Hyperprolactinemia, with these symptoms

Hyperprolactinemia can cause menstrual disorders in women. Menstruation becomes very infrequent and many women may experience amenorrhea. This can also lead to infertility. It requires timely diagnosis and treatment. During the examination, it is important to explain your medical history to the doctor to facilitate treatment.

1. Clinical manifestations

1. Menstrual disorders

Primary amenorrhea accounts for 4%, secondary amenorrhea accounts for 89%, oligomenorrhea accounts for 7%, functional uterine bleeding and luteal dysfunction accounts for 23% to 77%.

2. Breast leakage

Typical HPRL manifestations include amenorrhea-galactorrhea syndrome, which occurs in 20.84% ​​of non-tumor types and 70.58% of tumor types. Simple galactorrhea occurs in 63-83.55% of cases. Galactorrhea is overt or occurs when the breasts are squeezed. It is watery, serous, or milky. The breasts are mostly normal or accompanied by lobular hyperplasia or macromastia.

3. Infertility

70.71% are primary or secondary, caused by anovulation, corpus luteum deficiency or luteinized unruptured follicle syndrome (LUFS).

2. Diagnosis

1. Medical history

Emphasis should be placed on understanding menstrual history, marital history, the causes and triggers of amenorrhea and galactorrhea, systemic diseases, and history of drug treatment related to HPRL.

2. Physical examination

A full body examination should be performed to note the presence of acromegaly, myxedema, etc. A gynecological examination should be performed to understand whether the genitals and sexual characteristics are atrophic or have organic lesions. A breast examination should pay attention to size, shape, presence of lumps, inflammatory galactorrhea (gently squeeze the breasts with both hands), and the nature and amount of the discharge.

3. Endocrine function test

(I) Pituitary function: FSH and LH decrease, LH/FSH ratio increases, PRL increases ≥ 25ng/ml. It is generally believed that <100ng/ml is mostly functional, and ≥100mg/ml should be used to exclude PRL adenoma. The larger the tumor, the higher the PRL. For example, if the tumor diameter d≤5mm, PRL is 171±38ng/ml; d=5～10mm 206±29ng/ml; ≥10mm 485±158ng/ml. PRL may not increase when a giant adenoma is hemorrhagic and necrotic. It should be pointed out that the PRL radiotherapy kit currently used in clinical practice only measures small molecule PRL (MW25000), but cannot measure large/large molecule (MW5～100000) PRL. Therefore, in some patients with obvious clinical symptoms but normal PRL, the so-called occult hyperprolactinemia (occult hyperprolactinemia), that is, large/large molecule hyperprolactinemia, cannot be ruled out.

(ii) Ovarian function test: E2 and P decreased, and T increased.

(III) Thyroid function test: When HPRL is combined with hypothyroidism, TSH increases, while T3, T4, and PBI decrease.

(IV) Adrenal function test: When HPEL is combined with Cushing's disease and virilization symptoms, T, △4dione, DHT, DHEA, 17KS and plasma cortisol are elevated.

(V) Pancreatic function examination: When HPRL is combined with diabetes and acromegaly, insulin, blood sugar, glucagon and glucose tolerance test should be measured.