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Hyperprolactinemia

Hyperprolactinemia, also known as galactorrhea, is inappropriate breast milk secretion. It generally occurs 3 to 6 months after the discontinuation of breast-feeding (usually after a first delivery).lt may also follow an abortion or may develop in a female who hasn't been pregnant; it rarely occurs in males. Normal ovulation is a complex process that requires many things to happen properly and at the correct time with the proper hormone levels. Often subtle hormonal imbalances or ovulation abnormalities result in decreased fertility.  One hormone imbalance that can affect fertility is prolactin levels. Excessive prolactin levels in nonpregnant women is known as hyperprolactinemia.

Hyperprolactinemia can create several problems including:

• inadequate progesterone production during luteal phase after ovulation
• irregular ovulation and menstruation
• absence of menstruation
• galactorrhea (breast milk production in non-nursing woman)

Causes of Hyperprolactinemia

Hyperprolactinemia usually develops in a person with increased prolactin secretion from the anterior pituitary gland, with possible abnormal patterns of secretion of growth hormone, thyroid hormone, and corticotropin. However, increased prolactin serum concentration doesn't always cause hyperprolactinemia.

Additional factors that may predpitate this disorder include:

• endogenous - pituitary (high inddence with chromophobe adenoma), ovarian, or adrenal twnors and hypothyroidism; in males, pituitary, testicular, or pineal gland twnors
• idiopathic - possibly from stress or anxiety, which causes neurogenic depression of the prolactin-inhibiting factor
• exogenous - breast stimulation, genital stimulation, or drugs (such as hormonal contraceptives, meprobamate, and phenothiazines).

Signs and symptoms of hyperprolactinemia

In the female with hyperprolactinemia, milk continues to flow after the 21-day period that's normal after weaning. Hyperprolactinemia may also be spontaneous and unrelated to normal lactation, or it may be caused by manual expression. Such abnormal flow is usually bilateral and may be accompanied by amenorrhea.

Diagnosis information

Characteristic clinical features and the patient history (including drug and sex histories) confirm hyperprolactinemia. Laboratory tests to help determine the cause include measurement of serum levels of prolactin, cortisol, thyroid-stimulating hormone, triiodothyronine, and thyroxine. A pregnancy test, computed tomography scan and, possibly, mammography may also be indicated.

Treatment of Hyperprolactinemia

Treatment varies according to the underlying cause and ranges from simple avoidance of precipitating exogenous factors, such as drugs, to treatment of twnors with surgery, radiation, or chemotherapy.

Therapy for idiopathic hyperprolactinemia depends on whether the patient plans to have more children. If she does, treatment usually consists ofbromocriptine; if she doesn't, oral estrogens (such as ethinyl estradiol) and progestins (such as progesterone) effectively treat this disorder. idiopathic hyperprolactinemia may recur after discontinuation of drug therapy. For patients with idiopathic hyperprolactinemia, medical therapy should be the mainstay. For patients whose condition is a result of other medical problems, it is usually enough to treat the underlying cause.

Special considerations

• Watch for central nervous system abnormalities, such as headache, falling vision, and dizziness.
• Maintain adequate fluid intake, especially if the patient has a fever. However, advise the patient to avoid tea, coffee, and certain tranquilizers that may aggravate engorgement.
• Instruct the patient to keep her breasts and nipples clean.
• Tell the patient who's taking bromocriptine to report nausea, vomiting, dyspepsia, loss of appetite, dizziness, fatigue, numbness, and hypotension. To prevent GI upset, advise her to eat small meals frequently and to take this drug with dry toast or crackers.after treatment with bromocriptine, milk secretion usually stops in 1 to 2 months, and menstruation recurs after 6 to 24 weeks.