Hyperprolactinemia is a condition characterized by an increased content of prolactin (PRL) in the blood. Among the endocrine pathologies has frequent manifestation, however, it is more common in women (about 7 times) than in men. This condition is also called hyperprolactinemic hypogonadism, being one of the forms of hypogonadism (not all authors agree with this classification).

The normal concentration of prolactin in a man’s blood should not exceed 15-20 ng / ml (400 mU / l). The basal (primary) level is 7 ng / ml. However, depending on the laboratory taking the analysis, the upper permissible levels of PRL may differ, but do not exceed 20-27 ng / ml.

The reasons

Depending on the reasons, the following forms of hyperprolactinemia are distinguished:

1. Physiological hyperprolactinemia, not associated with pathological changes and is the result of a natural increase in hormone secretion due to:

  • sleep;
  • physical exertion;
  • stressful situations (correlation is not proven);
  • taking protein foods;
  • medical and surgical interventions;
  • hypoglycemia (decrease in blood glucose).

2. Pathological hyperprolactinemia, is the result of diseases and pathological changes in the body (tumors). The causes of pathological hyperprolactinemia can be:

  • hypothalamic and pituitary diseases and tumors;
  • primary hypothyroidism;
  • chronic prostatitis;
  • systemic lupus erythematosus;
  • chronic renal failure;
  • cirrhosis of the liver;
  • work disorders and adrenal gland diseases;
  • idiopathic hyperprolactinemia (when the reasons for the increase in BPD are not established).

3. Pharmacological hyperprolactinemia caused by medication:

  • antihypertensive drugs (reserpine, methyldopha);
  • antidepressants (sulprimid, amitriptyline, imipramine, doxepin);
  • estrogen preparations;
  • drugs (morphine, heroin, cocaine, amphetamines, hallucinogens);
  • calcium antagonists (verapamil);
  • histamine H2 receptor antagonists (cimetidine, famotidine).

To determine the nature of treatment, it is customary to single out:

  • Tumor (macro and microprolactinomas) hyperprolactinemia;
  • Non-tumor hyperprolactinemia.

Clinical manifestation

In men, high levels of prolactin are manifested by the following symptoms:

  • Decrease or absence of libido and potency (50-85%);
  • Infertility due to oligospermia (3-15%);
  • Reduction of secondary sexual characteristics (2-21%);
  • Gynecomastia (6-23%);
  • Metabolic disorders (obesity, hypercholesterolemia);
  • Osteopenia and osteoporosis , bone pain (observed with prolonged hyperprolactinemia);
  • Emotional disturbances (depression, sleep disturbance, fatigue, memory loss).

Diagnostics

The main diagnostic marker is a triple blood test for prolactin. The analysis of hormones is carried out on different days, the interval between which is 7-10 days.

Hyperprolactinemia is diagnosed in the presence of elevated serum PRL concentrations in several samples that exceed 20 ng / ml or 400 mU / L.

The level of PRL usually indicates the size of prolactinomas:

- the level of PRL in 200 ng / ml (4000 mU / l) is characteristic of macroprolactinomas;

- PRL level less than 200 ng / ml (4000 mU / l) may indicate the presence of microprolactinoma or idiopathic hyperprolactinemia;

- moderately elevated levels of PRL (40-85 ng / ml or 800-1700 mU / l) are more common for craniopharyngiomas, hypothyroidism, and also drug hyperprolactinemia;

- periodic increases in the level of PRL are not necessarily associated with the presence of a tumor, and a combination of two or more provoking factors may be due (for example, when patients with renal failure receive metoclopramide).

To clarify the diagnosis may need:

  • MRI or CT of the hypothalamic-pituitary system, for the detection of macro and microprolactinomas, craniopharyngiomas;
  • The study of the fundus and visual fields, the pathology of which, as a rule, indicates macroprolactin;
  • Ultrasound of the prostate gland.

Treatment

Treatment of hyperprolactinemia involves the normalization of prolactin levels. Normalization of androgen levels by exogenous testosterone preparations is indicated only in the case when correction of hyperprolactinemia does not normalize the level of androgens.

When pharmacological hyperprolactinemia cancels drugs, and after three days, repeat the analysis for prolactin.

