How does hyperprolactinemia develop?

Hyperprolactinemia is not a very common disease, but once you have it, it is very scary. Hyperprolactinemia seriously affects the physical and mental health of patients, making them very painful. Next, let's take a look at how hyperprolactinemia is formed.

Hyperprolactinemia is the most common pituitary disease, with galactorrhea and hypogonadism as prominent manifestations. Hyperprolactinemia refers to a syndrome caused by internal and external environmental factors, characterized by elevated prolactin PRL>25ng/ml, amenorrhea, galactorrhea, anovulation and infertility. From the perspective of pathological changes, it can be divided into physiological hyperprolactinemia, pharmacological hyperprolactinemia, idiopathic hyperprolactinemia and pathological hyperprolactinemia. The main clinical features are amenorrhea, infertility and galactorrhea.

PRL secretion is regulated by the hypothalamic PRL releasing factor PRF and the PRL releasing inhibitory factor PIF. Under normal circumstances, the inhibitory regulation of PIF represented by dopamine DA is dominant. Any factors that interfere with the synthesis of hypothalamic DA, its transport to the pituitary gland, and the interaction between DA and PRL cell DA receptors can weaken the inhibitory regulation and cause high PRL blood disease. The causes can be summarized into four categories: physiological, pathological, pharmacological and idiopathic.

1. Physiological

Pregnancy, breastfeeding, nipple irritation, physical exercise, hypoglycemia, sleep, trauma, newborns

2. Pharmacology

Hyperprolactinemia PRF, such as long-term users of estrogen, oral contraceptives, TRH and VIP, dopamine antagonists, such as phenothiazines such as chlorpromazine, perphenazine and butyrophenones such as antipsychotics such as haloperidol, tricyclics such as imipramine, amitriptyline and monoamine oxidase inhibitors such as phenelzine and other antidepressants, reserpine, methyldopa, metoclopramide and sulpiride antiemetics, clopidogrel, opioid preparations, cimetidine and other H2 receptor blocking preparations for intravenous use; licorice, verapamil hydrochloride and some new drugs that affect PRL secretion, which are not yet known or well-known, can promote PRL secretion by antagonizing PIF and enhancing PRF or enhancing the effect of DA at the DA receptor level.

3. Pathological

Pituitary prolactinoma, hypothalamic or pituitary stalk lesions, brain and spinal cord radiation, chest wall lesions, spinal cord disease, hypothyroidism, chronic renal failure, severe liver disease.

4. Idiopathic

Those who do not belong to the above three categories have unknown reasons. Most of them have mild PRL elevation and a long course of disease, but they can return to normal. Some patients with menstrual disorders and PRL often higher than 100ng/ml need to be alert to the possibility of latent PRL microtumor. After follow-up, it can be found that PRL gradually increases, and positive changes in imaging reexamination can be confirmed.