hyperprolactinemia - a condition of the body, which is characterized by an increase in the hormone prolactin (PRL) in the blood.Hyperprolactinemia occurs as physiological (during pregnancy, in infants during lactation) and pathological form. When a high content of PRL levels after a single analysis can not be accurately speak of hyperprolactinemia.The fact of venipuncture, visits to the doctor can provoke stress transient hyperprolactinemia.
disease is significantly more marked among women, but can also develop in men.Furthermore, prolactin may exist in different molecular formulas therefore emit so-called big-prolactinemia, which is not related to a pathology and does not require treatment.Such a condition occurs without specific symptoms and is usually detected by chance.
Pathological hyperprolactinemia is essential (primary) and acts as an independent form of the hypothalamic-pituitary disease.And allocate symptomatic hyperprolactinemia, which is a feature of other dis
syndrome hyperprolactinemia is formed as a result of various disorders such as somatogenic, endocrine and neuro-psychiatric.Causes of hyperprolactinemia may be a physiological nature, pathological and pharmacological.For the physiological characteristic of the release of prolactin during physical activity, stress, sleep, sex and eating protein-rich.Prolactin is produced against the background of physical activity in the moment of reaching the anaerobic threshold.This hormone is considered stressful, but its effectiveness during mental or psychological stress has not been fully demonstrated.The concentration of BPD in the blood increases when stress factors, which are accompanied by hypotension or syncope.These reactions are responsible for the increase of a hormone that occurs during venipuncture.Hypoglycemia is also a strong stimulus formation of prolactin, both among women and among men.
Among the pharmacological causes of hyperprolactinemia secrete many drugs that disrupt metabolism, synthesis, absorption or binding by dopamine receptor, which reduce its effectiveness and cause increased secretion of prolactin.These drugs include Domperidone, phenothiazines, pimozide, Butirofen, reserpine, Dekorboksilaza, methyldopa.
to a powerful stimulant for the human prolactin include endogenous opioid properties.
addition, enhances the formation and development of BPD under the influence of estrogen.They using pharmacological doses cause an increase in the PRL in men and women, while the suppression of LH and FSH in the blood.
Occurrence hyperprolactinemia direct effect may have different pathological diseases.It is a tumor of the hypothalamus, tuberculosis, gistotsitoz, germinomas, sarcoidosis, craniopharyngiomas and suprasellar region glioma cause syndrome pererezyvaniya pituitary stalk.And it helps to reduce the exposure of the synthesis and release of dopamine and prolactin - raising.
Among the most frequent causes of hyperprolactinemia is considered to be a pituitary adenoma.It is a benign tumor that produces prolactin.Prolactinoma may have different sizes, but mostly up to 10 mm, and called mikroprolaktinomami.The rest are called macroprolactinoma with tumor size greater than 10 mm.
Hyperprolactinaemia functional etiology is caused by a lack of the thyroid gland, chronic renal failure, cirrhosis, polycystic ovary syndrome.Hyperprolactinemia may occur as a result of surgical interventions and various injuries of the chest and part of the process of uterine curettage.
sometimes elevated prolactin levels may occur for no apparent reason.This form is called idiopathic hyperprolactinemia.It is characterized by increased work of pituitary cells, in which the number may increase slightly or remain normal.
Clinical symptoms of various forms of hyperprolactinemia varies in its flow.Women age at which marked the development of prolactinomas refers to 25-30 years, and men - to 45-50 years.Among the most persistent causes of treatment of women to a gynecologist at the prolactinoma is infertility and menstrual disorders.Such violations can range from opsooligomenorei before amenorrhea, which acts as a secondary pathology.But the symptoms are not typical for polimenorei hyperprolactinemia.
Many patients symptoms a few late menarche and account for 14-15 years.Almost every fifth patient diagnosed with irregular menstrual periods since the start of menarche.Then, these menstrual irregularities clearly observed at the time of repetitive stress.
Usually, amenorrhea begins to develop at the same time with such features as sexual initiation, cancel previously used contraceptives, pregnancy, the birth process, carrying out manipulations on the introduction of intrauterine contraceptive or performing surgery.We do not have symptoms as hot flashes and symptoms of primary amenorrhea are very rare.
