The gold standard for the diagnosis of hyperprolactinemia

Hyperprolactinemia is the most common disease in women. Symptoms are often clues to the disease. It is necessary to understand the patient's menstrual history, reproductive history, breastfeeding history, medication use, and changes in male sexual function in detail. It is also necessary to pay attention to whether the patient's disease is related to increased PRL levels. It is important to exclude physiological and pharmacological factors, and the cause of related diseases must also be preliminarily identified. Related tests can also be used to help diagnose the disease: serum PRL determination and PRL dynamic test, imaging examination, and endocrine function test.

(I) Symptoms are often clues to this disease:

It is also necessary to understand the patient's menstrual history, reproductive history, breastfeeding history, medication use, and changes in male sexual function in detail, and to note whether the patient's disease is related to increased PRL levels. It is important to exclude physiological and pharmacological factors, and the etiology of related diseases must also be preliminarily identified.

(II) Serum PRL determination and PRL dynamic test:

In non-prolactinoma-induced hyperPRLemia, PRL rarely exceeds 200ng/ml. Those with >200ng/ml are very likely to have PRL tumors. The larger the PRL tumor, the higher the PRL level, which may even exceed 2000ng/ml. Mild PRL increase (<60ng/ml) may be due to stress or pulse secretion peak. To avoid stress, blood can be collected for 3 consecutive days or 3 consecutive blood collections on the same day, each separated by 1 hour. In this way, the pulse peak can be excluded from the 3 serum measurement values, which is conducive to the judgment of high PRL secretion. Drugs that stimulate PRL secretion, such as TRH, metoclopramide, chlorpromazine, cimetidine, or drugs that inhibit PRL secretion, such as levodopa, can be selectively used to observe the dynamic changes of PRL. PRL tumors have no obvious changes or weakened reactions to the above stimulants and inhibitors, which can be used to distinguish idiopathic hyperPRLemia from RPL tumors, but when the PRL level is high, its identification value is small.

(III) Other endocrine function tests:

Thyroid function tests, gonadotropin, E2 and testosterone tests, GH and ACTH tests, DHEA tests, etc. should be performed in different situations to help determine the cause and condition of the disease.

(IV) Imaging examination:

See Pituitary Tumor and PRL Tumor.

Tips: You can also rely on the chlorpromazine test to confirm the diagnosis: chlorpromazine inhibits norepinephrine reabsorption and dopamine function through the receptor mechanism, and promotes PRL secretion. In normal women, after intramuscular injection of 25-50 mg of chlorpromazine, the blood PRL increases 1-2 times compared with before injection for 60-90 minutes, and lasts for 3 hours. It does not increase in pituitary tumors. In recent years, some people have used 11C-labeled dopamine D2 receptor antagonists methylspiperone and raclopride for PET imaging, which is not only of diagnostic significance, but also can predict the efficacy of dopamine receptor agonists. Generally speaking, those who can be imaged respond well to dopamine receptor agonists.