Hyperprolactinemia in women

Hyperprolactinemia is actually not very familiar to women. In fact, hyperprolactinemia is an endocrine disorder syndrome that occurs in women of childbearing age. After the disease occurs, patients will experience symptoms such as infrequent menstruation, amenorrhea, sexual dysfunction, and obesity. Although the cause of hyperprolactinemia is still unclear, patients can be treated with medication or surgery.

Hyperprolactinemia, also known as hyperprolactinemia, is a syndrome of reproductive-endocrine disorders of the hypothalamus-pituitary axis caused by various reasons, characterized by elevated serum prolactin and its related clinical manifestations. It is a general term for a common clinical disease that can affect the reproductive, endocrine and nervous systems. At present, the general standard is a serum prolactin level higher than 1.14nmol/L (25μg/L). Due to different detection methods, the normal reference range of each unit varies slightly.

Clinically, patients often present with symptoms such as amenorrhea, lactation, frequent menstruation, oligomenorrhea, infertility, sexual dysfunction, headache, obesity, etc. Therefore, patients may seek treatment in the departments of obstetrics and gynecology, reproductive medicine, andrology, breast medicine, neurology, and neurosurgery. Hyperprolactinemia is currently still treated mainly with medication, supplemented by surgery and radiotherapy, and treatment is selected based on individualized principles. Generally speaking, it accounts for about 0.4% of women of childbearing age, 5% of women with abnormal menstruation, and 17% of women with abnormal reproductive function.

Clinical manifestations

1. Lactation

It is the main clinical manifestation of hyperprolactinemia. About 2/3 of patients will lactate during the non-pregnancy and non-lactation period. Male patients may also experience breast development and lactation. The secreted milk is colostrum-like or watery, serous, yellow or white. In most cases, the amount is not much, and usually the milk will flow out only when squeezed. In severe cases, the milk may flow out on its own. Although lactation is closely related to increased blood prolactin levels, the amount of lactation has nothing to do with the degree of increase in prolactin levels. Lactation is more common in patients with pituitary microadenomas, accounting for about 70%; only 30% of patients with non-tumor hyperprolactinemia will experience lactation.

2. Menstrual disorders and amenorrhea

Patients may experience menstrual disorders, secondary amenorrhea, decreased libido, and in severe cases, genital atrophy and osteoporosis. When the patient has decreased lactation, menstrual flow or even amenorrhea, it is called amenorrhea-galactorrhea syndrome. Patients with polycystic ovary syndrome often have hyperprolactinemia. In addition to elevated prolactin, blood androgen levels are also elevated. They also have obesity, hirsutism, acne, and infrequent menstruation.

3. Infertility and sterility

Most cases of hyperprolactinemia are caused by pituitary microadenomas. About 90% of patients experience oligomenorrhea or amenorrhea, and infertility may also occur in about 70%. Men may experience decreased libido, poor sperm quality, and infertility.

4. Others

Patients with hyperprolactinemia caused by pituitary or intracranial tumors may also have headaches, blurred vision or visual field loss, blindness, diplopia, and hypopituitarism; those caused by growth hormone adenoma may also develop gigantism and acromegaly; those caused by thyrotropinoma may also develop hyperthyroidism and non-functional tumors.