In women, chronic hyperprolactinemia causes decreased bone mineral density, especially in the setting of significant hypoestrogenism. There are numerous reasons for both male and female infertility but many ways in which. Hyperprolactinemia is an extremely common disorder, especially among reproductive age women, affecting about onethird of infertile females. In men, an elevated prolactin level is suspected in the presence of erectile dysfunction, infertility, headaches, or vision problems. Otherwise hyperprolactinemia is often undiagnosed for the absence of specific symptoms. Hyperprolactinemia is a relatively common cause of menstrual abnormalities and infertility. Abnormal prolactin prl secretion is usually related to an idiopathic. Another term for high prolactin levels is hyperprolactinemia.
Lindsay, md, saint louis university family medicine residency, belleville. This hormone is made by the pituitary gland, which is located at the base of the brain. While hyperprolactinemia is a wellestablished cause of hh and infertility, the mechanisms of these effects are not well understood. Diagnosis and management of hyperprolactinemia cmaj. Mean prolactin level was 83 2 49 ngml range 46260 ngml. It may be accompanied by galactorrhea, a milky or watery nipple discharge.
Hyperprolactinemia, prolactin, mri, hypothyroidism, pituitary tumor, infertility hyperprolactinemia is the most common endocrine disorder of the hypothalamicpituitary axis. An expert infertility specialist would, however, keep the hyperprolactinemia analysis on her checklist to ensure timely and effective treatment. An excess of prolactin above a reference laboratorys upper limits, or biochemical hyperprolactinemia, can be identified in up to 10% of the population. Schenker hyperprolactinemia associated with male infertility or impotence was found in ten patients. Effect of bromocriptine treatment on male infertility associated with hyperprolactinemia n. If a nonpregnant woman has abnormally high levels of prolactin, it may cause her difficulty in becoming pregnant. Pat i e n t i n f o r m at i o n pituitary society. Hyperprolactinemia is a condition in which a person has higherthannormal levels of the hormone prolactin in the blood. Hyperprolactinemia hyperprolaktihneemeeuh is a condition in which a person has higherthannormal levels of the hormone prolactin prolaktin in the blood. The magnitude of the increase, however, is quite variable. Chronic hyperprolactinemia may present with osteopenia, reduced muscle mass, and decreased beard growth. Hyperprolactinemia, infertility, and hypothyroidism.
Hospital based analytical cross sectional study was conducted for 1. Hyperprolactinaemia is amongst the endocrine disorders known to influence male infertility. Effect of bromocriptine treatment on male infertility. Elevated prolactin levels, or hyperprolactinemia, is among common causes of infertility affecting men, but more often women. Implications and future directions the study by sonigo et al. Hyperprolactinaemia in men is defined by the presence of a high serum prolactin level of 15 gl. She became pregnant within a month following institution of levothyroxine replacement, and the pituitary enlargement. Hyperprolactinemia is the most common cause of hypogonadotropic anovulation and is one of the leading causes of infertility in women aged 2534. When this happens, a woman might have trouble getting pregnant or her breasts may start producing milk outside of pregnancy galactorrhea. Careful clinical evaluation, focused laboratory testing, and in many cases, pituitary imaging are important for elucidating the underlying cause of hyperprolactinemia and guiding appropriate patient management. There is higher incidence of hyperprolactinemia among infertile females.
Prevalence of hyperprolactinemia in infertile women and its. In young women, hyperprolactinemia is probably one of the most common endocrine disorders related to pituitary function. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Prolactin also affects the levels of sex hormones estrogen and testosterone in both. So estimation of serum prolactin should be done at an early stage of. It is estimated to occur in 9%17% of women with reproductive disorders 1, 2. Galactorrhea, hyperprolactinemia, infertility, menstrual abnormality, prevalence how to cite this article. Women who are not pregnant and are not breastfeeding should have low levels of prolactin.
Over time, the patient may have diminished energy, reduced muscle mass, and increased risk of osteopenia. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities andor galactorrhea at a. In women, prolactin regulates periods and helps the breasts grow and produce milk. Hyperprolactinemia is when theres too much prolactin in a persons blood. Prevalence of hyperprolactinemia among patients with infertility. Clinical manifestations of hyperprolactinemia include hypogo. The occurrence of clinically apparent hyperprolactinemia depends on the study. Hyperprolactinemia is the most common endocrine disorder of the hypothalamuspituitary axis. Abnormal prolactin prl secretion is usually related to. Infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. Although relatively asymptomatic, she was found to have primary hypothyroidism. 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. A man with untreated hyperprolactinemia may make less sperm or. Normal levels are less than 500 miul 20 ngml or ugl for women, and less than 450 miul for men.
There is a paucity of data on the pattern of clinical presentation of hyperprolactinemia among infertile female patients in nigeria. Hyperprolactinemia has diverse causes, which may include physiological, pituitary, and systemic etiologies. Hyperprolactinemiaa significant factor in female infertility. Hypogonadism infertilitylike symptoms menstrual abnormalities such as amenorrhea or oligomenorrhea in women galactorrhea less often, but more common in women. Pituitary imaging is indicated for the evaluation of. Causes, symptoms, and treatment of hyperprolactinemia. Among the pharmacological treatments studied, aripiprazole switching or augmentation possessed the strongest evidence. Hyperprolactinemia is a disorder in which your pituitary gland produces excessive amounts of the hormone prolactin. Careful clinical evaluation, focused laboratory testing, and in many cases, pituitary imaging are important for elucidating the underlying cause of hyperprolactinemia and guiding. Prevalence of hyperprolactinemia among infertile patients.
