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Hyperprolactinaemia: a Monster Between the Woman and Her Conception *Seriki A

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Hyperprolactinaemia: a Monster Between the Woman and Her Conception *Seriki A Archives of Reproductive Medicine and Sexual Health ISSN: 2639-1791 Volume 1, Issue 2, 2018, PP: 61-67 Hyperprolactinaemia: A Monster Between the Woman and Her Conception *Seriki A. Samuel1, Odetola O. Anthony2 1Department of Human Physiology, College of Medicine, Bingham University, Karu, Nigeria. 2Department of Human Physiology, College Medical Sciences, NnamdiAzikwe University, Awka, Nigeria. [email protected] *Corresponding Author: Seriki A. Samuel, Department of Human Physiology, College of Medicine, Bingham University, Karu, Nigeria. Abstract Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Normal levels are less than 5000 ml U/L [20ng/mL or µg/L] for women, and less than 450 ml U/L for men.Prolactin is a peptide hormone produced by the adenohypophysis (also called anterior pituitary) that is primarily associated with milk production and plays a vital role in breast development during pregnancy. Hyperprolactinaemia may cause galactorrhea (production and sp; ontaneous ejection of breast milk without pregnancy or childbirth). It also alters/disrupts the normal menstrual cycle in women. In other women, menstruation may cease completely, resulting in infertility. In the man, it could causeerectile dysfunction.The present study is to review the pathophysiology of the abnormality in the woman, and how it relates to the functioning of the hypothalamo- hypophyseal-gonadal system. The article also looks at the effect of hyperprolactinaemia on the fertility of the woman, and attempts to proffer non-surgical remedy to the condition. Keywords: Galactorrhea, adenohypophysis,hypoestrogenism,prolactinoma, amenorrhoea, macroprolactin, microprolactin Introduction It is synthesized by the anterior pituitary lactotrophs and regulated by the hypothalamic–pituitary axis Hyperprolactinaemia, which is a high level of through the release of dopamine, which acts as a prolactin in the blood can be a part of normal prolactin inhibitory factor[2]. physiological changes in the body during pregnancy and breastfeeding. Pathologically, it can be caused During pregnancy and lactation there is considerable by diseases a hypothalamus and pituitary hyperplasia of lactotrophs, resulting in up to a ten- gland. It may also be caused by disruption of the fold increase in the circulating levels of prolactin. normal regulationffecting of the prolactin levels by drugs, medicinal herbs and heavy metals inside the body. pregnancy, predominantly the change in estrogen Hyperprolactinaemia may also be the result of disease levels.This effect Subsequently, is secondary prolactin to the levels hormonal return tochanges baseline of of other organs such as the liver, kidneys, ovaries and concentrations within 6 months of delivery [3]. thyroid[1]. Dopamine is the predominant physiological prolactin The pituitary gland is a small bean-shaped gland inhibitory factor[2]. situated at the base of the brain. Despite its small size, Approximately 80–90% of prolactin is monomeric (23 human body. Its hormones help regulate important kDa), and this is its most potent biological form; 8–20% functionsthe pituitary such gland as growth, influences metabolism, nearly every blood part pressure of the is dimeric (45–50 kDa); and 1–5% is polymeric (150 and reproduction. Prolactin is one of thehormones. kDa). The latter fraction is called macroprolactin[4]. Prolactin is a single-chain polypeptide hormone which In women, a high blood level of prolactin often causes hypoestrogenism (low level of oestrogen in the hasArchives effects of onReproductive reproduction, Medicine lactation andand Sexualmetabolism. Health V1 . I2 . 2018 61 Hyperprolactinaemia: A Monster Between the Woman and Her Conception blood) with anovulatoryinfertility and a decrease in Likewise, an abnormality of a division of the pituitary menstruation. In some women, menstruation may stalk could also cause hyperprolactinaemia. Other disappear altogether (amenorrhoea). In others, causes include chronic renal failure, hypothyroidism, bronchogenic carcinoma and sarcoidosis. Some may change. Women who are not pregnant or nursing women with polycystic ovary syndrome may have maymenstruation begin producing may become breast irregular mil kor. menstrualSome women flow mildly-elevated prolactin levels. may experience a loss of libido (interest in sex) and Non-puerperal mastitis may induce transient breast pain, especially when prolactin levels begin hyperprolactinemia (neurogenic hyperprolactinemia) of about three weeks’ duration; conversely, tissue changes in the breast. Intercourse may become hyperprolactinemia may contribute to non-puerperal to rise for the first time, as thevaginal hormone