Otherwise hyperprolactinemia is often undiagnosed for the absence of specific symptoms. Hyperprolactinemia refers to an abnormally high level of the hormone prolactin in the body. The specialists at the johns hopkins pituitary center will utilize a number of diagnostic technologies and methods, which may include magnetic resonance imaging mri, a single blood draw, or more complex hormonal, dynamic testing. It is a common and reversible cause of male infertility accounting for about 11% of men whose sperm concentration is low. Management of hyperprolactinemic infertility article pdf available in the journal of reproductive medicine 4412 suppl. Patients typically present with hypogonadism, infertility or, in the case of macroadenomas, symptoms related to mass effect headache and visual field defects. A 30yearold woman presented with infertility, hyperprolactinemia, and pituitary enlargement.
Although you may be aware that many different problems can lead to infertility, you may not know that high amounts of a reproductive hormone called prolactin in a disorder called hyperprolactinemia may cause both men and women to become infertile. Babycenter is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. However, the published reports on prolactin and female fertility included small numbers of women. Prolactin is a hormone secreted by the anterior pituitary gland. Prolactin is a hormone produced by your pituitary gland which sits at the bottom of the brain. Strategies for managing medicationinduced hyperprolactinemia. She became pregnant within a month following institution of. After menarche at age 12, menses occurred irregularly for a year and then became regular. Hypoprolactinemia is a medical condition characterized by a deficiency in the serum levels of the hypothalamicpituitary hormone prolactin. These include hyperprolactinemia, nonclassic congenital adrenal hyperplasia, and cushings syndrome. Management of hyperprolactinemic infertility article pdf available in the journal of reproductive medicine 44 12 suppl. Prolactinomas are the most common type of pituitary tumor.
Challenges and pitfalls in the diagnosis of hyperprolactinemia. A prolactinoma is a benignnoncancerous tumor of the pituitary gland that produces a hormone called prolactin. She initiated use of oral contraceptive pills at the age of 18, then stopped at age 27 to try to conceive. Latent hyperprolactinemia and infertility salt lake city, usa july 11 th, 2012 maciej barczentewicz, radoslaw maksym, oksana furman, elzbieta rydz. Hyperprolactinemia the journal of clinical endocrinology. Refractory cases require surgery, and when hyperprolactinemia. Frequency of hyperprolactinemia in female infertility.
The management of anovulatory infertility due to hyperprolactinaemia requires. Hyperprolactinemia, prolactin, mri, hypothyroidism, pituitary tumor, infertility hyperprolactinemia is the most common endocrine disorder of the hypothalamicpituitary axis. Prolactin prl is one of several hormones that are produced by the pituitary. Hyperprolactinemia is an absolutely treatable condition and getting pregnant is possible if treated in time. A scrotal ultrasound noted to be similar to the exam and a repeat semen analysis showed 9 million sperm with normal motility. We collected descriptive, quality and outcome data tumor growth, visual field defects, infertility, sexual. Here are three simple ways to treat hyperprolactinemia naturally. Hyperprolactinemia has been proposed to block ovulation through inhibition of gnrh release. Hyperprolactinemia high prolactin levels what is prolactin. It is estimated to occur in 9%17% of women with reproductive disorders 1, 2. Prolactinoma is the most common cause of infertility due to hyperpro lactinemia and is seen in approximately 11% of individuals with. Hyperprolactinemia hyperprolaktihneemeeuh is a condition in which a person has higherthannormal levels of the hormone prolactin prolaktin in the blood. Hyperprolactinaemia in men is defined by the presence of a high serum prolactin level of 15 gl. Prolactinoma is the most common cause of hyperprolactinemia, which is a common cause of infertility in males and females.
Prolactin is a hormone that stimulates milk production in women. Treatment with antipsychotic medication can be associated with hyperprolactinemia, which may be asymptomatic or associated with a wide variety of side effects. High levels of prolactin are important for pregnant or breastfeeding women, however in everyone else it may indicate a problem with the pituitary gland or an abnormal reaction to certain medications. Pitfalls in the diagnostic evaluation of hyperprolactinemia fulltext. Nice guidelines on infertility 200414 state that fertility investigations should not routinely include assessment of prolactin levels and that this should only be offered to women with ovulatory disorders, galactorrhoea or pituitary tumours. Prolactin and infertility 149 hyperprolactinemia is commonly found in both female and male patients with abnormal sexual andor reproductive function or with galactorrhea.
Prolactin causes breasts to grow and develop and causes milk to be made after a baby is born. Evaluation and management of galactorrhea wenyu huang, md. Hyperprolactinemia is a condition of elevated serum prolactin. Guidelines for antipsychoticinduced hyperprolactinemia. Hyperprolactinemia is the most common cause of hypogonadotropic anovulation and is one of the leading causes of infertility in women aged 2534. Higher prolactin levels are like a red signal telling you that your fertility system is degenerating.
In most cases prolactinemia means hyperprolactinemia. Once the presence of prolactin excess is identified, further evaluation to establish the underlying cause is usually straightforward. Guidance on the treatment of antipsychotic induced. Prolactinhyperprolactinemiamacroprolactinemiapitfalls. Estrogen deficiency can cause decreased vaginal lubrication, irritability, anxiety, and depression. Therefore, diagnostic tests for hyperprolactinemia are to be included in the checklist for male infertility treatment too. Symptoms of prolactinoma are caused by hyperprolactinemiatoo much prolactin in the bloodor by pressure of the tumor on surrounding tissues. Some of these causes are physiologic and others pathologic. Prolactin is a 198amino acid protein 23kd produced in the lactotroph cells of the anterior pituitary gland. Women who are not pregnant and are not breastfeeding should not have higher prolactin levels. An xray may also be conducted around the bones surrounding the pituitary gland in the brain. 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. Kisspeptin neurons, which express prolactin receptors, were recently identified as.