Hyperprolactinaemia and female reproductive function. When this hormone is in excess, the chances of conceiving are lower than usual. In a retrospective study of 104 patients with hyperprolactinemia ages 30 to 44 years, the most commonly reported symptoms were infertility, headache, and. Polycystic ovarian syndrome pcos and hyperprolactinemia hprl are the two most common endocrine disorders in women of reproductive age. The task force consisted of endocrine societyappointed experts, a methodologist, and a medical writer. Management of hyperprolactinemic infertility article pdf available in the journal of reproductive medicine 4412 suppl. The probable cause of the hyperprolactinemia is the. Prolactin is a hormone produced by the brains pituitary gland. Pdf pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. A high level of prolactin reduces estrogen and interferes with ovulation. There is an absence of robust evidence for the management of antipsychoticinduced hyperprolactinemia. The prevalence of hyperprolactinemia ranges from 0.
Prolactin is a hormone that stimulates milk production in women. Prolactinoma is a benign noncancerous tumor of the pituitary gland that causes hyperprolactinemia. A paper published in november 2011 in current opinion in urology estimates that about 1 of every 10,000 men who visit a specialist in infertility or other sexual disorders has hyperprolactinemia, but its prevalence in the general population of men is. It is the most commonly diagnosed tumor type in the pituitary gland that affects hormone production. Therapy was initiated with bromocriptine, but it was poorly tolerated, with fatigue, nausea, and lightheadedness to the point of syncopal events during her work as a hairdresser. Prolactinoma causes a condition called hyperprolactinemia. Premenopausal women hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea.
Management of antipsychoticinduced hyperprolactinemia. Hyperprolactinemia is characterized by an increased production of the hormone prolactin. Hyperprolactinemia endocrinology jama jama network. She became pregnant within a month following institution of. Hyperprolactinemia and infertility endocrinology and metabolism. Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. While hyperprolactinemia is considered perfectly normal during pregnancy and breastfeeding, it can occur at other times due to disease and medication use. Normal levels are less than 500 miul milliinternational units per litre23. In men, hyperprolactinemia may present acutely with diminished libido and infertility. Hyperprolactinemia is a sign of underlying problems of infertility, menstrual irregularities, and sexual dysfunction. The first step in the evaluation is to draw a blood sample to determine the.
Oct 01, 2012 evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. It increases to 9% in women with amenorrhea and occurs in 25% of those with galactorrhea. Elevated prolactin may impact reproduction through inhibitory effects on hypothalamic gonadotropinreleasing hormone gnrh neurons and or on the pituitary gland to reduce secretion of the gonadotropins luteinizing hormone lh and folliclestimulating hormone. Nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event. Management of hyperprolactinemic infertility sciencedirect. A 30yearold woman presented with infertility, hyperprolactinemia, and pituitary enlargement. It can result from physiological or pathological conditions.
Hyperprolactinemia is a relatively common cause of secondary amenorrhea. The aim was to formulate practice guidelines for the diagnosis and treatment of hyperprolactinemia. Evaluation revealed hyperprolactinemia with serum prolactin of 90 ngml. Pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. Hyperprolactinaemia or hyperprolactinemia hp is the presence of abnormally high levels of prolactin in the blood. In men and premenopausal women, hyperprolactinemia presents with typical symptoms that include. Elevated prolactin may impact reproduction through inhibitory effects on hypothalamic gonadotropinreleasing hormone gnrh neurons andor on the pituitary gland to reduce secretion of the gonadotropins luteinizing hormone lh and folliclestimulating hormone. Hyperprolactinaemia and female reproductive function disconnection hyperprolactinaemia should be differentiated from a prolactinsecreting adenoma, to facilitate planning the appropriate therapy, as the former is unlikely to benefit from medical treatment. Hyperprolactinemia is also responsible for fertility problems in men, although the condition is diagnosed in men less often than in women. Hyperprolactinemia is suspected in women who have absent or irregular menstrual periods, abnormal breast discharge, or fertility issues.
Evaluation of hyperprolactinemia differential diagnosis of. Hyperprolactinemia can affect both women and men, resulting in irregular menstrual periods and erectile dysfunction, among other things. May 01, 2015 nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event of potential hyperprolactinemia, permitting greater. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, but rarely galactorrhea. Pdf management of hyperprolactinemic infertility researchgate. In men, high prolactin levels can cause galactorrhea, impotence inability to have an erection during sex, reduced desire for sex, and infertility. The mainstream treatment cant root out the disease. Hyperprolactinemia the journal of clinical endocrinology. Indeed, the prevalence of pcos is estimated at about 4 to 21% when the pcos is diagnosed according to the rotterdam criteria 1 and the prevalence of hprl was estimated at 4% in a cohort of female blood donors 2, and with an estimated incidence. Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and or galactorrhea at a university teaching hospital, north west nigeria. The prolactin is a hormone produced by the pituitary gland.
Diagnosis and treatment of hyperprolactinemia hyperprolactinemia is diagnosed using a simple blood test that measures the levels of prolactin. This evidencebased guideline was developed using the grading of recommendations, assessment, development, and evaluation grade system to. Jan 04, 2018 infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. Pharmacological treatments with less evidence encompassed dose reduction, switching to lower potency. Ninety percent of women with galactorrhea also have hyperprolactinemia. A man with untreated hyperprolactinemia may make less sperm or no sperm at all. It is also a signal of impending chronic diseases including breast cancer. Guidelines for antipsychoticinduced hyperprolactinemia. High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. Prolactin and infertility 149 hyperprolactinemia is commonly found in both female and male patients with abnormal sexual andor reproductive function or with galactorrhea.