Hyperprolactinemia in men: hormonal cause of infertility. Hyperprolactinemia in men: symptoms and treatment

Hyperprolactinemia is a pathology of the endocrine system, in which the amount of the hormone prolactin in the blood serum significantly exceeds the norm (15–20 ng/ml).

Most often, this disorder is observed in women, however, men aged 25–45 years are not immune from it.

Since prolactin is involved in spermatogenesis, enhancing the effects of luteinizing and follicle-stimulating hormones, an increase in its level leads to impaired reproductive functions and male infertility.

Characteristic symptoms hyperprolactinemia in men is associated with the fact that due to an increase in prolactin levels, testosterone secretion decreases.

Therefore, the pathology manifests itself with the following symptoms:

• decreased potency and libido;
• decrease in the amount of ejaculate and inability to conceive a child;
• slight reduction in the testicles and penis;
• increase mammary glands(gynecomastia) and milk secretion;
• metabolic disorders and obesity;
• soreness and fragility bone tissue;
• headache, depression, insomnia, fatigue, memory and attention impairment;
• decreased visual acuity.

Sometimes the disease is characterized for a long time only by sexual dysfunction. In this case, incorrect diagnoses are often made.

If you have problems with potency, be sure to take a blood test for hormones.

Causes

Hyperprolactinemia can be long-term or short-term.

A short-term increase in prolactin levels can be associated with eating, sleeping, stress, sexual intercourse, or exercise. This condition does not last long and is not considered a pathology.

But prolonged hyperprolactinemia - serious illness, which is called by the whole series various reasons.

Physiological reasons:

• abuse of foods high in protein;
• chronic stress;
• lowering glucose levels in the body;
• surgical interventions.

Pathological reasons:

• injury, cyst or tumor in the pituitary gland or hypothalamus (prolactinoma, adenoma, craniopharyngioma, meningioma, glioma, germinoma);
• infectious diseases brain (encephalitis, meningitis, neurosyphilis);
• systemic diseases (sarcoidosis, lupus erythematosus);
• infiltrative and garnulomatous processes (tuberculosis, histiocytosis);
• diseases internal organs(liver cirrhosis, renal failure, prostatitis);
• endocrine pathologies (adrenal dysfunction, hypothyroidism).

Sometimes hyperprolactinemia develops as a result of taking certain groups of drugs: narcotics, dopamine blockers, antipsychotics, antidepressants, calcium antagonists or histamine receptors and antihypertensive drugs.

Most often, after stopping these drugs, the man’s condition returns to normal.

In some cases, the cause of the pathology cannot be identified. Then they talk about idiopathic hyperprolactinemia.

Consequences

If excess prolactin is not eliminated in a timely manner, a man will face the following complications:

• violations in endocrine system;
• infertility;
• loss of vision;
• osteoporosis.

Benign tumor, which caused the disease, can eventually transform into malignant. If the tumor is not treated in time, the disease will lead to death.

Diagnostics

It is not difficult to identify hyperprolactinemia and its causes.

It is enough to go through a series of studies:

• blood test for prolactin and hormone levels thyroid gland;
• MRI and CT of the brain;
• X-ray of the skull;
• Ultrasound of the prostate gland;
• fundus examination;
• functional tests with cerucal and thyroliberin.

According to research results, hyperprolactinemia is divided into two types: caused by tumors and non-tumor. Depending on this, treatment is selected.

Treatment

Treatment of hyperprolactinemia involves taking medications or surgical intervention.

Sometimes both methods are used in combination: before the operation, the patient undergoes a course of treatment with drugs that reduce the size of the tumor.

Drug treatment

Conservative drug therapy is aimed at normalizing prolactin levels in the blood and reducing the size of prolactinoma (if any).

The patient is prescribed the following ergoline and non-ergoline drugs that inhibit prolactin secretion:

• based on bromocriptine (“Bromocriptine”, “Lactodel”, “Parlodel”);
• based on cabergoline (“Dostinex”);
• "Abergyn";
• "Norprolac".

Products based on bromocriptine act faster than others, but have a lot of side effects.

The best remedy Dostinex is recognized as having a prolonged effect, a minimal number of side effects and greater effectiveness compared to other drugs.

Surgery

Surgery is indicated when hyperprolactinemia is caused by a large tumor that is rapidly growing, compresses the optic nerves, or is not amenable to drug treatment.

The same method is used to get rid of cysts and metastases.

The operation is performed through the nose. Usually it does not take much time and effectively removes the tumor.

A microtumor of the pituitary gland is successfully cured in 65–90% of cases, a macrotumor – in 3–40% of cases.

Treatment with folk remedies

However, there is no need to give up sedatives at all. herbal infusions: chamomile tea, decoction of valerian or motherwort, infusion of St. John's wort, hops or hawthorn. These remedies will relieve psycho-emotional stress, eliminate depression and insomnia, which will have a positive effect on general condition sick.

Prevention

To avoid the occurrence of hyperprolactinemia, a man should:

• give up bad habits;
• exclude casual sex to prevent sexually transmitted diseases;
• lead healthy image life and eating right;
• promptly treat infectious and inflammatory diseases;
• reduce psychological stress.

If symptoms appear that may indicate a violation of prolactin production, you need to be diagnosed by an endocrinologist. In this case, the disease can be captured initial stage and cure as quickly as possible.

