Hyperprolactinemia should be considered especially in childless couples who ardently desire a child. This elevation of prolactin levels causes infertility in women and men alike, in addition to other symptoms.
What is hyperprolactinemia?
Hyperprolactinemia refers to an excess of prolactin in the blood. The hormone ensures breast growth during pregnancy and is involved in milk production afterwards. At the same time, it suppresses ovulation during this period. An increased prolactin level is then by no means a disturbance but desirable. Outside of pregnancy and breastfeeding, however, hyperprolactinemia can also occur in men and women and is associated with various complaints. In women, it leads to menstrual irregularities up to the absence of the period as well as to a milk-like secretion from the breast. In men, the mammary gland tissue visibly grows while their libido decreases. As a result, they may also experience infertility.
Causes
There are many causes of hyperprolactinemia. A benign tumor on the anterior lobe of the pituitary gland (hypophysis) may be responsible for the increased prolactin secretion. This tumor is also called a prolactinoma. However, drugs that counteract the natural production of dopamine are often the cause of the symptoms. These include certain antihypertensive drugs as well as antidepressants and painkillers 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, the aforementioned drugs suppress this mechanism. More rarely, an accident or fall is causative, damaging or tearing the pituitary stalk. In this case, the neurotransmitter dopamine can no longer reach the anterior pituitary to regulate the production of prolactin. Hypothyroidism or liver weakness can also cause hyperprolactinemia.
Symptoms, complaints, and signs
In hyperprolactinemia, it is important to distinguish between symptoms of the disorder itself and symptoms of the underlying condition. Hyperprolactinemia is a hormonal disorder characterized by the presence of excessive levels of the hormone prolactin. In women, hyperprolactinemia is associated with secondary amenorrhea. In approximately 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 pregnancy and lactation. Furthermore, edema (water retention in the tissues) may develop. Often there is also a reduction in bone density (osteoporosis) with an increased risk of spontaneous bone fractures. Men can also be affected by excessive prolactin concentration. As a result, testosterone production decreases. Affected men suffer from a reduction in potency and libido. In addition, beard growth is reduced and the mammary gland is enlarged (gynecomastia). The other symptoms depend on the particular cause of hyperprolactinemia. Often the trigger is a benign tumor of the pituitary gland, which stimulates prolactin production. If the tumor is of a certain size, headaches, visual field limitations, and fatigue may occur. Other possible causes include renal insufficiency, liver disease, hypothyroidism, or chest wall injuries with their own symptomatology.
Diagnosis and course
To diagnose hyperprolactinemia, the physician will have a detailed discussion about the patient’s symptoms. Then a blood sample is taken. Magnetic resonance imaging (MRI) can reveal a possible tumor of the anterior pituitary. This tumor, called a prolactinoma, is benign and should not be confused with a brain tumor. Changes in the style of the pituitary gland can also be seen by MRI examination. If a prolactinoma is the cause of the prolactin excess, the affected person 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.
Complications
Because hyperprolactinemia means that there is too much of the hormone prolactin in the body, numerous complications can result. The hormone prolactin promotes milk secretion and mammary gland growth during pregnancy. If there is no pregnancy, the mammary glands nevertheless secrete a milky-white fluid, ovulation is suppressed and the menstrual cycle is disrupted. In the long term, this can damage the reproductive organs and lead to premature osteoporosis. Excessive prolactin levels also promote 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. Often, the use of certain psychotropic drugs or cannabis consumption is the cause of an elevated prolactin level. An underactive thyroid gland is also conceivable. A pathologically elevated prolactin level must be treated urgently. Otherwise, there is a risk of long-term damage to health. The prolactin level is measured by means of a blood analysis. To lower it, various drugs such as bromocriptine can be administered. They are intended to ensure that the concentration in the blood returns to normal. Often, a prolactinoma can also be positively influenced in this way. In this case, surgery is not necessary. If medication does not work, additional hormones are administered to normalize ovulation and the menstrual cycle and to stop the flow of milk. If prolactinoma is refractory to treatment, surgery must be performed.
When should you see a doctor?
