Treatment of hyperprolactinemia

Hyperprolactinemia is a condition in which the level of the hormone prolactin in the blood is elevated outside the periods of pregnancy and breastfeeding. This disorder may be associated with diseases of the pituitary gland, hormonal imbalance, the use of certain medications, or other factors.

Prolactin is often referred to as a female hormone, although it is also produced in men. It affects breast formation and the development of the mammary glands, and its main physiological function is to ensure lactation. During pregnancy, prolactin levels increase, preparing the woman’s body for breastfeeding, and remain elevated until the end of this period.

In addition, prolactin is involved in the development of oocytes, regulation of estrogen and progesterone secretion, the menstrual cycle, metabolism, and other processes. In men, the hormone affects spermatogenesis, sperm motility, and testosterone synthesis.

Hyperprolactinemia in women may be accompanied by menstrual cycle disorders, breast enlargement, and the appearance of colostrum. Hyperprolactinemia in men manifests in a similar way. If left untreated, the condition may lead to problems with conception and other disorders.

There are many causes of hyperprolactinemia. To determine them, a comprehensive diagnostic evaluation of the body is required.

All causes are divided into physiological and pathological. Physiological causes include pregnancy and lactation, stimulation of the mammary glands, sexual intercourse, intense physical exertion, emotional stress, and consumption of large amounts of protein-rich foods. In these cases, prolactin levels return to normal relatively quickly.

Pathological causes of hyperprolactinemia may include:

• neoplasms of the pituitary gland or hypothalamus;

• thyroid gland disorders;

• polycystic ovary syndrome;

• adrenal cortex insufficiency;

• chronic renal failure;

• chronic prostatitis;

• liver cirrhosis and certain other diseases.

Excessive prolactin production may also be caused by the use of hormonal, antihistamine, anticonvulsant medications, antidepressants, and some other drugs.

In rare cases, so-called idiopathic hyperprolactinemia occurs, when no probable causes of elevated prolactin levels are identified, but the hormone is nevertheless produced in excessive amounts.

In men, hyperprolactinemia may cause enlargement of the mammary glands and the appearance of discharge from them. Decreased libido is also considered a symptom. Without therapy, elevated prolactin levels may lead to impaired spermatogenesis and infertility.

When hormonal balance is disrupted, systemic dysfunction occurs in the body, which can result in the development of various diseases. In cases of hyperprolactinemia, it is important to address not only the symptoms and consequences of the condition, but also its underlying cause.

If left untreated, prolonged elevation of prolactin levels may lead to persistent reproductive dysfunction, including infertility in both women and men. Hormonal imbalance also increases the risk of metabolic disorders, osteoporosis, and psychoemotional disturbances.

In cases of hyperprolactinemia, it is important not only to reduce the manifestations of the condition but also to identify and eliminate the underlying cause of elevated prolactin levels.

Primary diagnosis of hyperprolactinemia is performed using laboratory blood tests. As a rule, they are repeated 2–3 times on different days to determine whether the elevated prolactin level is temporary and related to physiological processes.

Blood testing is recommended in the morning on an empty stomach at the beginning of the menstrual cycle. Prolactin concentration increases in the middle and at the end of the cycle. Men can undergo testing on any day.

To identify the cause of hyperprolactinemia, the physician may prescribe instrumental examinations and refer the patient for consultation with another specialist. For pituitary diagnostics, X-ray imaging, computed tomography (CT), or magnetic resonance imaging (MRI) may be performed. These examinations allow assessment of the structure of the pituitary gland and hypothalamus and help rule out the presence of neoplasms.

Additional examinations may also be prescribed depending on the symptoms of the disease and the presence of concomitant conditions.

To prevent hyperprolactinemia, it is recommended to avoid hormonal imbalance in the body and to promptly treat conditions that may trigger excessive prolactin production. Preventive measures may also include avoiding hormonal contraceptives and intrauterine devices, as they increase the risk of developing this condition.