Hyperprolactinemia is an increase in the concentration of prolactin in the blood, which can be both physiological and pathological in nature.

Prolactin is a peptide hormone produced by the anterior pituitary gland, belonging to the family of prolactin-like proteins. It is a single-chain polypeptide that consists of 199 amino acids. The main isoforms of the hormone circulating in the blood are small, large and very large, as well as glycosylated prolactin. Small has high biological activity, and large and very large have low; these forms of prolactin are characteristic of patients with adenomas, although they can also be found in healthy people. Due to the loss of disulfide bonds, large prolactin is able to turn into small prolactin.

Prolactin is produced by lactotrophic cells of the pituitary gland. The secretion of the hormone is influenced by the hypothalamus, the central nervous system also takes part in the production of prolactin, the immune system, mammary glands, placenta. Dopamine, a neurotransmitter produced primarily by the adrenal glands, and its agonists block the secretion of prolactin; prolactin, in turn, inhibits the production of dopamine. In addition, the secretion of prolactin in the pituitary gland is reduced under the influence of the hormones progesterone and somatostatin. These properties are used in the treatment of hyperprolactinemia.

In a woman’s body, prolactin stimulates the maturation of the egg, helps prolong the luteal phase of the menstrual cycle, and has an effect on the developing fetus. The main target organs of the hormone are the mammary glands. Prolactin stimulates the growth and development of the mammary glands, affects the lactation process, and promotes the conversion of colostrum into mature milk. In turn, irritation of the nipples according to the principle feedback stimulates the production of prolactin.

In the male body, prolactin affects sexual function, release of sex hormones, sperm motility. In addition, this hormone is an activator of new growth. blood vessels. In addition to the mammary glands, prolactin receptors are found in the uterus, ovaries, testicles, skeletal muscle tissue, heart, lungs, liver, pancreas, spleen, kidneys, adrenal glands, skin, and some parts nervous system, however, its effect on these organs has not been studied enough.

The production of prolactin depends on the emotional and physical state, sexual life, and lactation. The level of the hormone in the blood increases with injury and stress, as well as with the use of alcohol, narcotic and psychotropic drugs.

Violation of prolactin secretion is one of the most common reasons changes in menstrual function and concomitant infertility. In women, levels of prolactin in the blood change throughout the menstrual cycle. In addition, prolactin is characterized by daily fluctuations, with the lowest level of the hormone in the blood observed immediately after waking up, and the peak of production occurs between 5 and 7 am.

An increase in hormone levels is most often diagnosed in women aged 25–40 years. Hyperprolactinemia develops much less frequently in men.

Lack of adequate timely treatment pathological conditions that caused the development of hyperprolactinemia leads to further endocrine disorders.

Causes of hyperprolactinemia

The causes of hyperprolactinemia are divided into physiological and pathological. TO physiological reasons increase in the concentration of prolactin in the blood, in addition to pregnancy and breastfeeding, relate:

deep dream;

sexual intercourse;

consumption of certain foods (including alcoholic beverages);

stressful situations.

These factors cause a short-term increase in the level of prolactin in the blood.

The following conditions contribute to the development of pathological hyperprolactinemia:

• diseases associated with disruption of the hypothalamus (tuberculosis, neurosyphilis, malignant neoplasms, severe injuries, etc.);
• prolactin-secreting pituitary adenomas (prolactinomas) are the most common type of pituitary tumors;
• hyperfunction of the pituitary gland;
• systemic diseases (rheumatoid arthritis, systemic lupus erythematosus);
• ovarian dysfunction;
• chronic renal failure, hemodialysis;
• injuries (extensive burns, surgical interventions in the chest area);
• artificial termination of pregnancy;
• lack of vitamin B 6 in the body;
• taking a number of medications ( hormonal drugs, antidepressants, neuroleptics, adrenergic blockers); and etc.

Hyperprolactinemia in women often accompanies amenorrhea and infertility, and is also observed in 50% of women with galactorrhea.

Violation of prolactin secretion is one of the most common causes of changes in menstrual function and concomitant infertility.

Forms of hyperprolactinemia

Depending on the cause, hyperprolactinemia occurs:

• primary– due to pathological processes in the hypothalamus or pituitary gland;
• secondary– develops against the background of other diseases;
• idiopathic– the mechanism of development cannot be elucidated.

In addition, the following forms of pathology are distinguished by origin:

• asymptomatic hyperprolactinemia;
• hyperprolactinemic hypogonadism (prolactin-secreting pituitary adenomas, idiopathic forms);
• symptomatic hyperprolactinemia (alcohol, drug, psychogenic, neuro-reflex);
• extrapituitary secretion of prolactin;
• hyperprolactinemia against the background of other hypothalamic-pituitary diseases (empty sella syndrome, hormonally inactive sellar and parasellar neoplasms, cerebrovascular accident, syphilis, tuberculosis);
• combined forms of hyperprolactinemia.

Symptoms of hyperprolactinemia

In some cases clinical manifestations there is no hyperprolactinemia, and an elevated level of prolactin in the blood is an incidental diagnostic finding for another reason.

