Hyperprolactinemia is characterized by the elevation of the prolactin in the blood, which usually results from several factors such as pathological, physiological, or idiopathic. Prolactin is a pituitary gland hormone responsible for milk production during lactation and breastfeeding.
It is also responsible for reproductive mammary development and stimulates an immune response. It is considered hyperprolactinemia when the serum prolactin levels are elevated above the normal limit of 15 to 20ng/ml.
Epidemiology
It is a common hypothalamic-pituitary endocrine disease. Most commonly occurs in females and rare in males. The prevalence of 9-15% is observed in women with reproductive diseases, 5% in family planning clinics, and 17% in women with polycystic ovary syndrome. Women with secondary amenorrhea have an incidence rate of 5-14%. It usually occurs in less than 1% of the general population.
Anatomy
Pathophysiology
The hormone prolactin is responsible for the production of milk during the span of pregnancy and lactation. Prolactin, estrogen, progesterone, placental hormones, and insulin-like growth factors increase breast alveolar proliferation during pregnancy.
During pregnancy, lactation is suppressed as there is an increase in levels of estrogen. Lactation begins after delivery when there are increased levels of prolactin and a decrease in levels of estrogen and progesterone. Estrogen stimulates the proliferation of lactotrophs in pregnancy, which further secrete prolactin.
The pituitary hypothalamic secretion of prolactin is inhibited by dopamine, the prime inhibitor acting via type 2 dopamine receptor situated on the lactotrophs. Prolactin inhibits the gonadotropin-releasing hormone (GnRH), which further results in the inhibition of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion.
Etiology
The physiological cause such as pregnancy, nipple stimulation, lactation, stress, exercise, sexual intercourse, and seizures cause symptomatic hyperprolactinemia and have an acute effect on health. The pituitary gland increases in size during pregnancy, which further increases lactotrophs’ size.
The serum prolactin increases during pregnancy and reaches a peak during delivery. After delivery, the prolactin level decreases. Nipple stimulation increases prolactin mediated by neural pathways during breastfeeding. The pathological cause comprises certain pituitary diseases such as Cushing, prolactinoma, acromegaly, lymphocytic hypophysitis, paraseller mass.
The pharmacological causes are drug-induced such as haloperidol, risperidone, metoclopramide, amitriptyline, fluoxetine, phenytoin, morphine, methadone, and estrogen therapy—systemic disorders such as Polycystic ovary syndrome, primary hyperthyroidism, pseudocyesis (false pregnancy).
Genetics
Prognostic Factors
In patients with prolactinomas, the level of prolactin, size of the tumor, treatment, and surgical intervention success rate determine the prognosis, which is usually good. Such patients are managed with pharmacological therapy for a prolonged period. Recurrence of hyperprolactinemia is higher even after surgical intervention.
Begin with a dosage of 0.025 mg one time every day orally for the first three days, then increase to 0.05 one time every day for the subsequent three days (starter package)
Maintenance dosing (initiated on day seven): 0.075 mg taken one time every day If necessary, additional incremental adjustments may be made with intervals of at least one week between titrations
maintenance range: The recommended dosage is 0.075-0.15 mg/day; if elevated doses are necessary, Gradually increase the dosage by 0.075-0.15 mg/day every four weeks or more until reaching a maximum dose of 0.9 mg/day
Hyperprolactinemia is characterized by the elevation of the prolactin in the blood, which usually results from several factors such as pathological, physiological, or idiopathic. Prolactin is a pituitary gland hormone responsible for milk production during lactation and breastfeeding.
It is also responsible for reproductive mammary development and stimulates an immune response. It is considered hyperprolactinemia when the serum prolactin levels are elevated above the normal limit of 15 to 20ng/ml.
It is a common hypothalamic-pituitary endocrine disease. Most commonly occurs in females and rare in males. The prevalence of 9-15% is observed in women with reproductive diseases, 5% in family planning clinics, and 17% in women with polycystic ovary syndrome. Women with secondary amenorrhea have an incidence rate of 5-14%. It usually occurs in less than 1% of the general population.
The hormone prolactin is responsible for the production of milk during the span of pregnancy and lactation. Prolactin, estrogen, progesterone, placental hormones, and insulin-like growth factors increase breast alveolar proliferation during pregnancy.
During pregnancy, lactation is suppressed as there is an increase in levels of estrogen. Lactation begins after delivery when there are increased levels of prolactin and a decrease in levels of estrogen and progesterone. Estrogen stimulates the proliferation of lactotrophs in pregnancy, which further secrete prolactin.