In 20% of the first symptoms of hypogonadism hyperprolactinemic (GG) galactorea acts, but in rare cases it is the complaint of patients.Galactorrhea may vary from abundant spontaneous discharge to single drops when applying strong pressure.In the long hyperprolactinemia, galactorrhea becomes smaller as a result of the replacement of glandular tissue in the fat, which is explained by the duration hypoestrogenemy.
most important complaint of patients is a primary or secondary forms of infertility and miscarriages in the first half of pregnancy.Most showed a decrease in libido, vaginal dryness, frigidity, 80% moderate obesity.In 25% of the significant growth of facial hair, the white line of the abdomen and in the area of the nipple.When microadenomas, as well as the development of the Turkish saddle, frequent pain in the head by type of migraine and vertigo.Signs of the subjective and the objective nature of the work expressed in violation of the optic nerves, especially in men.Some people are prone to emotional and personality disorders as well as depression.This may be due to changes in the content of hormones in the body, and biogenic amines.In a survey recorded bradycardia and hypotension, so it is necessary to rule out hypothyroidism.Mammary glands are presented in the form of soft consistency with involutive changes.When amenorrhea primary types of breast is pale nipples that are usually flat and inverted.Very rarely develops and makromastiya gigantomastia.
When hyperprolactinemia possible hypoplasia of the uterus, there are no symptoms, "pupil" and "tension" slime.Patients who are sick in the pre-adolescent, reveal hypoplasia of the clitoris and the labia minora.Today, with early diagnosis of more than are women without obvious signs of hypoplastic internal genitalia.Sometimes even revealed an increase of the ovaries, which are melkokistoznoe rebirth.
Symptoms of hyperprolactinemia in men is associated, as a rule, with such symptoms as loss of libido and impotence.Gynecomastia and galactorrhea they can be found very rarely.Hyperprolactinaemia develops as a consequence of pituitary macroadenomas, so patients the symptoms associated with loss of tropic hormones of the pituitary gland and the tumor inside the skull (68% - it's a pain in the head, and 65% - a dysfunction of vision).
This disease is a hypersecretion of prolactin and the reasons that cause the development of hyperprolactinemia in men can be varied and can be divided into several groups.
Firstly, this variety of diseases that result in malfunction of the hypothalamus.These include infections such as encephalitis and meningitis;granulomatous processes and infiltrative nature: tuberculosis, histiocytosis, sarcoidosis, etc .;various neoplastic pathology: germinoma, craniopharyngioma, meningioma, glioma, etc .;injuries associated with rupture of the pituitary stalk, bleeding in the hypothalamus, the blockade of vascular neurosurgery, radiation;metabolic disorders - a chronic renal insufficiency and liver cirrhosis.
Secondly, it is a kind of destruction of the pituitary gland, which appear in the form of prolactin, a mixed somatototropno-prolactin adenoma, other tumors (gonadotropinoma, tirotropinoma, kortikotropinomy) syndrome sella, craniopharyngiomas, gormonalnoneaktivnoy adenoma cyst Rathke's pouch, meningiomas and intrasellyarnoy germinomas.
Third, hyperprolactinemia in men can provoke primary hypothyroidism etiology and ectopic secretion of hormones, and damage to the chest.
Fourth, a variety of medications can cause the disease in men.These include hormone dopamine blockers;antidepressants;Verapamil, which blocks calcium channels;adrenergic inhibitors;H2 blockers receptors;Cocaine and opiates;Thyrotropin.
Men prolaktinoma compared to women is found in a ratio of 1: 8.Basically hyperprolactinemia occurs simultaneously with macroadenomas.But microadenomas identified men in rare cases.As a rule, this is due to late diagnosis of the pathology.
X-ray examination fails to detect deformation sella.Dysregulation of the hypothalamus as a result of reduced production of dopamine or enhance the production of prolaktoliberina causes hyperplasia laktotrofov with further education microadenomas and macroadenomas.Sometimes hyperprolactinemia in men is formed on the background of pituitary adenomas, which compress the hypothalamus, the pituitary stalk and disrupt the secretion prolaktostatina.In these patients, blood prolactin fixed to Figures 25-175 ng / ml, while prolactinoma - 220-1000 ng / ml.If the values are above two hundred and prolactin, it testifies to a pituitary tumor.
