Prolactin: the norm in women, the causes of increased andlow hormone levels

Update: October 2018

Prolactin (PRL) is a hormone synthesized by the pituitary gland in extremely small
quantities. But even such a small level is having a colossal
effect on the entire body. It is important to know the rate of prolactin in the blood
women, as the causes of deviations from it can be very
serious.

Prolactin rate

It is noted that the amount of this hormone does not always reflect the strength
clinical manifestations. For example, women with severe
hyperprolactinemia can have regular menstruation, good
ability to conceive and bear a child, and a slight excess
norms can be combined with serious and unpleasant symptoms.

This phenomenon is associated with the existence of 4 different forms of the hormone:

  • �”Small” PRL
  • �”Big” PRL
  • macro PRL
  • glycosylated PRL

All of these forms affect target organs differently, so their
definition is crucial. Microprolactin is considered the most active.
it is he who causes all the external manifestations of hormonal failure.
Large forms of this substance are related, so almost
inactive.

Outside of pregnancy, the norm of the hormone prolactin in women does not exceed
20 ng / ml (600 iU / ml). A level rise to 1000µU / ml is considered
soft, insignificant. If hyperprolactinemia is detected
additionally prescribed analysis for macroprolactin. If his
the amount exceeds 60%, it means the bioactive PRL is only
40%, which may well fit into the norm. If macroprolactin
a little (less than 40%), then the active hormone still goes beyond
standards and requires further examination.

Prolactin during pregnancy

With the approach of the day of birth in the blood of the expectant mother rises
amount of estrogen. This, in turn, stimulates the synthesis of PRL,
the level of which increases several times, which is
absolute norm. Therefore, for women in the position of this analysis
not informative and it does not pass.

Nature has created such a mechanism so that by the time the baby is born
the mammary glands of the woman were ready to excrete milk. Maximum
PRL is increased at 25 weeks, before childbirth is somewhat reduced. WITH
prolactin level increases in response to breast lumping
on nipple stimulation.

Hormone functions

Prolactin has many different effects on female
an organism. This is not surprising, because the receptors for it are in dairy
glands, ovaries, uterus, placenta, liver, eyes, lymphatic and
immune cells, brain, kidney, adrenal glands, intestines and
pancreas.

Effects of PRL:

  • Prepares mammary glands for lactation
  • WITHтимулирует синтез молока после родов
  • In the second phase of the cycle, the yellow function is maintained.
    progesterone producing body
  • Takes part in the ovulation process
  • Regulates the composition and volume of amniotic fluid
  • Has immune properties

WITHимптомы гиперпролактинемии

  • Violation of the menstrual cycle (rare menstruation or their
    absence)
  • Infertility (due to lack of ovulation or shortening 2
    cycle phases)
  • Galactorrhea (the release of milk from the breast) – found in 70%
    cases
  • Headache, loss of vision (with large tumors
    pituitary gland)
  • WITHнижение либидо
  • Acne, facial hair growth (in 20% of patients)
  • Osteoporosis
  • Ожирение (в 40-60% cases)
  • Депрессии, бессонница (в 20% cases гиперпролактинемии)
  • WITHнижение памяти

Causes of increased prolactin levels

Physiological

  • Exercise stress
  • WITHон
  • Starvation
  • WITHтресс
  • Gestation and lactation period
  • Sexual intercourse
  • Eating high in protein

Pathological

  • Diseases of the pituitary (often – prolactinoma)
  • Primary hypothyroidism
  • WITHиндром поликистозных яичников
  • Chest damage (surgery, shingles and
    others)
  • Idiopathic hyperprolactinemia (in the absence of visible
    reasons)
  • Chronic renal and hepatic failure
  • Diseases of the hypothalamus
  • Estrogen producing tumors

Medication intake

  • neuroleptics (haloperidol, aminazine)
  • antiemetic (tsirukal, moltilium)
  • reserpine
  • levodopa
  • opiate substances (morphine)
  • verapamil
  • hormonal contraceptives.

Physiological причины

The amount of hormone in each woman varies in
during the day. It is known that during sleep the PRL level increases,
starting from 60-90 minutes. It happens like during a night rest,
during daytime sleep, and after waking up, the amount of the hormone is dramatically
is falling. A slight rise is also noted during physical
load, sexual intercourse, and after consumption of protein foods.
WITHтрессовые реакции также способны повлиять на гормон, особенно в
combination with physical exposure (for example, fainting during
blood sampling – a guarantee of increasing PRL).

Diseases of the pituitary gland

Prolactinoma – a common pituitary tumor – is
The most common cause of high levels of PRL in the blood. Depending
its size is called microprolactinoma (less than 1 cm) or
macroprolactinoma (more than 1 cm). About a quarter of the population
of our planet there are undiagnosed micro-swelling of the pituitary,
which do not cause significant symptoms and may simply become
random find.

Most often, such adenoma is diagnosed in women aged
30-40 years. For female is characterized by precisely small size
neoplasms. In addition to impaired fertility, a tumor may
squeeze the visual pathways, leading to loss of vision, and also cause
headache and worsen the quality of life. Therefore, when proven
adenoma (prolactin is higher than normal due to microfraction, MRI –
tumor) Dostinex treatment or surgical removal is necessary
(rarely). When planning a pregnancy you need to take
Dostinex for a year, then with a successful attempt at conception
cancel the drug.

