Treatment of hyperprolactinemia

Hyperprolactinemia is a common endocrine disease caused by disorders of the hypothalamic-pituitary axis. It can also affect men, but is more common in women. Treatment of hyperprolactinemia depends on the cause.

Hyperprolactinemia is a condition in which there is too much prolactin in the blood of non-pregnant women and in men. Hyperprolactinemia is relatively common in women. About one-third of women of reproductive age with irregular menstrual cycles but normal ovaries have hyperprolactinemia. When this happens, a woman may have trouble getting pregnant or her breasts may begin to produce milk outside of pregnancy (galactorrhea). 90% of women with galactorrhea also have hyperprolactinemia.
High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. This can change or stop ovulation, leading to irregular periods or amenorrhea. Some women have high prolactin levels without any symptoms.

In men, high prolactin levels can cause galactorrhea, impotence (the inability to get an erection during sex), decreased sex drive, and infertility. A man with untreated hyperprolactinemia may produce fewer or no sperm at all.

2.1 Diagnosis A blood test is used to detect excess prolactin. If prolactin levels are high, there are usually multiple tests to check thyroid hormone levels in the blood. Normal thyroid hormone levels rule out hypothyroidism as the cause of hyperprolactinemia. Doctors will also ask about medications the patient is taking and rule out pregnancy.
If hyperprolactinemia is suspected, an MRI (magnetic resonance imaging) of the brain and pituitary gland is usually the next step.

2.2 Treatment Treatment is based on the cause of the elevation of prolactin. Some people with high prolactin levels, but few or no signs and symptoms, do not need treatment. Options for tumor treatment include:
Medical treatment: First choice in all cases of hyperprolactinemia. The drugs are mainly dopamine agonist drugs (dopamine agonist drugs) such as: Bromocriptine, Cabergoline, Pergolide. Surgical removal of a tumor. Surgery may be used if medical treatment fails. Surgery is sometimes needed if the tumor is affecting vision. There are two types of pituitary adenomas: microadenoma (less than 10mm) and macroadenoma (larger than 10mm). With microadenomas the success rate is quite high up to 80%, but with macroadenomas the success rate is as low as 30-40%. Radiation therapy: Currently rarely used, only used for special cases when both medical drugs and surgery to remove the adenoma have failed. In summary, hyperprolactinemia is a pathology that causes lactation, amenorrhea and infertility in both men and women. Common causes of hyperprolactinemia are pituitary tumors that increase prolactin secretion, dysfunction of the body's hormone production regulation,...
When hyperprolactinemia is present, patients are often ordered to have imaging scans. X-ray or MRI of the brain to determine if a tumor is present and if surgery is needed to remove it. If there is no tumor or small tumor that does not require surgery, the patient will be prescribed medication.
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