The pituitary hypothalamic secretion of prolactin is inhibited by dopamine, the prime inhibitor acting via type 2 dopamine receptor situated on the lactotrophs. Prolactin inhibits the gonadotropin-releasing hormone (GnRH), which further results in the inhibition of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion.
The physiological cause such as pregnancy, nipple stimulation, lactation, stress, exercise, sexual intercourse, and seizures cause symptomatic hyperprolactinemia and have an acute effect on health. The pituitary gland increases in size during pregnancy, which further increases lactotrophs’ size.
The serum prolactin increases during pregnancy and reaches a peak during delivery. After delivery, the prolactin level decreases. Nipple stimulation increases prolactin mediated by neural pathways during breastfeeding. The pathological cause comprises certain pituitary diseases such as Cushing, prolactinoma, acromegaly, lymphocytic hypophysitis, paraseller mass.
The pharmacological causes are drug-induced such as haloperidol, risperidone, metoclopramide, amitriptyline, fluoxetine, phenytoin, morphine, methadone, and estrogen therapy—systemic disorders such as Polycystic ovary syndrome, primary hyperthyroidism, pseudocyesis (false pregnancy).
In patients with prolactinomas, the level of prolactin, size of the tumor, treatment, and surgical intervention success rate determine the prognosis, which is usually good. Such patients are managed with pharmacological therapy for a prolonged period. Recurrence of hyperprolactinemia is higher even after surgical intervention.
Begin with a dosage of 0.025 mg one time every day orally for the first three days, then increase to 0.05 one time every day for the subsequent three days (starter package)
Maintenance dosing (initiated on day seven): 0.075 mg taken one time every day If necessary, additional incremental adjustments may be made with intervals of at least one week between titrations
maintenance range: The recommended dosage is 0.075-0.15 mg/day; if elevated doses are necessary, Gradually increase the dosage by 0.075-0.15 mg/day every four weeks or more until reaching a maximum dose of 0.9 mg/day
Hyperprolactinemia is characterized by the elevation of the prolactin in the blood, which usually results from several factors such as pathological, physiological, or idiopathic. Prolactin is a pituitary gland hormone responsible for milk production during lactation and breastfeeding.
It is also responsible for reproductive mammary development and stimulates an immune response. It is considered hyperprolactinemia when the serum prolactin levels are elevated above the normal limit of 15 to 20ng/ml.
It is a common hypothalamic-pituitary endocrine disease. Most commonly occurs in females and rare in males. The prevalence of 9-15% is observed in women with reproductive diseases, 5% in family planning clinics, and 17% in women with polycystic ovary syndrome. Women with secondary amenorrhea have an incidence rate of 5-14%. It usually occurs in less than 1% of the general population.
The hormone prolactin is responsible for the production of milk during the span of pregnancy and lactation. Prolactin, estrogen, progesterone, placental hormones, and insulin-like growth factors increase breast alveolar proliferation during pregnancy.
During pregnancy, lactation is suppressed as there is an increase in levels of estrogen. Lactation begins after delivery when there are increased levels of prolactin and a decrease in levels of estrogen and progesterone. Estrogen stimulates the proliferation of lactotrophs in pregnancy, which further secrete prolactin.
The pituitary hypothalamic secretion of prolactin is inhibited by dopamine, the prime inhibitor acting via type 2 dopamine receptor situated on the lactotrophs. Prolactin inhibits the gonadotropin-releasing hormone (GnRH), which further results in the inhibition of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion.
The physiological cause such as pregnancy, nipple stimulation, lactation, stress, exercise, sexual intercourse, and seizures cause symptomatic hyperprolactinemia and have an acute effect on health. The pituitary gland increases in size during pregnancy, which further increases lactotrophs’ size.
The serum prolactin increases during pregnancy and reaches a peak during delivery. After delivery, the prolactin level decreases. Nipple stimulation increases prolactin mediated by neural pathways during breastfeeding. The pathological cause comprises certain pituitary diseases such as Cushing, prolactinoma, acromegaly, lymphocytic hypophysitis, paraseller mass.
The pharmacological causes are drug-induced such as haloperidol, risperidone, metoclopramide, amitriptyline, fluoxetine, phenytoin, morphine, methadone, and estrogen therapy—systemic disorders such as Polycystic ovary syndrome, primary hyperthyroidism, pseudocyesis (false pregnancy).
In patients with prolactinomas, the level of prolactin, size of the tumor, treatment, and surgical intervention success rate determine the prognosis, which is usually good. Such patients are managed with pharmacological therapy for a prolonged period. Recurrence of hyperprolactinemia is higher even after surgical intervention.
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