Source: prolactin-info.ru

In women, hyperprolactinemia usually begins to manifest clinically with the onset of sexual activity, use intrauterine contraceptives, cancellation of oral contraceptives, after childbirth, artificial or spontaneous termination of pregnancy, as well as at the end of breastfeeding.

Symptoms of hyperprolactinemia in women include menstrual irregularities ( irregular menstruation, amenorrhea, oligomenorrhea, hypomenorrhea, bradymenorrhea, opsomenorrhea, spaniomenorrhea), discharge of milk or colostrum from the mammary glands in the absence of pregnancy and lactation (galactorrhea). The severity of galactorrhea in women with hyperprolactinemia varies from single drops that are released with strong pressure on the mammary glands to copious spontaneous discharge. The color of the discharge may be white, yellowish, or opalescent. In addition, adenomas or cysts can form in the mammary glands.

Hyperprolactinemia in women often accompanies amenorrhea and infertility, and is also observed in 50% of women with galactorrhea.

Patients with hyperprolactinemia often develop acne, hirsutism (excessive body hair growth). male type), seborrhea of ​​the scalp, hypersalivation (increased salivation).

The development of neuroleptic hyperprolactinemia during pregnancy is dangerous if it is interrupted in the early or later and slowing of intrauterine growth and fetal development.

A manifestation of hyperprolactinemia can be hypoplasia of the genital organs (in particular, the ovaries), dryness of the mucous membrane of the vulva and vagina, which causes discomfort during sexual intercourse, thinning of hair under the arms and on the pubis, and reduction of the mammary glands.

Excessive production of prolactin in men causes a decrease in testosterone levels in the blood, which causes the development of gynecomastia, galactorrhea, and reproductive dysfunction (including erectile dysfunction, decreased libido). The number and motility of sperm decreases, pathological forms of sperm appear, which becomes the cause of infertility. In some cases, retrograde or painful ejaculation occurs.

In patients with hyperprolactinemia, it is not uncommon neurological disorders and psychoemotional disorders, disorders of bone tissue metabolism, lipid and carbohydrate metabolism. Psycho-emotional disorders that accompany hyperprolactinemia are usually manifested by asthenia, indifference, frequent mood swings, memory and attention disorders, psychonegative disorders, slowing of the associative process, increased irritability, a tendency to depression, reduced tolerance (even autism).

Patients may complain of persistent headaches, attacks of dizziness, decreased visual acuity, and narrowing of visual fields. Nonspecific complaints presented by patients with hyperprolactinemia also include weakness, increased fatigue, nagging pain in the chest without irradiation and clear localization. Such signs are especially often observed when an increase in prolactin concentration develops against the background of pituitary tumors. Such patients may experience liquorrhea, inflammatory processes in the sphenoid sinus, diplopia, ptosis, and ophthalmoplegia.

An increase in hormone levels is most often diagnosed in women aged 25–40 years.

Hyperprolactinemia often causes increased appetite, which leads to weight gain. In addition, this condition may be accompanied by insulin resistance, changes in blood lipid composition with the development of hypercholesterolemia, increased levels of very low-density and low-density lipoproteins and decreased lipoproteins high density. This causes an increased risk of developing coronary heart disease and/or arterial hypertension and type 2 diabetes.

With prolonged hyperprolactinemia, a decrease in bone mineral density occurs with the subsequent development of osteoporosis and osteopenia. Bone mineral density loss can reach 3.8% per year. Patients become susceptible to fractures, in particular fractures of the femoral neck, forearm, etc. While maintaining the menstrual cycle in women with hyperprolactinemia and normal estrogen levels, bone density does not change.

Manifestations of secondary hyperprolactinemia depend on the disease against which it developed. Irregular bursts of prolactin hypersecretion lead to swelling, enlargement and tenderness of the mammary glands.

Diagnostics

The main method for diagnosing hyperprolactinemia is to determine the level of prolactin and thyroid hormones in the patient's blood. Blood sampling to determine the concentration of prolactin should be carried out before 10 a.m., but not immediately after waking up and not after medical procedures.

Prolactin is characterized by daily fluctuations.

Patients should refrain from visiting the sauna and having sexual intercourse the day before the test. In women with a preserved menstrual cycle, blood sampling to determine prolactin levels is carried out between the 5th and 8th days of the cycle. To exclude a temporary increase in the level of this hormone, which is not pathological, repeated tests may be required. It should be taken into account that the stress associated with blood sampling can cause moderate hyperprolactinemia in emotionally labile patients.

In order to determine the cause of hyperprolactinemia, they resort to x-ray examination of the skull, computed tomography or magnetic resonance imaging, ophthalmological examination, including examination of the fundus and determination of visual fields. To diagnose the uterus and appendages, ultrasonography pelvic organs. If necessary, other studies are also carried out: mammography in women, determination of the level of prostate-specific antigen in men, general and biochemical tests of urine and blood, etc.

Treatment of hyperprolactinemia

Treatment for physiological hyperprolactinemia is not required. Treatment tactics for hyperprolactinemia pathological forms depends on its root cause. The goals of therapy for hyperprolactinemia are to reduce prolactin levels to normal values, restore reproductive and other impaired body functions. The first priority is to eliminate the factor that caused the development of the pathological condition.