Symptoms of hyperprolactinemia in men manifests as impotence and decreased libido, which in the beginning of the disease are seen as a consequence of psychogenic factors.Very often, patients diagnosed with psychogenic impotence.But it is important to confirm a diagnosis of exclusion hyperprolactinemia.Sometimes this disease is on the background to changes in the testes of gynecomastia in the form of reduction and softening.About 25% of men suffer laktoreey with varying degrees of severity.Osteoporosis also occurs, though to a lesser degree, in contrast to women.
masculine characteristic symptom of hyperprolactinemia include pain in the head, caused by the pituitary macroadenomas.Other symptoms may include violation of visual acuity and tropic anterior pituitary function.
treatment of hyperprolactinemia is to find out the reasons that contributed to the development of the disease, and then to assign appropriate therapy.But the most important is the reduction and normalization of elevated prolactin, to reduce the size of the pituitary tumor, correction laktorei and hypogonadism in the restoration and operation of the cranial nerves at their violation.
It is a condition in which there is an increase of PRL (prolactin) in your blood.This is possible when the physiological hyperprolactinemia and anomalies of the disease (pathological), which may be a signal of heavy pathologies.
main cause of hyperprolactinemia in women are physiologically, which include the entire period of pregnancy and after birth, and in non-breastfeeding women - is from one to seven days;sore nipples and the newborn;sleep, sexual intercourse, food intake and stress.By pathological causes include: diseases of the hypothalamus and the pituitary stem;various diseases of the pituitary gland (adenoma, kraniofaringomy, hypothyroidism, malignant tumors with metastasis, tuberculosis, sarcoidosis);different surgeries using general anesthesia;cirrhosis, and 75% in chronic renal insufficiency and diseases of the chest as burns, herpes zoster.Furthermore, the use of some drugs can promote the formation of hyperprolactinemia.Basically are drugs that block dopamine receptors;reduce the level itself dopamine (reserpine, Methyldopa, verapamil, and others.), oral contraceptives, and phenothiazines.
Functional hyperprolactinemia in women can be observed in various gynecological diseases such as endometriosis, uterine fibroids, and inflammation.This is due to the constant irritation interoceptors process against the background of the pathological process and impulses in the central nervous system as a result of the chronic form of the endogenous stress.In recent decades, marked transient hyperprolactinemia, which is often accompanied by infertility, and is characterized by the effect of prolactin on the corpus luteum.
Hyperprolactinaemia functional nature occurs in many women with PCOS, as a consequence of violations of dopaminergic control of prolactin.
However, the most common causes of hyperprolactinemia in women is still considered mikroprolaktinomy and hyperplasia of the pituitary gland.
Symptoms of the disease is made up of some of the symptoms, namely 15% amenorrhea occurs, which leads to infertility.Also occurs galactorrhea associated with abnormal spontaneous expiration milk which is not a process lactation.However, the sign of the level of prolactin in the majority of patients can be normal, due to transitory hyperprolactinemia, which has moved into the rack galaktoreyu.
characteristic symptoms of the disease appear hyperestrogenia, dyspareunia and reduced libido and osteoporosis on the background of a long course of the disease.Then the women deteriorating eyesight as a result of a pituitary tumor and its increase, which compresses the optic nerve.In case of delay of sexual development requires a study to check the level of TSH.Sometimes hyperprolactinemia occurs with hyperandrogenism.
Lately, when hyperprolactinemia in 35% of women increased amount of adrenal androgens.Furthermore, it is proved that they are reduced when using bromocriptine treatment.
Hyperprolactinaemia and pregnancy
During pregnancy medical procedure in respect of prolactin is of particular interest, as giperprolaktonemiya can develop for other reasons.In this case, patients may experience other specialists and treat the underlying disease, which may include pituitary adenoma, infiltrativnodestruktivnye or tumor lesion area sella, hypothalamus, Cushing's disease, and others. But hyperprolactinemic state does not require a certain correction in functional hyperprolactinemiaduring stress.
Almost 40% of infertility associated with the pathology of the endocrine system.And hyperprolactinemia refers to one of the common causes of endocrine infertility.Therefore, to restore fertility, as well as to pregnancy syndrome hyperprolactinemia is necessary to conduct a thorough examination of patients.And today hyperprolactinemia and pregnancy are an important reproductive health problem throughout the world.
Delivered doctors diagnose hyperprolactinemia, says about infertility in women result of high levels of prolactin.