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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: | ||
* | * Prolactinoma (most common cause) | ||
* Damage to the hypothalamus and | * Damage to the hypothalamus or infundibulum | ||
* [[Hypothyroidism]] | |||
* Dopamine antagonist drugs (like [[antipsychotics]] and certain [[antiemetics]]) | |||
* [[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 == | ||
| Line 14: | Line 18: | ||
* Decreased gonadotropic effects | * Decreased gonadotropic effects | ||
** Hypogonadism | ** [[Hypogonadism]] | ||
** | ** [[Amenorrhoea]] | ||
** Infertility | ** [[Infertility]] | ||
** | ** [[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 | ||
== 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]] | ||