Hyperprolactinemia

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Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood. The main function of prolactin is to stimulate breast milk production after … Read More

Top Doctors For Hyperprolactinemia Treatments

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Hyperprolactinemia

Hyperprolactinemia is defined as an abnormal medical condition in which the body produces excessive prolactin. Prolactin is produced by a small pea-sized hormone-secreting gland, the pituitary gland, situated at the base of the neck. It helps in body functions like the formation of blood cells, reproduction, ovulation, immunity and stimulates the production of breast milk also called lactation.  It can cause serious damage to the body such as osteoporosis and infertility. It also affects sex hormone levels- oestrogen and testosterone in women and men respectively. Level of prolactin is generally high during pregnancy. Hence, all this leads to Hyperprolactinemia. The basic range of prolactin in females is less than 25 ng/ml, in males, it is less than 20 ng/ml and in pregnant females, it ranges from 80-400 ng/ml.

Diagnosis of Hyperprolactinemia

Primary tests include detection of the level of prolactin in blood in the basis of galactorrhea or infertility. It is also applicable to men. If the secretion of prolactin is high then thyroid tests are conducted. X-ray of the pituitary gland is done to highlight the presence of macro-adenoma. MRI can be employed to diagnose the size of a tumour. These are frequent tests for checking the growth of a tumour. CT scan is another important measure to generate the images of the gland though less clear than MRI. If the growth of hormones is abnormal then damage to adjacent tissues is expected in which eye check up is necessary.  

Treatment for Hyperprolactinemia

Types of treatment involve medications, synthetic thyroid hormone and radiation surgery. Sometimes hyperprolactinemia shows no indications which do not require any treatment. Depending on severity Medicines are prescribed like for tumours cabergoline and bromocriptine are used. These medicines have a long lasting effect in treating hyperprolactinemia in early stages. For chronic hyperprolactinemia, surgery is a must. Radiation therapy is used to reduce the size of the tumour by reducing prolactin level. According to the location and size of the tumour, different types of radiation are used.

Hyperprolactinemia infertility

Hypersecretion and microadenomas of prolactin, mostly, results in infertility, galactorrhea and amenorrhea. This condition is similar in the case of men which results in infertility and hypogonadism.  The common medication is dopamine, cabergoline and bromocriptine. The aim is to achieve fertility, reduction in the size of the tumour and neutralize the level of prolactin. 
  • Bromocriptine: it proved effective in restoring fertility in almost 75%-90% of patients diagnosed with microadenomas. Though it has minor side effects such as nausea, fatigue and headache. 
  • Cabergoline: it is widely prescribed medications in women trying to conceive a baby. It can be used with bromocriptine for better results and safety.
  • Dopamine: it is used against intolerance and pain. It ceases pain and proved effective in 20%-30% of patients.

How does hypothyroidism cause hyperprolactinemia?

Early stages of hypothyroidism can raise the level of prolactin by increasing the level of thyroid-releasing hormone. According to the study, in almost 30% of patients varied levels of serum prolactin is diagnosed. It is characterized by normal thyroid hormone with high thyroid releasing hormone. Symptoms of hypothyroidism are fatigue, intolerance to cold and musculoskeletal problems. Subclinical and primary are two categories of hypothyroidism. Disorders of cardiovascular metabolic and musculoskeletal are common in both. Elevation of serum prolactin is first diagnosed in 1988 in a female with subclinical hypothyroidism and carpal tunnel syndrome and eventually resulting in hyperprolactinemia.

Idiopathic Hyperprolactinemia

Idiopathic hyperprolactinemia is a condition in which levels of elevated serum prolactin are present in a patient. In this condition, there are no previous symptoms of diseases of the nervous system and pituitary gland. Idiopathic hyperprolactinemia can occur due to dopamine resistance or macroprolactinomas. It is non-cancerous. It does not spread rapidly. The symptoms of early-stage idiopathic hyperprolactinemia can be cured using bromocriptine. 

Risperidone Hyperprolactinemia

Risperidone is of two types- typical and atypical antipsychotic. Atypical antipsychotics can lead to hyperprolactinemia. Medications are necessary to reduce the symptoms and side effects of Hyperprolactinemia.

What antipsychotic causes most hyperprolactinemia?