The main form of treatment for hyperprolactinemia of any form is drug therapy. Therapy with medications not only normalizes the level of PRL, but also reduces the size of the tumor (prolactinomas), and with long-term treatment, in some cases, the prolactinoma completely disappears.

Drug treatment

Derivatives of ergot alkaloids (ergoline)
bromokriptin Bromocriptine preparations (Bromocriptine, Lactodel, Parlodel, Serocriptine, Apo-Bromocriptine, Bromargon) - until recently was the only series of drugs in the treatment of hyperprolactinemia, but significant drawbacks in the form of a short half-life (3-4 hours) and pronounced side effects caused many Patients refuse to use it. Up to 30% of patients are resistant to bromocriptine. начиная с небольших доз (0,625-1,25 мг (1/4-1/2 таблетки) перед сном с едой) увеличивая дозировку каждые 3-4 дня на 0,625-1,25 мг, пока не будет достигнута доза в 2,5-7 мг, принимаемых дробно 2-3 раза в течение суток во время еды. Dosage features: starting with small doses (0.625-1.25 mg (1 / 4-1 / 2 tablets) before bedtime with food), increasing the dosage every 3-4 days by 0.625-1.25 mg until the dose in 2.5-7 mg, taken fractional 2-3 times a day during the meal. Dose selection is made individually for each patient depending on the level of PRL achieved.
Abergin is a domestic agent that has a depressant effect on PRL and does not affect the normal level of other pituitary hormones. Compared with bromocriptine, it has a longer PRL-inhibiting effect. By side effects, abergin is similar to bromocriptine, but has a less pronounced hypotonic effect. аналогично дозировкам бромокриптина. Dosage characteristics: similar to bromocriptine dosages.
dostineks Dostinex - prolonged action drug. Is the "gold standard" in the modern treatment of hyperprolactinemia in men. Its advantages over bromocriptine are due to greater efficacy, ease of use (2 times a week, instead of daily techniques), as well as less severe and frequent side effects. A decrease in the level of PRL in plasma is noted already 3 hours after ingestion and maintains within 7-28 days. In addition to reducing the level of the hormone, there is a decrease in the tumor. обычно терапевтическая доза составляет 0,5-1 мг (1-2 таблетки) в неделю в 2 приема во время еды, однако дозы могут лежать в промежутке от 0,25 до 4,5 мг в неделю. Dosage Features: The usual therapeutic dose is 0.5-1 mg (1-2 tablets) per week in 2 divided doses with meals, but doses may range from 0.25 to 4.5 mg per week.
Derivatives of tricyclic benzoguanolines (non-ergoline)
Norprolac is a long-acting oral non-ergoline dopamine antagonist. The clinical effect of the drug is manifested 2 hours after administration, and retains its effect for about 24 hours, which allows you to take the drug once a day. It has better tolerability than preparations of bromocriptine. начальная дозировка составляет 0,025 мг первые 3 дня, 0,05 мг в течение последующих 3-х дней, после чего увеличивают дозу до 0.075 мг. Dosage characteristics: the initial dosage is 0.025 mg for the first 3 days, 0.05 mg for the next 3 days, after which the dose is increased to 0.075 mg. A subsequent increase in dosage (if necessary) is carried out with a weekly interval.

Surgery

Surgical treatment is prescribed in the case of:

  • when drug therapy is not effective (the immunity of the tumor to dopamine inhibitors);
  • patient immunity to dopamine inhibitors;
  • threat of vision loss.

You need to know that the frequency of prolactinoma relapses in patients, within 6 years after surgery, is 50%. Currently, due to the effectiveness of drug therapy, surgical treatment is rarely resorted to.

Drug and surgical therapy are not mutually exclusive method and can be used in complex therapy, for example, prior to surgery, drug therapy to reduce the size of the tumor for more convenient surgical access.

The operation, with its successful outcome, has the advantage of a one-step procedure, but, like any other surgical intervention, has its own complications.

Sources:

1. G.A. Melnichenko, E.I. Marova, L.K. Dzeranova, V.V. Wax " Hyperprolactinemia in women and men . "

2. S.Y. Kalinchenko, I.A. Tyuzikov "Practical Andrology".

See also:

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