Hyperprolactinemic hypogonadism

Now there is a lot of data on the effect of prolactin on the human reproductive system. It is established that it actively affects the hormonal and spermatogenic functions of the testicles. In physiological conditions, prolactin stimulates the synthesis of testosterone. However, prolonged hyperprolactinemia disrupts its production in the testicles. A decrease in the level of this hormone in the plasma of patients with prolactinomas was revealed, and with prolonged treatment with antipsychotics increasing the secretion of prolactin in men, an inverse correlation between prolactin levels and testosterone in the plasma was noted. Hyperprolactinemia, which occurred in prepubertal and puberty periods, can lead to a delay in sexual development and hypogonadism. In the genesis of the disease, an important role belongs to the disruption of the conversion of testosterone to its most biologically active metabolite, dihydrotestosterone in peripheral tissues, which explains the clinical severity of androgen deficiency with a relatively small decrease in testosterone levels in plasma. With prolonged hyperprolactinemia, a decrease in the level of gonadotropins was also revealed in it. In the case of prolactinomas, the testicular tissue showed an atrophy of Leydig cells with preserved seminiferous tubules.

Usually, hyperprolactinaemia is combined with symptoms of hypogonadism, disappearance of sexual desire, gynecomastia, impaired spermatogenesis. Since the most common cause of the disease is the prolactin- producing adenoma of the pituitary gland - prolactinoma, then with a decrease in sexual activity in men in combination with signs of hypogonadism, it is necessary to perform an X-ray examination of the skull and fields of vision. The combination of a decrease in sexual activity with an increase in the Turkish saddle on an X-ray diffraction pattern is characteristic of prolactinoma. Microadenomas of the pituitary gland, as a rule, do not give an increase in the size of the Turkish saddle. In such cases, the diagnosis of plasma prolactin levels helps, which can be increased tens or even hundreds of times with prolactinomas. It is known that in 40% of patients with somatotropin-producing adenoma of the pituitary gland prolactin level in plasma is elevated. Sometimes, hyperprolactinaemia occurs in the case of Isenko-Cushing's disease. However, the level of prolactin in these diseases is not as high as with prolactinomas.

With volumetric processes in the hypothalamus, so-called hypothalamic hyperprolactinemia can occur, but the prolactin level is also not as high as with prolactinomas.

Hyperprolactinaemia is detected in a significant number of patients with primary hypothyroidism due to increased secretion of TRH - dysgormonal hyperprolactinemia.

It is proved that many drugs contribute to the development of hyperprolactinemia - drug hyperprolactinemia. Such drugs include: phenothiazine group (aminazine, haloperidol, etc.), antidepressants (amitriptyline, imipramine) and antihypertensives (reserpine, a-methyldopa).

Treatment of hyperprolactinemic hypogonadism. Currently, conservative and surgical methods are used. For treatment of non-tumor forms of hyperprolactinaemia, parlodel (bromocriptine) is most effective. Doses are selected under the control of prolactin levels in plasma. As a rule, doses of 5-7.5 mg (2-3 tablets a day) are effective. The use of drugs that reduce the secretion of prolactin (parlodel, metergoline, pergolide, lisinil, L-DOPA), is justified when there is a decrease in the level of prolactin in response to treatment. In a number of cases, combined therapy with parlodel and chorionic gonadotropin or androgens is advisable.

In tumorous forms of hyperprolactinaemia, sometimes, especially with narrowing of the visual fields, one must resort to removal of the pituitary adenoma by surgical means. After this, often there is panhypopituitarism. Then substitution therapy is prescribed by those hormones, the deficit of which appeared after the operation (chorionic gonadotropin, thyroidin, etc.).

With hyperprolactinaemia associated with hypothyroidism, treatment with thyroid medications usually leads to a decrease in the level of prolactin in the plasma and the restoration of sexual functions. When there is drug prolactinemia, drugs should be discontinued that caused an increase in plasma prolactin levels.

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