Antipsychotic agents raise the level of serum prolactin by inhibiting dopamine in the system of the hypothalamus. The pituitary gland is provided with dopamine through the pituitary veins system to the basal hypothalamus and periventricular. This dopamine provides stimulus to the cells of the lactotroph pituitary. Along with this, thyroid releasing hormone, vasoactive intestinal, oxytocin and peptide histidine-methionine promote the secretion of prolactin. Typical antipsychotic dose hinders unselected dopamine in the brain. Antipsychotic actions are the outcome of the opposition of dopamine which involves a reduction of delusions.

How does empty sella syndrome cause hyperprolactinemia

Empty sella syndrome is defined as the malformation or enlargement of a skull structure also called sella turcica. It is in the shape of a saddle situated at the base of the skull in the pituitary gland. The sella turcica is either filled with cerebrospinal fluid also known as completely empty sella or half-filled with cerebrospinal fluid known as partially empty sella. The symptoms of empty sella syndrome are extreme headaches. Headaches can occur due to hypertension or high blood pressure which is a common condition in empty sella syndrome. In a few cases, there is extreme pressure on the skull from inside as well as outside, optic disc sweeping caused by papilledema, cerebrospinal rhinorrhea or cerebrospinal fluid leakage through the nose and vision loss.  The main cause of empty sella syndrome is generally idiopathic hyperprolactinemia. However, other causes are Sheehan syndrome which is a rare disorder, surgery on the pituitary area, trauma and injury in the head, cured tumours of the pituitary gland and radiation therapy.

Hyperprolactinemia medications

Medications for Hyperprolactinemia are antagonists of dopamine receptors such as Risperidone, thioxanthenes, butyrophenones, metoclopramide, pimozide, phenothiazines, and sulpiride. Dopamine depleting agents- reserpine and methyldopa. Other medicines include cocaine, opiates, tricyclic antidepressants, estrogens, danazol, antiandrogens, cimetidine, cyproheptadine, and isoniazid.

Prevention of Hyperprolactinemia

Hyperprolactinemia can be prevented by altering the diet, by avoiding excessive stress, avoiding heavy weightlifting, high-intensity activities for some time, increasing intake of vitamin E and vitamin B-6, avoiding tight clothing, and avoiding breast pain.  Foods that contain a low level of prolactin are beef, beans, shellfish, and turkey which usually contain a high amount of zinc. Other foods are salmon, chicken, potatoes, spinach, and bananas. Green tea can help greatly, avoid refined carbs, avoid sugar and abstain from overeating or undereating.

Symptoms

Symptoms are different in men and women.

  • In males: infertility, frequent headaches, reduction in body hair and muscle mass, growth of breast also called gynecomastia, erectile dysfunction, changes in vision, lactation and lack of sexual desire.
  • In females: irregular menstrual flow or pause in menstrual cycle, lactation problems that is production of milk even during non-pregnancy, infertility, dryness in vagina, libido loss and breasts pain.

Causes

Several causes of Hyperprolactinemia include high blood pressure, nausea, disease of gastroesophageal reflux, vomiting, extreme pain, certain mental disorders, symptoms of menopause, heartburn, birth control pills and depression. Though these symptoms are caused due to some medications resulting in a high level of prolactin.

Some other causes include pregnancy as well as lactation problem, injuries of the chest wall, diseases and a tumour of the pituitary gland, deficiency of thyroid hormone or underactive thyroid and diseases of liver and kidney. Some antidepressants-desipramine and clomipramine, medications like Verelan, Isoptin, Calan, cimetidine, Primperan and Reglan are also responsible for Hyperprolactinemia. 

Other uncommon causes involve trauma and infection of the hypothalamus, high level of cortisol hormone which leads to Cushing syndrome and scar of the liver or cirrhosis.

FAQ

What is the cost of the treatment for Hyperprolactinemia?

The cost varies depending on the hospital and medical facilities. It can range from $20 to $35 if you have insurance cover but without it, this treatment can cost more. It can also vary depending on per visit cost. 

What is the time duration of the procedure?

The time duration is 2-3 hours for the therapy. Recovery can take a few more hours. Diagnosis and preparation of treatment take 4-5 hours. Regular medical visits will be beneficial for several months. 

Is the treatment procedure painful?

No, treatment is not painful. During radiation therapy, the patient is under general anaesthesia to numb the discomfort. However, mild pain is expected after treatment. 

How to prepare for Hyperprolactinemia treatment? 

Avoid medications for at least a week, intake of prescribed food and medicine is necessary to avoid discomfort after surgery. All the formalities must be done beforehand.

What are the side effects of Hyperprolactinemia treatment?

Some side effects are nausea, vomiting, pain in the area, abstain from sexual intercourse as it might cause pain, mild discomfort and stiffness.