In young women, hyperprolactinemia is probably one of the most common endocrine disorders related to pituitary function. Hyperprolactinemia is a sign of underlying problems of infertility, menstrual irregularities, and sexual dysfunction. The magnitude of the increase, however, is quite variable. Polycystic ovarian syndrome pcos and hyperprolactinemia hprl are the two most common endocrine disorders in women of reproductive age. Chronic hyperprolactinemia may present with osteopenia, reduced muscle mass, and decreased beard growth. Galactorrhea, hyperprolactinemia, infertility, menstrual abnormality, prevalence how to cite this article. Lindsay, md, saint louis university family medicine residency, belleville. 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. Hyperprolactinemia is when theres too much prolactin in a persons blood. Hyperprolactinemia is characterized by an increased production of the hormone prolactin. A 30yearold woman presented with infertility, hyperprolactinemia, and pituitary enlargement. It may be accompanied by galactorrhea, a milky or watery nipple discharge.
Infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. The prolactin is a hormone produced by the pituitary gland. This hormone is made by the pituitary gland, which is located at the base of the brain. It is the most commonly diagnosed tumor type in the pituitary gland that affects hormone production.
Diagnosis and treatment of hyperprolactinemia hyperprolactinemia is diagnosed using a simple blood test that measures the levels of prolactin. The aim was to formulate practice guidelines for the diagnosis and treatment of hyperprolactinemia. Hyperprolactinemia is also responsible for fertility problems in men, although the condition is diagnosed in men less often than in women. Hospital based analytical cross sectional study was conducted for 1. Oct 01, 2012 evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. Pat i e n t i n f o r m at i o n pituitary society. In women, chronic hyperprolactinemia causes decreased bone mineral density, especially in the setting of significant hypoestrogenism. Prevalence of hyperprolactinemia among infertile patients. Pathological hyperprolactinemia may cause defective ovulation and reduced fecundability.
Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities andor galactorrhea at a. Hyperprolactinemia is suspected in women who have absent or irregular menstrual periods, abnormal breast discharge, or fertility issues. There is an absence of robust evidence for the management of antipsychoticinduced hyperprolactinemia. Prevalence of hyperprolactinemia in infertile women and its. Pdf pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Prolactin also affects the levels of sex hormones estrogen and testosterone in both. Hyperprolactinemia has diverse causes, which may include physiological, pituitary, and systemic etiologies. Schenker hyperprolactinemia associated with male infertility or impotence was found in ten patients. Hyperprolactinemia can affect both women and men, resulting in irregular menstrual periods and erectile dysfunction, among other things. Management of hyperprolactinemic infertility article pdf available in the journal of reproductive medicine 4412 suppl. Clinical manifestations of hyperprolactinemia include hypogo.
Pdf management of hyperprolactinemic infertility researchgate. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and or galactorrhea at a university teaching hospital, north west nigeria. There are numerous reasons for both male and female infertility but many ways in which. She became pregnant within a month following institution of. Pituitary imaging is indicated for the evaluation of. An excess of prolactin above a reference laboratorys upper limits, or biochemical hyperprolactinemia, can be identified in up to 10% of the population. Hypogonadism infertilitylike symptoms menstrual abnormalities such as amenorrhea or oligomenorrhea in women galactorrhea less often, but more common in women. When this hormone is in excess, the chances of conceiving are lower than usual.
The first step in the evaluation is to draw a blood sample to determine the. This evidencebased guideline was developed using the grading of recommendations, assessment, development, and evaluation grade system to. Evaluation of hyperprolactinemia differential diagnosis of. Hyperprolactinemia, prolactin, mri, hypothyroidism, pituitary tumor, infertility hyperprolactinemia is the most common endocrine disorder of the hypothalamicpituitary axis. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, but rarely galactorrhea. Abnormal prolactin prl secretion is usually related to an idiopathic. Elevated prolactin levels, or hyperprolactinemia, is among common causes of infertility affecting men, but more often women. Normal levels are less than 500 miul 20 ngml or ugl for women, and less than 450 miul for men. In men, an elevated prolactin level is suspected in the presence of erectile dysfunction, infertility, headaches, or vision problems. Pregnancy serum prolactin increases throughout pregnancy, reaching a peak at delivery figure 1 1. Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Hyperprolactinemia is a relatively common cause of menstrual abnormalities and infertility. Nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event.
Guidelines for antipsychoticinduced hyperprolactinemia. 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. Management of hyperprolactinemic infertility sciencedirect. There is a paucity of data on the pattern of clinical presentation of hyperprolactinemia among infertile female patients in nigeria. The task force consisted of endocrine societyappointed experts, a methodologist, and a medical writer.