Drug-induced hyperprolactinemia requires discontinuation of the drug that caused hormonal disturbances. In the event that an increase in prolactin levels occurred under the influence of taking psychotropic drugs, it may be necessary to reduce the dose of the drug, transfer the patient to a drug that does not have pronounced impact on prolactin levels or adding a dopamine receptor agonist to the drug taken.

Drug therapy for hyperprolactinemia includes the use of drugs that suppress prolactin production. In order to restore regular ovulatory menstrual cycles and the ability to conceive, dopamine receptor stimulants are prescribed, the use of which is indicated until the menstrual cycle normalizes. In some cases, to prevent relapses, it may be necessary to extend the course for several more menstrual cycles. Restoration of reproductive function during therapy that normalizes prolactin levels can occur quickly, so women who are not planning a pregnancy need to take care of contraception. In men, along with normalization of prolactin levels, testosterone levels are also normalized, and erectile function is restored.

For therapy increased anxiety, depressive states and psychovegetative disorders, in addition to dopamine receptor agonists, antidepressants and anticonvulsants can be used.

In the presence of prolactin-secreting pituitary adenomas, drug therapy is carried out. TO surgical interventions or radiation therapy for prolactinomas is rarely used, only for macroprolactinomas in case of ineffectiveness conservative therapy.

For hyperprolactinemia caused by hypothyroidism, it is prescribed replacement therapy thyroid hormones, this is enough to normalize prolactin levels in such patients.

Excessive prolactin production in patients with chronic renal failure is usually not corrected by hemodialysis, but on the contrary, may increase. In this case, the condition normalizes after kidney transplantation.

If the patient has tumors, cysts and other neoplasms, it may be advisable surgery and/or radiation therapy. The main indications for hypophysectomy (removal of the pituitary gland) are the absence positive effect from conservative therapy and the development of complications from visual system. In the postoperative period, the issue of prescribing replacement therapy is considered. hormone therapy, the need for which is determined by the results of a study of the state of the hypothalamic-pituitary system, determination of the concentration of testosterone and free thyroxine in blood.

During treatment mental disorders, occurring in some patients with hyperprolactinemia, there are difficulties with the use of psychopharmacological drugs, most of which help stimulate the production of prolactin. In this case, in addition to dopamine receptor agonists, antidepressants and anticonvulsants can be used to treat increased anxiety, depressive states and psychovegetative disorders.

Hyperprolactinemia in children

In newborns high level Prolactin is a physiological norm; by the end of the first month of life, its concentration in the blood corresponds to that of adults. Externally, this is manifested by enlargement (swelling) of the mammary glands. After a few months, the content of prolactin in the blood of children decreases.

Hyperprolactinemia in adolescents manifests itself in the form of delayed sexual development (hypogonadism, constitutional delayed sexual development, etc.). Reason increased output Prolactin in girls is often called prolactinoma. Boys often exhibit an idiopathic form of hyperprolactinemia.

Prevention

There is no specific prevention of hyperprolactinemia, since it can be caused by various factors and diseases. Measures to prevent it consist of prevention, timely identification and elimination of the cause.

Nonspecific preventive measures are general health measures:

• rejection of bad habits;
• regular physical activity;
• avoiding excessive physical and mental stress;
• normalization of sexual life, prevention of artificial termination of pregnancy, effective contraception;
• regular preventive examinations.

Consequences and complications

The lack of adequate timely treatment of pathological conditions that caused the development of hyperprolactinemia leads to further endocrine disorders (dysfunction of the thyroid gland, adrenal glands, ovaries, pituitary gland, etc.), infertility, anorgasmia, loss of vision, progression of neoplasms of the hypothalamus and pituitary gland, and the development of oncological pathologies of organs reproductive system, and in severe cases and to death.

Video from YouTube on the topic of the article:

The human body can be compared to a very complex mechanism, in which each screw must be in its place, performing its assigned function. Hormonal levels play a special role in ensuring the operation of this mechanism. Hormones regulate all processes in the body. If the production of any hormone is out of the norm, then the state of health deteriorates significantly. Take, for example, a hormone, how does excess production of it affect a person, as in case of need?

Prolactin and its functions

Prolactin is a hormone produced in the anterior lobe of the pituitary gland. IN medical literature Other names for this hormone are often found: lactotropic, luteotropic, lactogenic, mammotropic, and so on.

The production of prolactin is directly related to reproductive function. Breast growth in girls, the appearance of milk in nursing mothers, and maintenance of corpus luteum in a woman’s ovaries, the full formation of an embryo during pregnancy and much more. Is not full list, but from it one can already judge the importance of this hormone for humans. However, exceeding normal production also indicates health problems. What is the norm for such a hormone as prolactin? How to reduce its production if necessary?

Normal production rates for women

Prolactin production in women varies depending on the phase of the menstrual cycle:

• for the follicular phase, the norm is considered to be from 4.5 to 33 ng/ml;
• for the ovulatory phase normal value 6.3 - 49 ng/ml;
• for normal values ​​are from 4.9 to 40 ng/ml.

However, these values ​​only apply if the woman is not pregnant, since prolactin levels are significantly higher during pregnancy.

In what cases is it necessary to lower prolactin levels?

How should a person behave if his pituitary gland has exceeded the production of a hormone such as prolactin? How to lower its level, in what case is this necessary?