Individuals suffering from sexual dysfunction should be evaluated for hyperprolactinemia. An excess of prolactin in the body is usually harmless, but should be clarified if symptoms develop. Men who seem to experience low sexual activity for no reason should talk to their primary care physician or a urologist. Other warning signs include decreased sperm production, diminishing beard growth and a reduction in the field of vision. If one or more of these symptoms occur, a physician should be contacted. Women should see a gynecologist if menstrual cramps, acne, and excessive hair growth are noticed. If depression, anxiety, and personality changes develop, a physician must be consulted immediately. People who regularly take antihypertensive drugs, antidepressants, or pain medications are particularly susceptible to hyperprolactinemia. Hypothyroidism or liver weakness are also possible triggers. Anyone belonging to these risk groups should consult their family doctor at the first signs. An internist can also be consulted. In the case of psychological complaints, therapeutic advice is required.
Treatment and therapy
Treatment of hyperprolactinemia depends on its cause. Medications should be reduced in dosage or replaced. For prolactinoma, treatment depends on the size of the tumor. For small tumors, therapy often involves drugs that have a similar effect to dopamine. This inhibits the production of prolactin and blood levels normalize. In addition, the tumor shrinks. However, drug treatment has numerous side effects, such as nausea with nausea, as well as fatigue and constipation, so taking the drugs must always be started gradually. If the drugs are not well tolerated, small tumors can also be surgically removed. This procedure is used for large tumors with a size of more than one centimeter, if there is an impairment of the optic nerve and the affected person does not tolerate the drugs for inhibiting the release of prolactin well. However, in general, radiation of the tumor is preferred to surgical removal in such a case. It leads to damage and death of the tumor cells, which restores the prolactin concentration in the blood to normal. After irradiation, the function of the pituitary gland may be severely impaired, so the affected person must continue to replace hormones via medication even after hyperprolactinemia.
Outlook and prognosis
The underlying cause is determinant in establishing a prognosis. In some cases, a cure is possible. In other causes of hyperprolactinemia, recovery cannot be documented. If the condition is diagnosed as a side effect of medications taken, the treatment plan is usually optimized and modified.Once the triggering drugs have been discontinued, there is an improvement in symptoms and the hyperprolactinemia regresses. New preparations to cure the existing underlying disease are given so that there is an overall improvement in health. In tumor disease, the stage of the tumor is critical to the course of recovery. In an advanced stage, the treatment is usually changed. The focus is then on pain relief rather than a cure. In the case of an initial cancer, the tumor is removed and follow-up treatment is 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. Damage to the pituitary gland is compensated for in long-term therapy by administering medication. This is also done in cases of organ damage to the liver or hypothyroidism. A relief of the symptoms is achieved, but a cure is not possible. After discontinuation of the medication, there is an immediate relapse of the symptoms.
Prevention
There are no ways to prevent hyperprolactinemia. If increased breast growth and a decrease in libido occur in men and if menstruation stops in women without pregnancy, the physician should be consulted to diagnose or rule out hyperprolactinemia as early as possible.
Follow-up
In most cases of hyperprolactinemia, the measures or direct options for follow-up care are severely limited, so that the affected person is primarily dependent on a rapid diagnosis and treatment in this case to prevent further complications or further discomfort. The earlier hyperprolactinemia is detected and treated, the better the further course of this disease in most cases. As a rule, the life expectancy of the affected person is not negatively affected by this disease. In many cases, surgery is required to remove the tumor. In any case, the affected person should rest and take care of his body after such an operation. Efforts or stressful activities should be avoided in order not to put unnecessary strain on the body. Furthermore, medication must also be taken. Regular intake and the correct dosage must be ensured in order to alleviate the symptoms. In the case of hyperprolactinemia, those affected are also dependent on the help and support of their own family. This can also prevent psychological upset or even depression.
What you can do yourself
As a rule, the options for self-help in hyperprolactinemia are severely limited. If the condition is triggered by taking certain medications, the medication should be discontinued or replaced with another after consulting a physician. In the case of a tumor, medical treatment is inevitable. 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 shortage of hormones after surgery, patients are dependent on substitution therapy. In this case, regular intake of hormone preparations should be observed. Serious complaints or complications caused by hyperprolactinemia can be avoided if affected persons participate in regular check-ups. Especially in case of menstrual irregularity or unfulfilled desire to have children, early examinations in women can diagnose hyperprolactinemia. Early diagnosis increases the likelihood 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, discussions with close friends or relatives can also help.