A high level of prolactin reduces estrogen and interferes with ovulation. It is also a signal of impending chronic diseases including breast cancer. Pharmacological treatments with less evidence encompassed dose reduction, switching to lower potency. Over time, the patient may have diminished energy, reduced muscle mass, and increased risk of osteopenia.
Hyperprolactinaemia is amongst the endocrine disorders known to influence male infertility. The mainstream treatment cant root out the disease. Hyperprolactinemia and infertility endocrinology and metabolism. Hyperprolactinemia the journal of clinical endocrinology. Prevalence of hyperprolactinemia among patients with infertility. While hyperprolactinemia is a wellestablished cause of hh and infertility, the mechanisms of these effects are not well understood. Normal levels are less than 500 miul milliinternational units per litre23.
The prevalence of hyperprolactinemia ranges from 0. 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. Although relatively asymptomatic, she was found to have primary hypothyroidism. Diagnosis and management of hyperprolactinemia cmaj. Management of antipsychoticinduced hyperprolactinemia. Effect of bromocriptine treatment on male infertility.
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. 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. In men, hyperprolactinemia may present acutely with diminished libido and infertility. Hyperprolactinemia is a disorder in which your pituitary gland produces excessive amounts of the hormone prolactin. Abnormal prolactin prl secretion is usually related to. In women, prolactin regulates periods and helps the breasts grow and produce milk. Hyperprolactinemia is the most common endocrine disorder of the hypothalamuspituitary axis. Prolactinoma is a benign noncancerous tumor of the pituitary gland that causes hyperprolactinemia. Women who are not pregnant and are not breastfeeding should have low levels of prolactin. It can result from physiological or pathological conditions. It is estimated to occur in 9%17% of women with reproductive disorders 1, 2. Prolactinoma causes a condition called hyperprolactinemia. Hyperprolactinaemia and female reproductive function.
Ninety percent of women with galactorrhea also have hyperprolactinemia. 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, infertility, and hypothyroidism. 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. So estimation of serum prolactin should be done at an early stage of. Hyperprolactinemiaa significant factor in female infertility. Prolactin is a hormone produced by the brains pituitary gland. It increases to 9% in women with amenorrhea and occurs in 25% of those with galactorrhea. Hyperprolactinemia is a condition in which a person has higherthannormal levels of the hormone prolactin in the blood. Premenopausal women hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea. Causes, symptoms, and treatment of hyperprolactinemia. In men and premenopausal women, hyperprolactinemia presents with typical symptoms that include. Effect of bromocriptine treatment on male infertility associated with hyperprolactinemia n.
High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. The probable cause of the hyperprolactinemia is the. An expert infertility specialist would, however, keep the hyperprolactinemia analysis on her checklist to ensure timely and effective treatment. Hyperprolactinemia hyperprolaktihneemeeuh is a condition in which a person has higherthannormal levels of the hormone prolactin prolaktin in the blood. Careful clinical evaluation, focused laboratory testing, and in many cases, pituitary imaging are important for elucidating the underlying cause of hyperprolactinemia and guiding. Hyperprolactinemia endocrinology jama jama network. Hyperprolactinemia is the most common cause of hypogonadotropic anovulation and is one of the leading causes of infertility in women aged 2534. Prolactin and infertility 149 hyperprolactinemia is commonly found in both female and male patients with abnormal sexual andor reproductive function or with galactorrhea. Otherwise hyperprolactinemia is often undiagnosed for the absence of specific symptoms.
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. Among the pharmacological treatments studied, aripiprazole switching or augmentation possessed the strongest evidence. 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. Another term for high prolactin levels is hyperprolactinemia. Prolactin is a hormone that stimulates milk production in women. Evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. A man with untreated hyperprolactinemia may make less sperm or. While hyperprolactinemia is considered perfectly normal during pregnancy and breastfeeding, it can occur at other times due to disease and medication use. When this happens, a woman might have trouble getting pregnant or her breasts may start producing milk outside of pregnancy galactorrhea.
In a retrospective study of 104 patients with hyperprolactinemia ages 30 to 44 years, the most commonly reported symptoms were infertility, headache, and. She became pregnant within a month following institution of levothyroxine replacement, and the pituitary enlargement. Hyperprolactinemia is a relatively common cause of secondary amenorrhea. A man with untreated hyperprolactinemia may make less sperm or no sperm at all. Implications and future directions the study by sonigo et al. A paper published in november 2011 in current opinion in urology estimates that about 1 of every 10,000 men who visit a specialist in infertility or other sexual disorders has hyperprolactinemia, but its prevalence in the general population of men is. In men, high prolactin levels can cause galactorrhea, impotence inability to have an erection during sex, reduced desire for sex, and infertility. Hyperprolactinaemia or hyperprolactinemia hp is the presence of abnormally high levels of prolactin in the blood.
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