Exceeding the level of prolactin is hyperprolactinemia. Such a condition can have a physiological, pathological and pharmacological nature. Physiological increase- this is not a disease. The concentration of the hormone increases in the deep phase of sleep, during increased physical activity, during breastfeeding, sex, and due to prolonged stress. In this case, increasing the level of a hormone such as prolactin may be justified. It is not necessary to know how to lower this level, because the body will regulate it itself.

Pathological hyperprolactinemia is a completely different matter. In this case, an increase in the concentration of the hormone may be a symptom of various diseases of the pituitary gland, hypothalamus and other systems and organs.

The pharmacological nature of the increase in hormone levels may be associated with the use of antipsychotics, antiemetics, antihistamines, estrogens and other drugs.

But information on how to lower prolactin may be useful. Especially if the patient begins to experience some discomfort due to its level. A person must consciously avoid deteriorating the quality of life. It is advisable to consult qualified specialists in this regard.

Main symptoms in women

The question most often arises is how to lower prolactin in women? The main symptoms of excess prolactin concentration are:

• sharp enlargement of the mammary glands; in this case, the process can affect either both or one breast;
• milk secretion in non-lactating women;
• changes in the timing and duration of the menstrual cycle;
• weight gain, up to obesity;
• decreased sensitivity during sex, up to frigidity;
• increased hair growth in the nipple area, on the face, in the lower abdomen;
• deterioration of the hard tissues of the body. Frequent bone fractures, caries.

It is these symptoms that should make you visit a doctor and find out what is causing the change in hormonal levels. In addition to the prescribed treatment, you can use traditional medicine recipes, which give a lot of advice on how to lower prolactin in women. The main thing is to wisely combine medical and traditional therapy to successfully deal with the problem.

Why can't I get pregnant?

High prolactin levels may affect monthly cycle women. Often this indicator is the reason for the lack of ovulation, causing infertility. After examination, patients often face the question: how to lower prolactin in order to get pregnant?

For minor increases in concentration that are physiological in nature, it may be sufficient to change jobs to reduce physical activity, quit professional or amateur sports, calm down and avoid stressful situations. If the prolactin level is too high, then the cause is pathological, and it is necessary to overcome the underlying disease, growth-inducing hormone concentrations. Very often this involves surgical removal of tumors, followed by treatment.

ethnoscience

How to lower prolactin to get pregnant? Folk remedies in this case, aimed at stabilizing emotional state. First of all, it is necessary to overcome nervous tension and insomnia. In this case, a soothing mixture that contains mint, hops, valerian root, and a little motherwort helps a lot. The herbs are brewed like tea and drunk at night. The calming mixture may contain a little hawthorn and St. John's wort, but these herbs should not be used often.

Has an excellent anti-stress effect alcohol infusion twig It allows you to normalize mild imbalances and improves well-being due to the content of vitamins, organic acids and essential oils.

To remove nervous tension You can use decoctions and infusions of elderberry. You can also use homemade jelly and jelly from this berry.

However, it must always be remembered that ethnoscience will not help completely eliminate the problem, but will only slightly correct hormonal levels, so following medical prescriptions and following a daily routine is very important factors in the fight against elevated prolactin.

Prolactin in men

Many might think that prolactin is only present in female body. But this is a mistaken opinion. In the male body, this hormone also plays important role. Here it is also responsible for reproductive function, affects the formation of testosterone and the production of prostate secretion.

The question of how to lower prolactin in men arises in following cases:

• with atypical enlargement of the mammary glands;
• with increasing cases erectile dysfunction;
• if problems arise with conception due to decreased sperm motility;
• for frequent headaches with blurred vision.

The main reasons for increased prolactin in the body of men

High levels of prolactin in the blood of men can be concentrated in the following cases: tumors in the pituitary gland, taking antidepressants, taking drugs to lower blood pressure, irritation various kinds in the sternum area (surgical scars, uncomfortable underwear, skin diseases), the use of certain food products, stress, hypothyroidism and so on.

How to reduce Food should not contain too much protein. Eating should be regular, allow long fasting it is forbidden. Physical activity(hard work and sports) must be brought back to normal. Overvoltage should not be allowed. It is necessary to avoid stressful situations and calm agitated nerves. This can be done with the same set of herbs that are recommended for women (excluding hops). In addition, a man must follow a daily routine and be sure to get enough sleep, since insomnia also increases the concentration of prolactin.

If these measures do not lead to desired result, which means it is necessary to accept medicines, remove tumors and correct the functioning of the thyroid gland. You should not hesitate to consult a doctor, since only a doctor can determine why, how to lower its concentration and how to restore normal production.

Currently, there are many different diseases, among which hormonal disorders occupy an important place. Hormonal background both men and women, is unstable. It can change at a certain physiological state or if you have any diseases. Great importance has a condition called hyperprolactinemia. It is characterized increased content hormone prolactin in the blood. Each hormone in the body performs certain functions; there are norms for its concentration, the excess of which affects health.

An interesting fact is that prolactin is produced not only in the female body, but also in the male body. Undoubtedly, its concentration is several times less. Nevertheless, this hormone is involved in various processes, including the normalization of sexual function, which is very important for men. An increase in its concentration in the bloodstream is often observed, in which case hyperprolactinemia syndrome occurs. Under its mask, a serious pathology is often hidden, so when the first signs of the disease appear, it is necessary to urgently consult a doctor. Let us consider in more detail why hyperprolactinemia occurs in men, what is the etiology, clinical symptoms and treatment of this condition.

