Hyperprolactinaemia: Difference between revisions

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(Created page with "<section begin="pathophysiology" />'''Hyperprolactinaemia''' is the increased production of prolactin. It's a relatively rare disorder. == Etiology == hyperprolactinaemia occurs in: * Prolactinomas – prolactin-producing pituitary adenomas – most common cause * Damage to the hypothalamus and infundibular stalk – as this impairs the dopamine-mediated inhibition of prolactin * Hypothyroidism – as TRH stimulates prolactin * Dopamine antagonists * Chronic renal...")
 
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<section begin="pathophysiology" />'''Hyperprolactinaemia''' is the increased production of [[prolactin]]. It's a relatively rare disorder.
<section begin="pathophysiology" />'''Hyperprolactinaemia''' is the increased production of [[prolactin]]. It's a relatively rare disorder. Not all cases are patholohical, as it can occur physiologically in case of [[pregnancy]], nipple stimulation, and stress.


== Etiology ==
== Etiology ==
hyperprolactinaemia occurs in:
Pathological hyperprolactinaemia occurs in:


* Prolactinomas – prolactin-producing pituitary adenomas – most common cause
* Prolactinoma (most common cause)
* Damage to the hypothalamus and infundibular stalk – as this impairs the dopamine-mediated inhibition of prolactin
* Damage to the hypothalamus or infundibulum
* Hypothyroidism – as TRH stimulates prolactin
* [[Hypothyroidism]]
* Dopamine antagonists
* Dopamine antagonist drugs (like [[antipsychotics]] and certain [[antiemetics]])
* Chronic renal failure – due to decreased excretion
* [[Chronic kidney disease]] – due to decreased excretion
A prolactinoma is a prolactin-producing [[pituitary adenoma]]. Damage to the hypothalamus or infundibulum impairs the dopamine-mediated inhibition of prolactin. TRH stimulates prolactin, and so prolactin may be elevated in severe hypothyroidism. Dopamine antagonist drugs inhibit the dopamine D2 receptor, thereby inhibiting [[Dopamine|dopamine's]] inhibitory effects on prolactin secretion.
 
== Pathophysiology ==
As the level of prolactin is pathologically high the synthesis of dopamine is increased to attempt to inhibit prolactin synthesis. This is not sufficient or able to reduce the prolactin level back to normal. As a side effect of the increased dopamine synthesis, dopamine will suppress the production of [[GnRH]], which decreases [[LH]] and [[FSH]], which decreases [[androgen]] and [[oestrogen]] production.


== Clinical features ==
== Clinical features ==
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* Decreased gonadotropic effects
* Decreased gonadotropic effects
** Hypogonadism
** [[Hypogonadism]]
** Amenorrhea
** [[Amenorrhoea]]
** Infertility
** [[Infertility]]
** Gynecomastia
** [[Gynaecomastia]]
** Decreased libido
** Decreased libido
* Galactorrhoea – non-physiological milk discharge
* Galactorrhoea – non-physiological milk discharge
* Bilateral hemianopsia – if caused by a tumor which compresses the optic chiasm
* Bilateral [[hemianopsia]] – if caused by a tumor which compresses the optic chiasm
 
The cause of the decreased gonadotropic effects should be explained. As the level of prolactin is high will the body try to counteract this by producing more dopamine, which usually suppresses prolactin production. Dopamine fails to do this however, but it does suppress the production of GnRH, which decreases LH and FSH, which decreases testosterone and oestrogen production.


== Management ==
== Management ==
The treatment of choice is dopamine agonists and treating the underlying cause.<section end="pathophysiology" />
The treatment of choice is [[dopamine agonists]] and treating the underlying cause.<section end="pathophysiology" />
[[Category:Pathophysiology]]
[[Category:Pathophysiology]]

Latest revision as of 11:00, 8 May 2024

Hyperprolactinaemia is the increased production of prolactin. It's a relatively rare disorder. Not all cases are patholohical, as it can occur physiologically in case of pregnancy, nipple stimulation, and stress.

Etiology

Pathological hyperprolactinaemia occurs in:

A prolactinoma is a prolactin-producing pituitary adenoma. Damage to the hypothalamus or infundibulum impairs the dopamine-mediated inhibition of prolactin. TRH stimulates prolactin, and so prolactin may be elevated in severe hypothyroidism. Dopamine antagonist drugs inhibit the dopamine D2 receptor, thereby inhibiting dopamine's inhibitory effects on prolactin secretion.

Pathophysiology

As the level of prolactin is pathologically high the synthesis of dopamine is increased to attempt to inhibit prolactin synthesis. This is not sufficient or able to reduce the prolactin level back to normal. As a side effect of the increased dopamine synthesis, dopamine will suppress the production of GnRH, which decreases LH and FSH, which decreases androgen and oestrogen production.

Clinical features

The most common symptoms of hyperprolactinaemia are:

Management

The treatment of choice is dopamine agonists and treating the underlying cause.