Prolactin is a biologically active substance, a lactogenic hormone or mammotropin. Already in the title reflects the most striking effect of increasing its level – lactation, that is, the release of milk from the breasts, which usually appears in women after childbirth.
It is synthesized primarily in the pituitary gland and its main function is to stimulate lactation. It is also a stress hormone and is produced in large quantities by overstressing, injuries, chronic diseases and, possibly, has other functions that remain unexplored.
A moderate increase in prolactin occurs in many life situations that happen to us daily: during sleep, during sexual intercourse, physical exertion and stress, in women – during any stimulation of the mammary glands. A natural increase in the level of prolactin in the blood is not a disease and does not require treatment. On the other hand, an increase in prolactin concentration may be a sign of functional hyperprolactinemia and signal serious problems in the body.
But only a doctor can distinguish the norm from the disease. Therefore, in case of detection of elevated levels of prolactin in the blood, consultation of an endocrinologist and additional examination are required.
In women, prolactin is a hormone responsible for stimulating and maintaining lactation in women. This is the only known function of prolactin in a healthy and well-existing body.
The rest of its effects are related to diseases or are consequences of other deviations.
Prolactin in men in a normal, healthy body does not perform any known tasks. A significant increase in the content of this hormone in the blood can lead to a decrease in the production of male sex hormones, a decrease in sexual desire, erectile dysfunction and infertility.
Different laboratories indicate different units of measurement and the normal range of prolactin levels may vary greatly. The most common “standard” units of measure are honey / l.
When used, the content of prolactin should not exceed 400 mU / L. An increase in the range of 1000 mU / l is insignificant, with a value of 1000–2000 mU / l, it is necessary to alert and consult a doctor, more than 5000 mU / l is the level that occurs in pituitary tumors.
Often, prolactin levels are measured in ng / ml. In this case, its normal value is about 30 ng / ml.
The level of prolactin in women is highly dependent on the phase of the menstrual cycle. All of these norms relate to the first phase – the period from 2 to 7 day of the cycle.
Norms for other phases of prolactin does not exist, so his study in the middle or at the end of the cycle is not always correct in essence.
In men, the level of prolactin is stable and practically does not change.
If prolactin is elevated in a woman, the reasons may lie in the natural physiological processes in her body. A moderate (as a rule, less than 1000 mU / l) increase in prolactin in women occurs when:
- postpartum period and during breastfeeding (may last more than 1 year);
- breast stimulation (breastfeeding, injury or intimate relationships).
A natural moderate increase in prolactin in men and in women (as well as in children) can occur when:
- physical (active training, trauma) or psychological stress (for children it is often the procedure of blood sampling from a vein itself);
- food intake – after eating the level of prolactin increases.
A moderate and sometimes significant increase in prolactin levels can be the result of disease. Such hyperprolactinemia is called secondary, and its “seriousness” and the need for treatment depend on the presence of symptoms of hyperprolactinemia itself. Diseases that can cause a secondary increase in prolactin include:
- hypothyroidism (deficiency of thyroid hormones);
- polycystic ovary syndrome in women;
- chronic severe liver and kidney disease;
- celiac disease (gluten protein intolerance).
Also, prolactin may increase when taking certain medications, including sex hormones and antidepressants, as well as accompanying various serious injuries, such as fractures, conditions after irradiation, after radiation or chemotherapy, after an attack of seizures, etc.
Doctors call a significant increase in the level of prolactin in the blood, hyperprolactinemia. As a rule, we are talking about a pituitary tumor that secretes prolactin. The level of more than 1000-2000 IU / l can be attributed to a significant increase in prolactin.
In women, this leads to the suppression of the production of hormones that control the menstrual cycle (LH and FSH). As a result, menstruation becomes irregular or completely stopped.
Lactation may also occur, not related to childbirth.
Functional hyperprolactinemia in women is often associated with gynecological diseases, such as endometriosis, uterine myoma, PCOS (polycystic ovary syndrome).
In a strong half of humanity, hyperprolactinemia manifests itself differently. If prolactin is increased in men, it means that the production of testosterone, the main male sex hormone, can be reduced. In this process, the trigger is also a decrease in the secretion of LH and FSH, as in women.
The so-called “hypogonadotropic hypogonadism” is developing. As a rule, with hyperprolactinemia in men, there is erectile dysfunction and a decrease in sexual desire, infertility.
In children, an increase in prolactin is extremely rare. If this is a true increase in prolactin caused by a pituitary tumor, then its manifestations can be growth inhibition and sexual development.
In general, hyperprolactinemia is quite common. Among women diagnosed with infertility, it occurs in 9-17% of cases. Most often, this problem is detected in women 25-34 years.
But there are suggestions that, perhaps at this age, women simply go to doctors more often, because an excess of prolactin manifests itself in the form of menstrual disorders and problems with the onset of pregnancy.
The rarest cause of hyperprolactinemia is a pituitary tumor, or prolactinoma. At the same time, as a rule, there are small adenomas up to 1 cm in diameter – this is 90% of cases.
Another brain tumor can cause a significant increase in prolactin, which displaces the pituitary funnel (it structurally connects the hypothalamus and the pituitary gland). Prolactin increases, because it is through the funnel of the pituitary gland enters the substance dopamine, which suppresses the production of prolactin.
Prolactinomas can disappear with proper medication. In a third of women, they can pass on their own after the birth of a child or during menopause.
The revealed prolactin cannot be left without attention. Even if it is not found after long-term treatment, observation and periodic verification of the fact that the disease has not returned is required.
- in women – a violation of the menstrual cycle, discharge from the mammary glands, not associated with childbirth (galactorrhea);
- in men, erectile dysfunction, low testosterone levels (hypogonadism);
- children have delayed sexual development.
Regardless of gender, infertility, headache and visual defects (in case of suspected brain tumor), suspicion of any other pituitary tumor, prolonged use of psychotropic drugs.
In addition, there are many “minor” reasons for determining the level of this hormone, but then, to determine how necessary and appropriate to investigate the content of prolactin in the blood, it is necessary to consult with an endocrinologist.
If you plan to take a blood test for prolactin, be sure to follow these rules:
- the day before go to bed early and sleep for at least 8 hours;
- complete the meal by 20.00, avoid sports training, stressful situations, any stimulation of the mammary glands;
- on the eve of the analysis you should not have sex;
- it is desirable that about 1.5-2 hours pass between waking and blood sampling;
- analysis should be taken on an empty stomach, you can drink a few sips of water, but strong tea and coffee are excluded;
- do not smoke;
- for women – the analysis should be carried out from the 2nd to the 7th day of the menstrual cycle.
If a moderate (up to 1000 mU / l) increase in prolactin level is detected, the first step is to repeat the analysis. In this case, we can speak about the problem of hyperprolactinemia only after three tests, performed in accordance with all the rules: on an empty stomach, from the 2nd to the 7th day of the cycle (in women).
A significant increase (more than 2000 IU / l) in most cases requires an MRI scan of the brain.
It is carried out only together with the endocrinologist. Very often, a patient with an elevated prolactin level is observed by 2 doctors, for example, a gynecologist and an endocrinologist.
Not all cases of detection of increased content of prolactin, especially insignificant, require treatment.
If it is not associated with the intake of drugs, it is very rare. There are no direct consequences, however, such symptoms as well.
Hypoprolactinemia is described as a very rare disease, manifested exclusively by the absence of lactation. If the low content of prolactin is caused by a tumor of the anterior pituitary gland or some significant structural abnormality, then this condition will certainly have many clinical manifestations.
But these symptoms will be related to the deficiency of other hormones, not prolactin.
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