How does hyperprolactinemia develop?

How is hyperprolactinemia formed? The occurrence of the disease often catches us off guard and is difficult to prevent. Hyperprolactinemia is one of the more common pituitary diseases, which has a great impact. Therefore, patients should learn more about the causes of the disease and do a good job of daily prevention. So, how is hyperprolactinemia formed?

1. Physiological hyperprolactinemia

Normal healthy women have elevated plasma prolactin levels at night and during sleep (2-6am), in the late follicular phase, and in the luteal phase. Plasma prolactin levels increase 5-10 times during pregnancy. Prolactin concentrations in amniotic fluid are higher than in plasma after the second trimester of pregnancy. In lactating women, plasma prolactin concentrations are 1 times higher than in the non-pregnant period. Plasma prolactin levels in fetuses and newborns (28 weeks of gestation to 2-3 weeks postpartum) are equivalent to maternal levels. Breast massage and nipple sucking reflexively promote prolactin secretion. Plasma prolactin levels remain high during the puerperium (within 4 weeks). Prolactin levels in non-lactating women drop to non-pregnant levels within 3 months. Prolactin levels increase significantly during fasting, insulin-induced hypoglycemia, exercise, stress, and sexual intercourse.

2. Pathological hyperprolactinemia

(1) Hypothalamic-pituitary lesions:

① Non-functional hypothalamic tumors: including craniopharyngioma, invasive hypothalamic lesions sarcoid disease, histiocytosis, glioma and leukemia.

② Functional pituitary tumors: including pituitary adenoma (80% secrete prolactin), prolactinoma, acromegaly (25% with hyperprolactinemia), Cushing's syndrome (adrenal ACTH adenoma, 10% with hyperprolactinemia), and prolactin cell hyperplasia (80% with hyperprolactinemia).

③ Functional hyperprolactinemia: caused by dopamine function inhibition, including primary vacuolar sella syndrome (5% accompanied by amenorrhea and galactorrhea syndrome) and secondary vacuolar sella syndrome (10% accompanied by hyperprolactinemia).

④ Inflammatory and destructive lesions: including meningitis, tuberculosis, syphilis, actinomycosis, injury, surgery, arteriovenous malformation, granulomatous disease; pituitary stalk lesions, injury or tumor compression.

⑤Mental trauma, stress and Parkinson's disease.

(2) Thyroid and adrenal gland diseases:

These include primary and secondary hypothyroidism, pseudohypoparathyroidism, and Hashimoto's thyroiditis. Adrenal diseases, including chronic kidney disease, Addison's disease, and chronic renal failure, can cause hyperprolactinemia.

In women of childbearing age, the main manifestation of hyperprolactinemic hypogonadism is decreased menstruation or even amenorrhea, but it can also be manifested as menorrhagia or normal menstruation with infertility. Male patients mainly show decreased libido and impotence. In severe cases, body hair loss, testicular atrophy, decreased sperm count and even azoospermia may occur. The harm is so great that everyone must actively seek treatment.