Other pituitary tumors

Any neoplasm blocking the path between the pituitary and
hypothalamus, can cause an increase in the concentration of PRL in the blood.
Sometimes they are all united under the term “pseudoprolactinoma”, although
вместе с пролактином повышается и количество других гормонов (WITHТГ,
ACTH). Most of them have their own characteristics on MRI and CT, but
the number of PRLs is much lower than in the case of the true
prolactinomas.

Primary hypothyroidism

WITHвязь между пониженной функцией щитовидной железы и повышением
BPD in the blood is still not precisely explained. But almost half
hypothyroidism patients present similar changes in analyzes.
After the start of replacement therapy, prolactin also comes in
the norm. We must not forget that hypothyroidism can safely
coexist with brain tumors and other pathologies.

WITHиндром поликистозных яичников

Классический случай WITHПКЯ включает в себя нарушения
menstrual cycle, ovarian cystic masses and elevated
androgen level. Но в 30-40% cases к этим признакам
hyperprolactinemia is added. The reasons for this relationship are not exactly
are known. Но при любом подозрении на WITHПКЯ необходимо сдать анализ
for prolactin and macroprolactin to prescribe the necessary treatment
(see polycystic ovary).

Chest Damage

It is known that various surgical interventions can
to increase the rate of PRL for a period of days
stomach) up to several months (during manipulations in the thoracic region
cells). The same effect occurs with shingles (virus
Herpes zoster), struck the skin of the upper torso. WITHвязано это
with enhanced nerve impulses from the damaged area to the brain.
The closer is the source of irritation to the mammary glands, the
these pulses are more intense and longer.

Idiopathic hyperprolactinemia

It happens that a moderate increase in the amount of hormone in the blood
(25-80 ng / ml) exists independently, without visible pathology
hypothalamus and pituitary. Such cases are called idiopathic.
(unreasonable). Most people with this form of the syndrome have
macroprolactinemia without needing treatment.

Diseases of the hypothalamus

The hypothalamus is one of the highest links in the endocrine system.
Therefore, any violation of its function leads to a change in the level of all
hormones, including PRL. Hyperprolactinemia may be
the result of hypothalamic tumors, craniopharyngiomas, gliomas,
inflammations in the brain, metastatic lesions and abnormal
development of blood vessels. A similar effect occurs with therapeutic
irradiation of the brain.

Estrogen producing tumors

Many tumors can secrete hormones. Among women
опухоли яичников часто синтезируют эстроген в больших quantities.
This leads to a regular increase in prolactin. Therefore, similar
changes in the analyzes – a reason to examine the pelvic area on
Ultrasound.

Medication intake

At times, prolactin in women is elevated when taking some
лекарственных средств: neuroleptics (haloperidol, aminazine),
antiemetic (tsirukal, moltilium), reserpine, levodopa, опиатных
веществ (морфин), verapamil, hormonal contraceptives.

Causes of Prolactin Reduction

  • Infarction of the pituitary gland after childbirth
  • Medication intake

Инфаркт гипофиза (WITHиндром Шихана)

During pregnancy, the pituitary gland of a woman increases in size,
but his blood supply is not improving. Therefore, massive blood loss
or a drop in pressure during labor can lead to a heart attack
important body. As a result, the pituitary dies
cells and hormone deficiency, including prolactin. In such
patients in the analysis of prolactin is reduced, so it is impossible to feed
baby breastfeeding. If the volume of the pituitary gland that has undergone necrosis
too large, then the woman will need replacement therapy.

Medication intake

Some drugs and substances can reduce the secretion of the hormone:
dopamine, pyridoxine, diuretics, nicotine. Last explains
breastfeeding problems when smoking when prolactin is lower
norms.

When do you need analysis for prolactin?

  • Menstrual disorders
  • Infertility
  • Galactorrhea
  • WITHнижение либидо
  • Delayed sexual development in girls
  • Neoplasm in the pituitary and hypothalamus (by
    CT scan, MRI)

How to pass the analysis?

Hormone levels are fairly sensitive to all external
influences, including stress, physical and nutritional stress.
Therefore, to exclude physiological hyperprolactinemia
pass the analysis three times. Taking blood is carried out in the morning
on an empty stomach

A day before the analysis, it is necessary to exclude sexual acts
exposure to heat (in the sauna, bath), intense training.
Immediately before the procedure, it is better to sit in a chair, relax
and calm down.

Additional examination

If the blood test showed three times that the number of PRL is not
corresponds to the norm, then usually carry out additional tests:

  • Anamnesis of medication
  • Evaluation of the thyroid gland (TSH, T4 free)
  • CT, MRI of the pituitary and hypothalamus
  • Ultrasound of the pelvic organs
  • Evaluation of the liver and kidneys (biochemical blood test,
    Ultrasound)
  • Гормональный профиль (ФWITHГ, андрогены, эстрадиол)

Any changes in a woman’s hormonal profile are indications of
further examination. If deviations are only in numbers on
the symptoms are completely absent, the treatment is likely
not required.

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