Hyperprolactinemia

Hyperprolactinemia is a condition characterized by an increased level of prolactin (PRL) in serum. The ability to produce prolactin is possessed not only by the cells of the anterior pituitary (prolactotrophs), but also by the decidual cells of the endometrium, cells of the immune system, etc.
Symptoms of hyperprolactinemia
Women with hyperprolactinemia, as a rule, do not differ from healthy in appearance. Symptoms of hyperprolactinemia syndrome in women include:
• Menstrual disorders – amenorrhea, anovulatory cycle, oligomenorrhea;
• Infertility;
• Lactorea – abnormal secretion of milk or colostrum;
• Decrease in libido and frigidity – anorgasmia;
• Hirsutism – male-type overgrowth of terminal hair in women;
• Acne – inflammation of the sebaceous glands;
• Metabolic disorders (osteoporosis; obesity; hyperinsulinemia);
• Psycho-emotional disorders;
Hyperprolactinemia in men leads to the following symptoms:
• Reduced potency and libido;
• Infertility;
• Gynecomastia;
• Lactorea (rarely) – abnormal secretion of milk or colostrum;
• Reduced secondary sex characteristics;
• Metabolic disorders (osteoporosis; obesity; hyperinsulinemia);
• Psycho-emotional disorders;
Differential diagnosis in hyperprolactinemia
• Pituitary adenoma (prolactinoma, prolactin somatotropic adenoma);
• Parasellar tumors – craniopharyngioma, germinoma, etc.;
• Ectopic hyperprolactinemia of a hormonally active tumor (bronchogenic cancer, etc.)
• Polycystic ovary syndrome, chronic diseases of the female pelvic organs;
• Physiological hyperprolactinemia – breastfeeding, pregnancy;
• Pharmacologically related hyperprolactinemia;
• Primary hypothyroidism;
• Chronic renal failure;
• Liver cirrhosis;
Hyperprolactinemia treatment
Currently, the main treatment for hyperprolactinemia in pituitary adenoma, prolactinoma, is drug therapy with dopamine agonists. Surgical treatment is used for resistance to dopamine agonist drugs, for tumor hemorrhage (apoplexy) and tumor compression of the suprasellar structures leading to vital impairment. Radiotherapy in prolactinomas, as a rule, is not prescribed.