No treatment may be needed if a cause cant be found or if the high prolactin level is due to a small. The effect of antipsychotics on prolactin appears to be doserelated. Prolactin, male infertility, dopamine agonists, testosterone. Hyperprolactinaemia and female reproductive function. Patients with hyperprolactinemia desiring restoration of normal sexual function and fertility.
The aim of this study was to examine, in a very large number of hyperprolactinemic patients, the ability to normalize prl levels with cabergoline, to determine the effective dose and tolerance, and to assess the effect on clinical symptoms, tumor. In general, treatment of hyperprolactinemia, secondary to pituitary macroadenoma, is accepted as. Prevalence of hyperprolactinemia and abnormal magnetic resonance imaging. Prevalence of hyperprolactinemia and abnormal magnetic. Hyperprolactinemia is a disorder in which your pituitary gland produces excessive amounts of the hormone prolactin. Prolactin is secreted solely by the lactotroph cells of the pituitary gland. Our content is doctor approved and evidence based, and our community is moderated, lively, and welcoming. Hyperprolactinemia is a relatively common cause of menstrual abnormalities and infertility. With thousands of awardwinning articles and community groups, you can track your pregnancy and babys growth, get answers to your toughest questions, and connect with. Many factors contribute to the development of hyperprolactinemia. Continuous infusion of prolactin subcutaneously in female mice resulting in hyperprolactinemia mean, 260 ngml is associated with loss of estrous. Hyperprolactinemia is a regular indicator of impending or existing thyroid hormone deficiency or hypothyroidism hashimotos disease which in most cases results from antithyroglobulin andor antimicrosomal antibodies that attack thyroid hormone producing glands, substituting them with connective tissue. Current guidelines indicate hormone evaluation of infertile men in the.
The prolactin is a hormone produced by the pituitary gland. The best way to deal with hyperprolactinemia in males is through proper diagnosis. It can result from physiological or pathological conditions. Management of hyperprolactinemic infertility sciencedirect. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Pdf prolactin is a polypeptide hormone that is synthesized in the anterior pituitary. There is no local study available regarding frequency of hyperprolactinemia in female infertility, so, further studies and long follow up are necessary to validate variables prevalence of hyperprolactinemia among population of our different areas.
The national institute for health and clinical excellence nice guidelines on infertility 2004 14 state that fertility investigations should not routinely include assessment of prolactin levels and that this should only be offered to women with ovulatory disorders, galactorrhoea or pituitary tumours. Cabergoline is a new longacting dopamine agonist that is very effective and well tolerated in patients with pathological hyperprolactinemia. Hyperprolactinemia is the most common disorder of the hypothalamicpituitary axis. As a result, hyperprolactinemia results almost exclusively from diseases that cause hypersecretion of prolactin by lactotroph cells.
Prevalence of hyperprolactinemia among patients with infertility. Clinical manifestations of hyperprolactinemia include hypogo. The individual involved has to visit a reliable medical doctor who will carry out the proper test as required. Prolactinhyperprolactinemia macroprolactinemiapitfalls. Normally, both men and women have small amounts of prolactin in their blood.
A 29yearold woman is referred for management of infertility. The clinical manifestations of hyperprolactinemia are relatively few and usually easy to recognize. Hyperprolactinemia, as the name suggests, is the hypersecretion of the hormone prolactin, which leads to high prolactin levels in the blood. Results elevated levels of serum prolactin have a detrimental effect on male reproduction through inhibition of the pulsatile release of gonadotrophins from the. A thoroughly planned interactive scientific programme was created for this meeting by the international workshop and study committee in collaboration.
When this hormone is in excess, the chances of conceiving are lower than usual. Women with hyperprolactinemia usually present with symptoms of galactorrhea, menstrual disorders usually amenorrhea, and infertility. Cabergoline in the treatment of hyperprolactinemia. Hyperprolactinemia, infertility, and hypothyroidism. Hyperprolactinaemia is amongst the endocrine disorders known to influence male infertility. Of the atypicals, the highest prevalence is with risperidone. Hyperprolactinemia is a common endocrine disorder that can be associated with significant morbidity. Hyperprolactinemia is a relatively common cause of secondary amenorrhea. If a cause for hyperprolactinemia cannot be found by history, examination, and. Elevated prolactin levels, or hyperprolactinemia, is among common causes of infertility affecting men, but more often women. Not all women with hyperprolactinemia need treatment, although women wtih hyperprolactinemia who do not make estrogen as a result need a treatment that either causes her to make estrogen or provides estrogen to the patient.
The diagnosis is easily established by checking serum prolactin level followed by gadoliniumenhanced head mri, after ruling out physiologic and pharmacologic causes of hyperprolactinemia 2, 7. Hyperprolactinemia and infertility endocrinology metabolism infertility. Blood for aprolactin level should be drawn, along with a tsh level, in any patient with ovulatory or menstrual disturbances, or. Diagnosis of hyperprolactinemia is based on a patients individual symptoms and medical history. The role of prolactin in male infertility has not yet been defined. Bronstein3 abstract the definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Hyperprolactinemia symptoms and treatment medical library. Hyperprolactinemia has to be ruled out to make the diagnosis of pcos. Its prevalence and the mean prl levels did not differ with 1 the infertility diagnosis, 2 the presence or absence of menstrual irregularities, or 3 the. It may be accompanied by galactorrhea, a milky or watery nipple discharge either spontaneously present or easily expressed. A prolactinoma is the most common cause of chronic hyperprolactinemia after pregnancy, primary hypothyroidism, and drugs. It has been reported that 48%93% of premenopausal women and 42%47% of men taking antipsychotic medications have hyperprolactinemia3.