drynes promotess due mastitis[5]. to hypoestrogenism. Hyperprolactinaemia that is secondarydifficult or to painful pituitary because adenom ofa may cause headaches Prolactinoma could also be a tumor that develops in and visual blurredness caused by the enlarged the pituitary gland with an unknown cause. pituitary pressing against the adjacent optic chiasm. Apart from diagnosing hyperprolactinaemia and In men, the most common symptoms of hypopituitarism, prolactin levels are often checked hyperprolactinaemia are decreased libido, sexual seizure, dysfunction, erectile dysfunction, infertility, and when there is doubt as to whether they have had an gynecomastia. Seeing that men have no reliable epilepticby physicians seizur ine patients or a non-epileptic that have suffered seizure .a Shortly indicator such as menstruation to signal the problem, after epileptic seizures, prolactin levels often rise, many men with hyperprolactinaemia being caused whereas they are normal in non-epileptic seizures. by a pituitary adenoma may delay going to the doctor until they start having headaches or eye problems. Medical Causes They may not recognize a gradual loss of sexual Prolactin secretion in the pituitary is normally function or libido. suppressed by the brain chemical dopamine. Drugs Because of hypoestrogenism and hypoandrogenism, hyperprolactinaemia can lead to osteoporosis. or deplete dopamine storage in the brain may cause thethat pituitaryblock the to effectssecrete moreof dopamine prolactin. at Thesethe pituitary drugs Causes include the typical antipsychotics: phenothiazines such Physiological Causes as chlorpromazine (Thorazine), and butyrophenones such as haloperidol (Haldol); atypical antipsychotics Physiological (non-pathological) causes include: pregnancy, breastfeeding, and mental stress. such as risperidone (Risperdal) and paliperidone (Invega); gastroprokinetic drugs used to treat gastro- Pathological Causes x and medication-induced nausea Prolactinoma or other tumours arising in or near (such as that from chemotherapy). oesophageal reflu the pituitary — such as those that cause acromegaly In particular, the dopamine antagonists metoclopramide and domperidone are both powerful (hypothalamus) to the prolactin-secreting cells of prolactin stimulators and have been used to stimulate may block the flow of dopamine from the brain pituitary thereby hyperprolactimaemia. breast milk secretion for decades. However, since hyperprolactinaemia is a condition in which a non- prolactin is antagonized by dopamine and the body cancerous tumor (adenoma) of the pituitary gland in depends on the two being in balance, the risk of the brain overproduces the hormone prolactin. The prolactin stimulation is generally present with all drugs that deplete dopamine, either directly or — estrogen in women and testosterone in men. indirectly. major effect is decreased levels of some sex hormones Although prolactinoma isn’t life-threatening, it can Symptoms of Hyperprolactinaemia impair vision, cause infertility and produce other There may be no noticeable signs or symptoms hormone-producing tumor that can develop in the from prolactinoma. However, signs and symptoms pituitaryeffects. gland.Prolactinoma is the most common type of can result from excessive prolactin in your blood 62 Archives of Reproductive Medicine and Sexual Health V1 . I2 . 2018 Hyperprolactinaemia: A Monster Between the Woman and Her Conception (hyperprolactinemia) or from pressure on surrounding Risk Factors tissues from a large tumor. Because elevated prolactin Most prolactinomas occur in women between 20 and can disrupt the reproductive system (hypogonadism), 34 years old, but can occur in both sexes at any age. some of the signs and symptoms of prolactinoma are The disorder is rare in children. specificIn females, to females prolactinoma or males. can cause:Irregular menstrual periods (oligomenorrhea) or no menstrual periods (amenorrhea), Milky discharge from the breasts (galactorrhea) when not pregnant or breast- feeding, Painful intercourse due to vaginal dryness Acne and excessive body and facials, and hair growth (hirsutism). In males, prolactinoma can cause:Erectile dysfunction, Decreased body and facial hair, and enlarged breasts (gynecomastia) In both sexes, prolactinoma can cause:Low bone density, Reduction of other hormone production by the pituitary gland (hypopituitarism) as a result of tumor pressure, Loss of interest in sexual activities, Figure1. Showing the positions of the hypothalamus Headaches, and Visual disturbances, and Infertility and the pituitary gland Women tend to notice signs and symptoms earlier Complications than men do, when tumors are smaller in size, probably because they’re alerted by missed or Complications of prolactinoma may include: irregular menstrual periods. Men tend to notice signs • Vision loss. Left untreated,
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