Prolactin and its importance for men

For male body Prolactin is very important. It contains a protein consisting of large quantity amino acids. There are 198 of them. Prolactin can be formed in 3 main forms: small, medium and large. The adenohypophysis promotes the release of this hormone. In the human body, dopamine is an inhibitor of prolactin. It reduces the concentration of prolactin when introduced into the cavity of the pituitary gland vessels. There are hormones that, on the contrary, increase its concentration in the blood. These include serotonin and thyrotropin.

Prolactin performs a number of functions in the male body important functions. Firstly, it regulates sexual function. Of great importance is that if its production is disrupted, erectile function suffers. Secondly, it affects the synthesis of sex hormones and male germ cells. Thirdly, it increases the body's resistance (immunity). Fourthly, the activity of spermatozoa largely depends on the concentration of prolactin, which is very important during fertilization. In addition, prolactin is involved in the regulation of water-salt metabolism.

What is the normal concentration of prolactin?

To associate the clinical signs that occur in men with hyperprolactinemia, it is necessary to know its normal content in the bloodstream. Its norm is very low and is only 2.5-17 ng/ml (75-515 µIU/l. It is important that increased levels of this hormone occur in medical practice much more often than reduced.

Conditions such as macroprolactinoma and microprolactinoma are distinguished. In the first case, the hormone level exceeds 200 ng/ml. Very often, eye function suffers. Microprolactinoma (idiopathic hyperprolactinemia) is characterized by a prolactin concentration of less than 200 ng/ml.

If the increase in concentration is moderate (40-85 ng/ml), then this indicates the development of carniopharynoma. Similar levels may be observed when taking certain medicines or with hypothyroidism. Hyperprolactinemia is often observed periodically. This may indicate the presence chronic diseases. An interesting fact is that prolactin production can change throughout the day. Wherein circadian rhythms are unable to control it. For example, hyperprolactinemia occurs when a person is sleeping. This can be at any time of the day. The level does not increase immediately, but 1-1.5 hours after the person falls asleep. Upon awakening, the level begins to decrease.

Etiology of hyperprolactinemia

The doctor must know not only the signs and treatment of this condition in men, but also be able to identify possible causes of hyperprolactinemia. The most important reasons are: various diseases pituitary gland and hypothalamus. Symptoms of hyperprolactinemia may indicate the presence of an infection. It could be encephalitis, meningitis. Play an important role traumatic injuries: irradiation, cerebral peduncle rupture, hemorrhage in the hypothalamus. The function of the hypothalamus may be impaired as a result of cirrhosis of the liver or renal failure.

As for hyperprolactinemia due to disruption of the pituitary gland, tumors (prolactinoma, mixed adenoma, somatotropinoma and others) are of primary importance. An increase in prolactin is possible with empty sella syndrome, craniopharyngo and some other pathological conditions. Hypothyroidism and herpetic lesions can often cause prolactinemia in men. Conventionally, hyperprolactinemia syndrome in men can be divided into several forms: caused by damage to the pituitary gland, hypothalamic origin and iatrogenic (drug-induced).

Drug-induced hyperprolactinemia

Symptoms of increased levels of the hormone prolactin may occur when taking certain medications. These include drugs from the group of antidepressants, such as Amitriptyline, Haloperidol, Imipramine. Calcium channel blockers, such as Verapamil, can have a similar effect. Dopamine blockers: Metaclopramide, Domperidone, various antipsychotics and phenothiazide drugs are of great importance in the development of hyperprolactinemia.

Symptoms of elevated prolactin levels can be observed when the body is exposed to histamine receptor blockers, such as Cimetidine. Opiates and cocaine preparations are of some importance. Separately, it is necessary to highlight such a medicine as “Thyroliberin”. Representatives of the group of adrenergic inhibitors, such as Reserpine, Carbidopa, and Methiodofa, can cause hyperprolactinemia in men.

Symptoms of hyperprolactinemia in men

In men, the signs of increased levels of prolactin in the bloodstream will differ from those in women. The most common manifestations of this condition are decreased libido and potency. Similar symptoms may occur psychogenic cause, therefore, the doctor must first exclude hyperprolactinemia in men. Osteoporosis is common. In men it is less pronounced than in women. If there is pathology of the pituitary gland (macroadenoma), men may experience headaches. In addition, with an increase in prolactin, in some cases, visual acuity decreases.

In some sick men, examination reveals gynecomastia. It is characterized by enlargement of the mammary glands. This symptoms in men it can be determined visually or by palpation. With hyperprolactinemia, true gynecomastia occurs, which is characterized by an increase in tissue volume. It can be physiological or develop against the background of existing diseases. There are 3 stages of gynecomastia: proliferating, intermediate and fibrous. The first is reversible.

Since prolactin is involved in sexual function, when its content is elevated, disturbances in erection and the production of germ cells (sperm) can become manifestations. These symptoms are very dangerous because infertility may develop. Less common manifestations in men are galactorrhea, bone pain, neurological symptoms. In some cases, symptoms may include weight gain and a rash. They are much less common.

