A high level of prolactin reduces estrogen and interferes with ovulation. Lindsay, md, saint louis university family medicine residency, belleville. 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. Oct 01, 2012 evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. So estimation of serum prolactin should be done at an early stage of. Nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event. High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. Prolactin also affects the levels of sex hormones estrogen and testosterone in both. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities andor galactorrhea at a.
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. Hyperprolactinemia is when theres too much prolactin in a persons blood. Hyperprolactinaemia is amongst the endocrine disorders known to influence male infertility. Chronic hyperprolactinemia may present with osteopenia, reduced muscle mass, and decreased beard growth. Management of antipsychoticinduced hyperprolactinemia. Effect of bromocriptine treatment on male infertility associated with hyperprolactinemia n. 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. Diagnosis and management of hyperprolactinemia cmaj. 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. Prevalence of hyperprolactinemia among patients with infertility. Hyperprolactinemia endocrinology jama jama network. Schenker hyperprolactinemia associated with male infertility or impotence was found in ten patients. A 30yearold woman presented with infertility, hyperprolactinemia, and pituitary enlargement. Management of hyperprolactinemic infertility article pdf available in the journal of reproductive medicine 4412 suppl.
Hyperprolactinemia is characterized by an increased production of the hormone prolactin. Hypogonadism infertilitylike symptoms menstrual abnormalities such as amenorrhea or oligomenorrhea in women galactorrhea less often, but more common in women. Diagnosis and treatment of hyperprolactinemia hyperprolactinemia is diagnosed using a simple blood test that measures the levels of prolactin. Hyperprolactinemia is a relatively common cause of secondary amenorrhea. Careful clinical evaluation, focused laboratory testing, and in many cases, pituitary imaging are important for elucidating the underlying cause of hyperprolactinemia and guiding.
Ninety percent of women with galactorrhea also have hyperprolactinemia. In women, chronic hyperprolactinemia causes decreased bone mineral density, especially in the setting of significant hypoestrogenism. In young women, hyperprolactinemia is probably one of the most common endocrine disorders related to pituitary function. 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.
It increases to 9% in women with amenorrhea and occurs in 25% of those with galactorrhea. Pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. The first step in the evaluation is to draw a blood sample to determine the. There is higher incidence of hyperprolactinemia among infertile females. Abnormal prolactin prl secretion is usually related to. Mean prolactin level was 83 2 49 ngml range 46260 ngml. 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 the journal of clinical endocrinology. Guidelines for antipsychoticinduced hyperprolactinemia. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, but rarely galactorrhea. 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, an elevated prolactin level is suspected in the presence of erectile dysfunction, infertility, headaches, or vision problems.
The aim was to formulate practice guidelines for the diagnosis and treatment of hyperprolactinemia. Elevated prolactin levels, or hyperprolactinemia, is among common causes of infertility affecting men, but more often women. Pdf management of hyperprolactinemic infertility researchgate. Although relatively asymptomatic, she was found to have primary hypothyroidism. Prolactin is a hormone that stimulates milk production in women. When this happens, a woman might have trouble getting pregnant or her breasts may start producing milk outside of pregnancy galactorrhea. While hyperprolactinemia is considered perfectly normal during pregnancy and breastfeeding, it can occur at other times due to disease and medication use.
She became pregnant within a month following institution of. An expert infertility specialist would, however, keep the hyperprolactinemia analysis on her checklist to ensure timely and effective treatment. Pdf pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. Prolactinoma causes a condition called hyperprolactinemia. Hyperprolactinemia is the most common cause of hypogonadotropic anovulation and is one of the leading causes of infertility in women aged 2534. Pituitary imaging is indicated for the evaluation of. The prevalence of hyperprolactinemia ranges from 0. Hyperprolactinemia is the most common endocrine disorder of the hypothalamuspituitary axis. The prolactin is a hormone produced by the pituitary gland. There are numerous reasons for both male and female infertility but many ways in which. Women who are not pregnant and are not breastfeeding should have low levels of prolactin. It can result from physiological or pathological conditions. Causes, symptoms, and treatment of hyperprolactinemia.
There is a paucity of data on the pattern of clinical presentation of hyperprolactinemia among infertile female patients in nigeria. Prevalence of hyperprolactinemia among infertile patients. In men, hyperprolactinemia may present acutely with diminished libido and infertility. Clinical manifestations of hyperprolactinemia include hypogo.
Otherwise hyperprolactinemia is often undiagnosed for the absence of specific symptoms. When this hormone is in excess, the chances of conceiving are lower than usual. Pharmacological treatments with less evidence encompassed dose reduction, switching to lower potency. It may be accompanied by galactorrhea, a milky or watery nipple discharge. Prolactin is a hormone produced by the brains pituitary gland. Evaluation of hyperprolactinemia differential diagnosis of. Pregnancy serum prolactin increases throughout pregnancy, reaching a peak at delivery figure 1 1. Normal levels are less than 500 miul milliinternational units per litre23. This evidencebased guideline was developed using the grading of recommendations, assessment, development, and evaluation grade system to. Hyperprolactinaemia or hyperprolactinemia hp is the presence of abnormally high levels of prolactin in the blood.
