which is adjacent to the hypothalamus.