Establishing diagnosis

To make a diagnosis of elevated prolactin levels, the doctor must collect an anamnesis, including the patient’s complaints, evaluate symptoms, laboratory results and instrumental studies. First of all, the doctor must conduct general examination. In the presence of changes in secondary sexual characteristics (gynecomastia, testicular changes), the diagnosis of hyperprolactinemia is most likely. The process of male development and puberty is of great importance. To identify pathology of the hypothalamic-pituitary system, a CT or MRI is performed. To rule out hypothyroidism, you will need to evaluate your hormone levels. thyroid gland(T3 and T4). Testosterone levels are of great value in determining hypogonadism.

Basic diagnostic sign- increased concentration of the hormone prolactin in the blood. For determining possible reason To increase the hormone, various tests and stimulation tests are carried out. They help to exclude the presence of a tumor and indicate the drug etiology of this condition in men. The most common is the test with thyrotropin-releasing hormone. It is done very simply. First, thyroliberin is administered at a dose of 200-500 mcg. This is done intravenously in the morning on an empty stomach. Blood must be taken from men before the drug is administered, after 15 minutes, half an hour, an hour and 2 hours.

Normally healthy man After about 15 minutes, an increase in prolactin levels is observed. The concentration increases by 2 times or more. If there is a tumor, the reaction will be weakened or may be completely absent. If there are other reasons, then the concentration of the test hormone increases by 100% or more, but this does not always occur. Along with this, a test with Metoclopramide can be used. It is a dopamine antagonist. In addition, sick men should be consulted by a neurologist and an ophthalmologist if there are visual symptoms.

Treatment of this condition in men is aimed primarily at eliminating the cause. If such an illness is caused by taking medications, then treatment with them must be stopped or replaced with other medications. Whatever the etiology, the main goal of treatment is to normalize prolactin levels and correct conditions such as lactorrhea and hypogonadism. In a situation where the nerves or organs of vision are affected, treatment is aimed at normalizing their activity. Today there are various drugs available to treat this hormonal disorder. One of the most effective is the drug “Parlodel”.

It is a dopamine receptor stimulant. It helps inhibit prolactin production without affecting other hormones. Take it orally while eating food, 1/2 tablet 2-3 times a day. In this case, the dose must be increased to 2-4 tablets per day, but not abruptly, but gradually. Treatment with this drug has contraindications. These include arterial hypertension, uncontrollable, high sensitivity of the male body to this tool, heavy mental disorders, ischemic disease hearts.

Along with it, treatment may include the use of the drug "Bromocriptine" and its analogues, "Distinex", "Abergin" and others. "Abergin" is an analogue of "Parlodel". It is very important that some men have resistance to the main drug for treatment. IN last years synthesized new drug, which is called "Norprolak". It has fewer side effects and is able to normalize the level of gonadotropic hormones. His daily dose is 0.05-0.175 mg.

Other treatments

Treatment includes more than just the use of medications. Surgery or radiotherapy may be used.

Surgery is indicated in cases where men have a large tumor that destroys the sella turcica, compresses the area of ​​the optic chiasm, or prolactinoma, which is resistant to drug therapy.

The effectiveness of treatment depends on the tumor itself. If it is microprolactinoma, then normalization hormonal status observed in approximately 60-90% of men; if macroprolactinoma occurs, then this figure decreases. Of great importance is that in the latter case there is a greater likelihood of developing hypopituitarism.

As for radiotherapy, this treatment method is complementary. It is shown in postoperative period or if drug therapy is insufficiently effective. Treatment of hyperprolactinemia should be individualized and aimed at eliminating the cause of its occurrence. Drug treatment It is recommended to do it at the very beginning, since most drugs act quickly.

In a situation where, after treatment in men, testosterone levels do not normalize (remain low), androgens are prescribed. Thus, hyperprolactinemia in males occurs rarely and can be dangerous due to its complications, in particular the development of infertility. For successful treatment it will be necessary to establish the underlying cause, since elevated prolactin levels are not a disease, but a syndrome that may conceal a more severe pathology.

Hyperprolactinemia– a condition characterized by an increased level of prolactin (PRL) in the blood. Among endocrine pathologies has a frequent manifestation, but occurs more often in women (about 7 times) than in men. This condition also called hyperprolactinemic hypogonadism, being one of the forms (not all authors agree with this classification).

The concentration of prolactin in a man’s blood should normally not exceed 15-20 ng/ml (400 mU/l). The basal (main) level is 7 ng/ml. However, depending on the laboratory taking the analysis, the upper permissible levels PRL may vary, but does not exceed 20-27 ng/ml.

Depending on the causes, the following forms of hyperprolactinemia are distinguished:

1. Physiological hyperprolactinemia, not associated with pathological changes and is a consequence natural increase hormone secretion due to:

• physical activity;
• stressful situations (correlation not proven);
• eating protein foods;
• medical and surgical interventions;
• hypoglycemia (low blood glucose).

2. Pathological hyperprolactinemia is a consequence of diseases and pathological changes in the body (tumors). The causes of pathological hyperprolactinemia can be:

• diseases and tumors of the hypothalamus and pituitary gland;
• primary hypothyroidism;
• chronic prostatitis;
• systemic lupus erythematosus;
• cirrhosis of the liver;
• dysfunction and disease of the adrenal glands;
• idiopathic hyperprolactinemia (when the reasons for the increase in PRL are not established).