Hyperprolactinemia hyperprolaktihneemeeuh is a condition in which a person has higherthannormal levels of the hormone prolactin prolaktin in the blood. Prolactinoma is a benign noncancerous tumor of the pituitary gland that causes hyperprolactinemia. Management of hyperprolactinemic infertility sciencedirect. Hyperprolactinemia is a relatively common cause of menstrual abnormalities and infertility. Hyperprolactinemia is a condition in which a person has higherthannormal levels of the hormone prolactin in the blood.
Hyperprolactinaemia and female reproductive function. Hyperprolactinemia can affect both women and men, resulting in irregular menstrual periods and erectile dysfunction, among other things. Hyperprolactinemia is also responsible for fertility problems in men, although the condition is diagnosed in men less often than in women. If a nonpregnant woman has abnormally high levels of prolactin, it may cause her difficulty in becoming pregnant. Hyperprolactinemia is a disorder in which your pituitary gland produces excessive amounts of the hormone prolactin. The magnitude of the increase, however, is quite variable. 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. Hyperprolactinemia, prolactin, mri, hypothyroidism, pituitary tumor, infertility hyperprolactinemia is the most common endocrine disorder of the hypothalamicpituitary axis.
The task force consisted of endocrine societyappointed experts, a methodologist, and a medical writer. Prolactin and infertility 149 hyperprolactinemia is commonly found in both female and male patients with abnormal sexual andor reproductive function or with galactorrhea. Hyperprolactinemia, infertility, and hypothyroidism. Hyperprolactinaemia in men is defined by the presence of a high serum prolactin level of 15 gl. 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. Infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. The probable cause of the hyperprolactinemia is the. Hospital based analytical cross sectional study was conducted for 1.
Hyperprolactinemia and infertility endocrinology and metabolism. 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. Normal levels are less than 500 miul 20 ngml or ugl for women, and less than 450 miul for men. In men and premenopausal women, hyperprolactinemia presents with typical symptoms that include. Another term for high prolactin levels is hyperprolactinemia. Hyperprolactinemia is a sign of underlying problems of infertility, menstrual irregularities, and sexual dysfunction. The occurrence of clinically apparent hyperprolactinemia depends on the study.
There is an absence of robust evidence for the management of antipsychoticinduced hyperprolactinemia. In a retrospective study of 104 patients with hyperprolactinemia ages 30 to 44 years, the most commonly reported symptoms were infertility, headache, and. Hyperprolactinemia is suspected in women who have absent or irregular menstrual periods, abnormal breast discharge, or fertility issues. It is estimated to occur in 9%17% of women with reproductive disorders 1, 2. Polycystic ovarian syndrome pcos and hyperprolactinemia hprl are the two most common endocrine disorders in women of reproductive age. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and or galactorrhea at a university teaching hospital, north west nigeria.
This hormone is made by the pituitary gland, which is located at the base of the brain. 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. Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Prevalence of hyperprolactinemia in infertile women and its. Premenopausal women hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea.
Hyperprolactinemia has diverse causes, which may include physiological, pituitary, and systemic etiologies. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Among the pharmacological treatments studied, aripiprazole switching or augmentation possessed the strongest evidence. In men, high prolactin levels can cause galactorrhea, impotence inability to have an erection during sex, reduced desire for sex, and infertility. It is the most commonly diagnosed tumor type in the pituitary gland that affects hormone production. Pat i e n t i n f o r m at i o n pituitary society. While hyperprolactinemia is a wellestablished cause of hh and infertility, the mechanisms of these effects are not well understood. Over time, the patient may have diminished energy, reduced muscle mass, and increased risk of osteopenia. Effect of bromocriptine treatment on male infertility. An excess of prolactin above a reference laboratorys upper limits, or biochemical hyperprolactinemia, can be identified in up to 10% of the population. Implications and future directions the study by sonigo et al.
Galactorrhea, hyperprolactinemia, infertility, menstrual abnormality, prevalence how to cite this article. Hyperprolactinemia is an extremely common disorder, especially among reproductive age women, affecting about onethird of infertile females. Abnormal prolactin prl secretion is usually related to an idiopathic. A man with untreated hyperprolactinemia may make less sperm or no sperm at all. A man with untreated hyperprolactinemia may make less sperm or. In women, prolactin regulates periods and helps the breasts grow and produce milk. Evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. The mainstream treatment cant root out the disease. Jan 04, 2018 infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. Hyperprolactinemiaa significant factor in female infertility.
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