Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. The occurrence of clinically apparent hyperprolactinemia depends on the study. While hyperprolactinemia is considered perfectly normal during pregnancy and breastfeeding, it can occur at other times due to disease and medication use. High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. Effect of bromocriptine treatment on male infertility associated with hyperprolactinemia n. Evaluation of hyperprolactinemia differential diagnosis of. An expert infertility specialist would, however, keep the hyperprolactinemia analysis on her checklist to ensure timely and effective treatment. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and or galactorrhea at a university teaching hospital, north west nigeria. This evidencebased guideline was developed using the grading of recommendations, assessment, development, and evaluation grade system to. Careful clinical evaluation, focused laboratory testing, and in many cases, pituitary imaging are important for elucidating the underlying cause of hyperprolactinemia and guiding. Jan 04, 2018 infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. Abnormal prolactin prl secretion is usually related to an idiopathic.
Management of hyperprolactinemic infertility article pdf available in the journal of reproductive medicine 4412 suppl. Among the pharmacological treatments studied, aripiprazole switching or augmentation possessed the strongest evidence. Elevated prolactin may impact reproduction through inhibitory effects on hypothalamic gonadotropinreleasing hormone gnrh neurons andor on the pituitary gland to reduce secretion of the gonadotropins luteinizing hormone lh and folliclestimulating hormone. Hyperprolactinemia can affect both women and men, resulting in irregular menstrual periods and erectile dysfunction, among other things. When this happens, a woman might have trouble getting pregnant or her breasts may start producing milk outside of pregnancy galactorrhea. Although relatively asymptomatic, she was found to have primary hypothyroidism.
A 30yearold woman presented with infertility, hyperprolactinemia, and pituitary enlargement. In a retrospective study of 104 patients with hyperprolactinemia ages 30 to 44 years, the most commonly reported symptoms were infertility, headache, and. May 01, 2015 nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event of potential hyperprolactinemia, permitting greater. The aim was to formulate practice guidelines for the diagnosis and treatment of hyperprolactinemia. Hyperprolactinemia hyperprolaktihneemeeuh is a condition in which a person has higherthannormal levels of the hormone prolactin prolaktin in the blood. In men, hyperprolactinemia may present acutely with diminished libido and infertility. The magnitude of the increase, however, is quite variable. It increases to 9% in women with amenorrhea and occurs in 25% of those with galactorrhea. The prolactin is a hormone produced by the pituitary gland. Abnormal prolactin prl secretion is usually related to.
Causes, symptoms, and treatment of hyperprolactinemia. Galactorrhea, hyperprolactinemia, infertility, menstrual abnormality, prevalence how to cite this article. The mainstream treatment cant root out the disease. Ninety percent of women with galactorrhea also have hyperprolactinemia. She became pregnant within a month following institution of. There is higher incidence of hyperprolactinemia among infertile females. Hyperprolactinemia is also responsible for fertility problems in men, although the condition is diagnosed in men less often than in women.
In men, high prolactin levels can cause galactorrhea, impotence inability to have an erection during sex, reduced desire for sex, and infertility. She became pregnant within a month following institution of levothyroxine replacement, and the pituitary enlargement. It is also a signal of impending chronic diseases including breast cancer. Hyperprolactinemia is characterized by an increased production of the hormone prolactin.
It is estimated to occur in 9%17% of women with reproductive disorders 1, 2. Pat i e n t i n f o r m at i o n pituitary society. The objective of this study was to find out the prevalence of hyperprolactinemia in female infertility after excluding tubal factor and male factor and to find its correlation with hypothyroidism. Indeed, the prevalence of pcos is estimated at about 4 to 21% when the pcos is diagnosed according to the rotterdam criteria 1 and the prevalence of hprl was estimated at 4% in a cohort of female blood donors 2, and with an estimated incidence. It is the most commonly diagnosed tumor type in the pituitary gland that affects hormone production.
A man with untreated hyperprolactinemia may make less sperm or no sperm at all. The probable cause of the hyperprolactinemia is the. Prolactin and infertility 149 hyperprolactinemia is commonly found in both female and male patients with abnormal sexual andor reproductive function or with galactorrhea. A high level of prolactin reduces estrogen and interferes with ovulation. Over time, the patient may have diminished energy, reduced muscle mass, and increased risk of osteopenia. Oct 01, 2012 evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. Pharmacological treatments with less evidence encompassed dose reduction, switching to lower potency. When this hormone is in excess, the chances of conceiving are lower than usual. Normal levels are less than 500 miul 20 ngml or ugl for women, and less than 450 miul for men.
Hyperprolactinaemia in men is defined by the presence of a high serum prolactin level of 15 gl. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Pregnancy serum prolactin increases throughout pregnancy, reaching a peak at delivery figure 1 1. Guidelines for antipsychoticinduced hyperprolactinemia.
A man with untreated hyperprolactinemia may make less sperm or. An excess of prolactin above a reference laboratorys upper limits, or biochemical hyperprolactinemia, can be identified in up to 10% of the population. Hyperprolactinemia is suspected in women who have absent or irregular menstrual periods, abnormal breast discharge, or fertility issues. Prevalence of hyperprolactinemia among infertile patients. Hospital based analytical cross sectional study was conducted for 1. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, but rarely galactorrhea. Hyperprolactinemia is a relatively common cause of secondary amenorrhea.
