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Fecha de Publicación:
14 de octubre, 2012 

Hyperprolactinemia or high prolactin

What is hyperprolactinemia? Hyperprolactinemia is characterized by an increased level of prolactin in the blood. It is the hormone that stimulates breast growth during pregnancy and milk production after labor. Prolactin is a hormone secreted by the pituitary gland; its main functions are stimulating breast growth during pregnancy and breast milk production after giving birth. ...

Hyperprolactinemia or high prolactin

What is hyperprolactinemia?

Hyperprolactinemia is characterized by an increased level of prolactin in the blood. It is the hormone that stimulates breast growth during pregnancy and milk production after labor.

Prolactin is a hormone secreted by the pituitary gland; its main functions are stimulating breast growth during pregnancy and breast milk production after giving birth.

Inadequate secretion of prolactin by women may produce ovulation disorders, alterations to the menstrual cycle, infertility and milk production not related to breast-feeding or galactorrhea.

Main symptoms of hyperprolactinemia

Amenorrhea or the lack of menstruation and galactorrhea or milk production not related to breastfeeding are the main clinical manifestations of hyperprolactinemia and 75 percent of patients with both symptoms have this illness.

Other symptoms of hyperprolactinemia are:

•    Anovulation or the absence of ovulation
•    Opsomenorrhea or delayed menstruation
•    Infertility
•    Headaches. This pain is usually located below the eyes in the front part of the head.
•    Visual disorders
•    Reduced libido
•    Hirsutism or undesired growth of body hair. This symptom appears when hyperprolactinemia is associated to polycystic ovarian syndrome
•    Recurrent abortions

Causes of hyperprolactinemia

Hyperprolactinemia may be produced by different factors:

•    Corporal factors.- Prolactin levels may temporarily or permanently rise due to reasons such as the lack of sleep, pregnancy, breastfeeding, handling of breasts, excessive exercise and stress.

•    Side effects of illnesses.- It is common to find high prolactin levels as a consequence of other diseases, such as hypthyroidism, polycystic ovary syndrome, multiple sclerosis, lupus, chronic kidney disease and cirrhosis. Hyperprolactinemia may also be a consequence of burns or irritation of the chest wall due to trauma.

•    Side effects to drugs.- Psychopharmacologic drugs, drugs for high blood pressure, estrogen, and dopamine receptor agonists such as metoclopramide, which is widely used, are associated to hyperprolactinemia. and others  associated to hyperprolactinemia

•    Tumors in the pituitary gland.- Also known as adenomas, they are the main cause of about 30 percent of cases of hyperprolactinemia. These tend to be benign and stimulate excess prolactin secretion since they interfere in the production and transportation of dopamine, a hormone that inhibits prolactin secretion under normal conditions.

How is hyperprolactinemia diagnosed?

If you suffer menstrual alterations, galactorrhea or any symptoms of hyperprolactinemia, it is recommended that you:

•    Take a blood analysis to determine your prolactin level. This must be done during the earliest hours of the morning and with at least a half hour of rest beforehand; however, it can be done at any point in the menstrual cycle.

•    If high figures are obtained in the first analysis, this must be repeated to confirm the hyperprolactinemia diagnosis

•    When prolactin levels are still high after the second test, the first causes that must be ruled out before carrying out other studies are pregnancy and the use of drugs that increase prolactin secretion. Likewise, your doctor will perform tests to rule out conditions such as hypothyroidism, where the excess of prolactin is produced to compensate for poor thyroid activity and the resulting lack of the thyroid hormone.

•    Finally, once the other possible causes are ruled out, you should undergo magnetic resonance imaging or a tomography to remove from consideration the existence of a tumor in the pituitary or adenoma.

Treatments to become pregnant when suffering from hyperprolactinemia

Knowing the causes of hyperprolactinemia is essential when choosing a treatment for successful pregnancy with the least amount of stress. Currently, there are highly effective solutions for each of these causes.

If your high level of prolactin is caused by drugs, your doctor will ask you to stop using them and will help you find other options; if you have hypothyroidism, your doctor will prescribe a synthetic thyroid hormone in order to return your prolactin levels to normal.

In any other case, hyperprolactinemia treatment must begin with oral drugs such as bromocriptine and cabergoline. Your doctor will ask you to take a low dose and gradual increases until your prolactin level returns to normal. The use of drugs has a very favorable forecast, since besides reducing your prolactin level and pituitary tumors, these remedy galactorrhea, resuming menstruations and fertility quickly.

When the woman is under 32 years, drugs to induce ovulation can also be useful to restore ovulation; however, if these are insufficient, the best option is in vitro fertilization (IVF), which makes it possible to retrieve eggs directly from the ovaries to then fertilize and implant them in the woman’s uterus.

In a limited number of cases where prolactin increase is caused by pituitary tumors larger than 10 mm that do not improve with drugs, the possibility of performing a surgery or radiation treatment must be evaluated.

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