HYPERPROLACTINEMIA

Prolactin inhibits GnRH pulse secretion. Gonadotropin levels are suppressed. Hyperprolactinemia inhibits ovarian steroidogenesis. Hyperprolactinemia causes secondary amenorrhea in about 30% of women. There is anovulation and hypogonodotropic hypagonadism.

PROLACTINOMA: -

Prolactin is a protein hormone having 199 amino acids with a molecular weight of 23,000 daltons. Prolactin has got various forms, called as “little” or (monomer), “big” (dimer) or “big big” (multimeric) prolactin (glycosylated form) respectively. Little prolactin (90%) has got more biological activity. Prolactin is synthesized and released primarily by the lactotrophs located in the anterior pituitary gland. Extrapituitary sites of PRL production include decidua, endometrium, lungs, etc. Prolactin secretion from the anterior pituitary is under the inhibitory control of dopamine. Dopamine is produced in the arcuate nucleus of the hypothalamus and is released in the portal hypophyseal vessels.

Hyperprolactinemia is commonly due to pituitary adenomas (microadenoma or macroadenoma). There are other various causes of hyperprolactinemia. Normal plasma level of prolactin is 1–20 ng/ml.

CAUSES OF HYPERPROLACTINEMIA

1. Physiological:-

• Stress and exercise (raised endogenous opioids)
•  
• Stimulation of nipples
• Sleep
• Idiopathic

1. Hypothalamus and pituitary:-

• Craniopharyngioma
• Tuberculosis
• Hypothyroidism
• Multiple endocrine disorder (Cushing’s syndrome, Acromegaly)
• Pituitary adenomas (Prolactinomas)
• Resection of pituitary stalk.

1. Drugs:-

• Phenothiazines
• Metoclopramide
• (↓) Decreased hypothalamic PIF
• Methyldopa
• Reserpine
• Antidepressants
• Estrogens

1. Others: -

• Renal failure
• Cirrhosis of liver
• (↓) Decreased PRL clearance
• (↑) Increased PRL production
• PCOS
• Idiopathic

DIAGNOSIS OF PITUITARY ADENOMAS:-

Prolactin level is more than 100 ng/ml is often associated with prolactinoma. Most of the adenomas are microadenoma (diameter less than 1 cm). “Coned down” and lateral views of the sella turcica by radiography can detect gross abnormalities, calcification of tumor. Microadenomas rarely progress to macroadenomas. Computerized tomography (CT) is helpful for macroadenomas. Magnetic resonance imaging (MRI) with better resolution is superior to CT. MRI has no radiation risk.Visual field examination is essential to detect any compression effect on the optic nerves.

HOMOEOPATHIC MANAGEMENT OF HYPERPROLACTINEMIA: -

Sepia:- For irregular periods and Amenorrhea. The symptoms are late periods, sometimes appearing in a gap of three to four months. They are also scanty. Before periods there is pain in abdomen and back.

Pulsatilla:- It is very beneficial for irregular periods and absence of periods. The menses are late and scanty where it is required. The menstrual flow also lasts for too short a time.

Asafoetida:- Well indicated when there is milk production in non-pregnant females. With this the breast is congested, distended, and swollen.

Cyclamen:- Useful for non-pregnant Females who have discharge of milk from their breasts. Swelling in breasts and a hard tensed sensation with pain may appear.