If a nonpregnant woman has abnormally high levels of prolactin, it may cause her difficulty in becoming pregnant. Premenopausal women hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea. Hyperprolactinemia is a sign of underlying problems of infertility, menstrual irregularities, and sexual dysfunction. Prolactin normally circulates in the blood in small amounts in women who are not pregnant, and in large amounts during pregnancy and right after birth.
Another term for high prolactin levels is hyperprolactinemia. Hyperprolactinemia is an extremely common disorder, especially among reproductive age women, affecting about onethird of infertile females. The prevalence of hyperprolactinemia ranges from 0. Infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. Hypogonadism infertilitylike symptoms menstrual abnormalities such as amenorrhea or oligomenorrhea in women galactorrhea less often, but more common in women. So estimation of serum prolactin should be done at an early stage of. Pdf pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. In young women, hyperprolactinemia is probably one of the most common endocrine disorders related to pituitary function.
Hyperprolactinemia is a relatively common cause of menstrual abnormalities and infertility. While hyperprolactinemia is a wellestablished cause of hh and infertility, the mechanisms of these effects are not well understood. Hyperprolactinemia has diverse causes, which may include physiological, pituitary, and systemic etiologies. The first step in the evaluation is to draw a blood sample to determine the. Hyperprolactinemia is when theres too much prolactin in a persons blood. Implications and future directions the study by sonigo et al. Pituitary imaging is indicated for the evaluation of. Hyperprolactinaemia is amongst the endocrine disorders known to influence male infertility. Diagnosis and treatment of hyperprolactinemia hyperprolactinemia is diagnosed using a simple blood test that measures the levels of prolactin. Polycystic ovarian syndrome pcos and hyperprolactinemia hprl are the two most common endocrine disorders in women of reproductive age. Evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. In women, prolactin regulates periods and helps the breasts grow and produce milk. Hyperprolactinemia is a disorder in which your pituitary gland produces excessive amounts of the hormone prolactin.
It may be accompanied by galactorrhea, a milky or watery nipple discharge. It can result from physiological or pathological conditions. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities andor galactorrhea at a. Hyperprolactinemia, infertility, and hypothyroidism. Pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. Mean prolactin level was 83 2 49 ngml range 46260 ngml. Prolactin is a hormone that stimulates milk production in women. This hormone is made by the pituitary gland, which is located at the base of the brain. Hyperprolactinaemia or hyperprolactinemia hp is the presence of abnormally high levels of prolactin in the blood. Lindsay, md, saint louis university family medicine residency, belleville. Hyperprolactinemia endocrinology jama jama network. Effect of bromocriptine treatment on male infertility. Prolactin is a hormone produced by the brains pituitary gland.
Clinical manifestations of hyperprolactinemia include hypogo. Prolactinoma is a benign noncancerous tumor of the pituitary gland that causes hyperprolactinemia. There are numerous reasons for both male and female infertility but many ways in which. Management of hyperprolactinemic infertility sciencedirect. Diagnosis and management of hyperprolactinemia cmaj.
Hyperprolactinemia is the most common cause of hypogonadotropic anovulation and is one of the leading causes of infertility in women aged 2534. Pdf management of hyperprolactinemic infertility researchgate. There is an absence of robust evidence for the management of antipsychoticinduced hyperprolactinemia. Therapy was initiated with bromocriptine, but it was poorly tolerated, with fatigue, nausea, and lightheadedness to the point of syncopal events during her work as a hairdresser.
Hyperprolactinemia is a condition in which a person has higherthannormal levels of the hormone prolactin in the blood. Elevated prolactin may impact reproduction through inhibitory effects on hypothalamic gonadotropinreleasing hormone gnrh neurons and or on the pituitary gland to reduce secretion of the gonadotropins luteinizing hormone lh and folliclestimulating hormone. Hyperprolactinemia and infertility endocrinology and metabolism. Prevalence of hyperprolactinemia among patients with infertility. Elevated prolactin levels, or hyperprolactinemia, is among common causes of infertility affecting men, but more often women. Hyperprolactinemia, prolactin, mri, hypothyroidism, pituitary tumor, infertility hyperprolactinemia is the most common endocrine disorder of the hypothalamicpituitary axis. There is a paucity of data on the pattern of clinical presentation of hyperprolactinemia among infertile female patients in nigeria. Chronic hyperprolactinemia may present with osteopenia, reduced muscle mass, and decreased beard growth.
Prolactinoma causes a condition called hyperprolactinemia. Careful clinical evaluation, focused laboratory testing, and in many cases, pituitary imaging are important for elucidating the underlying cause of hyperprolactinemia and guiding appropriate patient management. The task force consisted of endocrine societyappointed experts, a methodologist, and a medical writer. Nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event.
Women who are not pregnant and are not breastfeeding should have low levels of prolactin. Hyperprolactinemiaa significant factor in female infertility. Hyperprolactinaemia and female reproductive function. Otherwise hyperprolactinemia is often undiagnosed for the absence of specific symptoms.
In men and premenopausal women, hyperprolactinemia presents with typical symptoms that include. Management of antipsychoticinduced hyperprolactinemia. Prevalence of hyperprolactinemia in infertile women and its. In women, chronic hyperprolactinemia causes decreased bone mineral density, especially in the setting of significant hypoestrogenism. Hyperprolactinaemia and female reproductive function disconnection hyperprolactinaemia should be differentiated from a prolactinsecreting adenoma, to facilitate planning the appropriate therapy, as the former is unlikely to benefit from medical treatment. In men, an elevated prolactin level is suspected in the presence of erectile dysfunction, infertility, headaches, or vision problems.
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