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Monday, 27.03.2023, 04:57
Main » Gynecology » Prolactin - hyperprolactinemia 
Prolactin - hyperprolactinemia

Prolactin - hyperprolactinemia

Prolactin - a hormone produced by laktotrofami - cells of the anterior pituitary. Prolactin plays an important role in many processes in the body. And, in particular, to ensure the normal functioning of the reproductive system. Increased level of prolactin is one of the most common causes of infertility and the most common cause of the hormonal forms of infertility in women.

There are many factors that lead to increased levels of prolactin:

Physiological, ie not associated with any disease and occur in healthy women. Thus, prolactin levels increase during sleep, breastfeeding, stress, intensive exercise, during sexual intercourse, pregnancy and the postpartum period.

Pathological hyperprolactinemia caused by pituitary tumors (micro-and makroprolaktinomami), various diseases (primary hypothyroidism, chronic renal failure, liver cirrhosis, polycystic ovarian syndrome, etc.).

Prolactin levels increased when taking certain medications: neuroleptics, antidepressants, antihypertensives, prostaglandins, estrogens in large doses, after operations and injuries in the chest, frequent scraping of the uterine cavity, etc.

Elevated levels of prolactin can be manifested in different ways:

women observed failure of phase II of the menstrual cycle, delayed menstruation or complete lack thereof, the violation of ovulation, the release of colostrum or milk from the breasts (galactorrhea), infertility

males increased prolactin levels accompanied by a decrease of sexual desire, potency, and galactorrhea.

Diagnosis of hyperprolactinemia. The leading method in the examination of patients with hyperprolactinemia belongs hormonal examination - definition of prolactin in the blood. Blood sampling is performed from a vein in the morning, between 5th and 8th days of the menstrual cycle. As a rule, elevated levels of a hormone needed re-definition (at least 3). This is due to the possibility of a temporary increase in prolactin levels, which does not mean there is any disease.

When prolactin levels up to about 2500 mIU / l, as a rule, there is, functional hyperprolactinemia. That is, this, in which are not determined by changes in the sella (which houses the pituitary gland), samples with metoclopramide and thyroliberin positive. These tests help to determine the presence or absence of tumors (prolactin). When functional hyperprolactinemia often diseases such as polycystic ovaries, hirsutism and other manifestations of hyperandrogenism, impaired fat metabolism, the outer genital endometriosis, inflammatory disease of the genitals and adhesions in the pelvis.

For the diagnosis of organic hyperprolactinemia used a survey of the pituitary gland with craniography (X-ray of the skull in 2 projections), computer (CT) and magnetic resonance imaging (MRI). The last two methods are significantly more accurate and informative.

Treatment of hyperprolactinemia. Currently, there are three generations of products for the treatment of hyperprolactinemia:

The derivatives of ergot alkaloids: bromocriptine (Parlodel), lizurida, pergolide, the little foxes). The most common of these is bromocriptine. Usually it is administered at a dose of 1.25 - 2.5 mg 2-3 times a day.

Drugs that are not related to the derivatives of ergot alkaloids, synthesized specifically to reduce the level of prolactin. These include kvinagolid (norprolak, "Sandoz"). This drug is available to us in the sale and is better tolerated than bromocriptine. Another advantage is the possibility of taking a once a day. The drug comes in tablets of 25, 50, 75 and 100 mg. Treatment is initiated with a dose of 25 micrograms per day in the first 3 days and continue on 50 mg a day over the next 3 days. Starting from the 7th day, the recommended dose is 75 mg per day. Then the dose, if necessary, gradually increased, but not more than 1 time per week. The maintenance dose is 75 - 150 mg per day. The drug is taken at bedtime with food.

A derivative of ergot alkaloid ergoline with a duration of action - karbegolin (dostineks, "Pharmacy and Upjohn"). At the beginning of treatment, he is assigned to a dose of 0.5 mg once a week (1/2 tablets 2 times daily with meals). The dosage is increased gradually, in increments of 0.5 mg per month. Maintenance dose is usually 1 - 2 mg per week. The benefits of this drug include, but are long-acting, more rapid decline in prolactin levels, a higher percentage of recovery of ovulatory cycles, a pronounced effect on prolactinoma, better tolerability.

In the treatment of prolactin used as the destruction or suppression of tumor irradiation, or surgical methods.

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