High prolactin and infertility

Emobileclinic Trending Topic: Hyperprolactinemia

Hyperprolactinemia is a condition characterized by excess prolactin, the hormone responsible for milk production in a woman’s breasts. It is a disorder marked by the overproduction of prolactin (one of eight hormones produced by the pituitary gland) in both men and non-pregnant women. It is the most common form of overproduction of hormones by the pituitary.
The pituitary is a peanut-size organ located at the base of the brain and it is the most important gland in the body’s hormonal system. Prolactin induces milk production in women following birth, so the levels are high in pregnant women. Although the hormone is also present in small quantities in men and non-pregnant women, elevated levels in these individuals can signal a pituitary tumor and cause other serious problems, such as infertility.

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Causes of Hyperprolactinemia

  • Benign pituitary tumor (adenoma or prolactinoma) is the major cause of hyperprolactinemia

  • High-dose estrogen like oral contraceptives

  • Underactive thyroid (Hypothyroidism)

  • Chronic kidney failure or cirrhosis

Symptoms of Hyperprolactinemia
In women:

  • Stoppage of menstrual periods (amenorrhea)

  • decreased menstrual flow (oligomenorrhea)

  • abnormal production of breast milk when not breastfeeding (galactorrhea)

  • excess facial hair (hirsutism)

  • vaginal dryness and pain during intercourse

  • infertility.

    In men:

  • Impotence

  • infertility

  • decreased libido and, rarely, enlarged breasts (gynecomastia) and galactorrhea

  • decreased muscle mass and reduced body hair.

Diagnosis
Diagnosis of hyperprolactinemia is based on a patient’s individual symptoms and medical history.
Clerking to get patient history and physical examination.
Blood tests to measure elevated levels of prolactin.
MRI (magnetic resonance imaging) to detect a pituitary tumor.
Thyroid test to diagnose thyroid disorders.
Computerized Tomography (CT) to determine the presence of a tumor or another abnormality.

Treatment of Hyperprolactinemia
This depends on the cause and the severity of the disorder. In some patients, prolactin levels spontaneously revert to normal. Some pituitary tumors may be small enough that treatment is not required, although regular follow-up evaluations are necessary.
When the disorder is caused by a tumor, the first line of treatment is medication, either bromocriptine or cabergoline. Pergolide may be used as a secondline agent. Therapy may even shrink the tumor. Levels of prolactin usually fall within days of beginning therapy.
If medication is not tolerated or is unsuccessful in reducing the size of a tumor and lowering prolactin levels adequately, surgical removal may be required.

Treatment of prolactinemia during pregnancy
Sometimes women who have prolactinoma become pregnant during treatment. These women may need special treatment to ensure their baby’s good health.
As soon as you know you are pregnant, it is usually best to stop taking cabergoline or bromocriptine. Do not stop taking the medicine unless your endocrinologist tells you to, however, the doctor may want you to stay on treatment if you have a large prolactinoma that is harming, or could harm, your vision. If you must continue treatment, bromocriptine is the preferred drug for pregnant women. There is no need to get prolactin blood tests while you are pregnant. Prolactin levels are normally high during pregnancy.

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