3. Pharmacological hyperprolactinemia caused by taking medications:

• antihypertensive drugs (reserpine, methyldopa);
• antidepressants (sulprimide, amitriptyline, imipramine, doxepin);
• estrogen preparations;
• drugs (morphine, heroin, cocaine, amphetamines, hallucinogens);
• calcium antagonists (Verapamil);
• histamine H2 receptor antagonists (cimetidine, famotidine).

To determine the nature of treatment, it is customary to distinguish:

• Tumor (macro and microprolactinomas) hyperprolactinemia;
• Non-tumor hyperprolactinemia.

Clinical manifestation

In men, high prolactin levels are manifested by the following symptoms:

• Decreased or absent libido and potency (50-85%);
• Infertility due to (3-15%);
• Reduction of secondary sexual characteristics (2-21%);
• Gynecomastia (6-23%);
• Metabolic disorders (obesity, hypercholesterolemia);
• Osteopenia and bone pain (observed with prolonged hyperprolactinemia);
• Psycho-emotional disorders (depression, sleep disturbances, increased fatigue, memory loss).

Diagnostics

The main diagnostic marker is a three-time blood test for prolactin. Hormone analysis is carried out in different days, the interval between which is 7-10 days.

Hyperprolactinemia is diagnosed by the presence of elevated serum PRL concentrations in multiple samples that exceed 20 ng/mL or 400 mU/L.

The PRL level usually indicates the size of the prolactinoma:

– a PRL level of 200 ng/ml (4000 mU/l) is characteristic of macroprolactinoma;

– PRL level less than 200 ng/ml (4000 mU/l) may indicate the presence of microprolactinoma or idiopathic hyperprolactinemia;

– moderately elevated levels PRL (40-85 ng/ml or 800-1700 mU/l) is more often characteristic of craniopharyngioma, hypothyroidism, and drug-induced hyperprolactinemia;

– periodic increases PRL levels are not necessarily associated with the presence of a tumor, and may be due to a combination of two or more provoking factors (for example, when patients receive metoclopramide for renal failure).

To clarify the diagnosis you may need:

• MRI or CT of the hypothalamic-pituitary system to identify macro and microprolactinoma, craniopharyngioma;
• Examination of the fundus and visual fields, the pathology of which, as a rule, indicates macroprolactinoma;
• Ultrasound of the prostate gland.

Treatment

Treatment of hyperprolactinemia involves normalizing prolactin levels. Normalization of androgen levels with exogenous testosterone preparations is indicated only in cases where correction of hyperprolactinemia does not normalize androgen levels.

In case of pharmacological hyperprolactinemia, medications are discontinued, and after three days the test for prolactin is repeated.

The main form of treatment for hyperprolactinemia of any form is drug therapy. Drug therapy not only normalizes PRL levels, but also reduces the size of the tumor (prolactinoma), and when long-term treatment, in some cases, prolactinoma completely disappears.

Drug treatment

Ergot alkaloid derivatives (ergoline)
Bromocriptine preparations(Bromocriptine, Lactodel, Parlodel, Serocriptine, Apo-Bromocriptine, Bromergon) - until recently, was the only range of drugs in the treatment of hyperprolactinemia, but significant disadvantages in the form of a short half-life (3-4 hours) and severe side effects force many patients to refuse from its use. Up to 30% of patients are resistant to bromocriptine. Dosage Features: beginning with small doses(0.625-1.25 mg (1/4-1/2 tablet) at bedtime with food) increasing the dosage every 3-4 days by 0.625-1.25 mg until a dose of 2.5-7 mg is reached, taken fractionally 2-3 times during the day with meals. The dose is selected individually for each patient depending on the achieved PRL level.
Abergeen – domestic remedy, which has an inhibitory effect on BPD and does not affect normal level other pituitary hormones. Compared to bromocriptine, it has a longer PRL inhibitory effect. In terms of side effects, abergine is similar to bromocriptine, but has a less pronounced hypotonic effect. Dosage Features: similar to bromocriptine dosages.
Dostinex– long-acting drug. Is the "gold standard" in modern treatment hyperprolactinemia in men. Its advantages over bromocriptine drugs are due to greater efficiency, ease of use (2 times a week, instead of daily doses), as well as less severity and frequency of side effects. A decrease in plasma PRL levels is observed within 3 hours after administration and persists for 7-28 days. In addition to a decrease in hormone levels, a decrease in tumor is observed. Dosage Features: usually therapeutic dose is 0.5-1 mg (1-2 tablets) per week in 2 divided doses with meals, but doses can range from 0.25 to 4.5 mg per week.
Tricyclic benzoguanoline derivatives (non-ergoline)
Norprolac– long-acting oral non-ergoline dopamine antagonist. The clinical effect of the drug appears 2 hours after administration, and retains its effect for about 24 hours, which allows you to take the drug once a day. It is better tolerated than bromocriptine drugs. Dosage Features: the initial dosage is 0.025 mg for the first 3 days, 0.05 mg for the next 3 days, after which the dose is increased to 0.075 mg. Subsequent increases in dosage (if necessary) are carried out at weekly intervals.

Surgery

Surgical treatment is prescribed in the case of:

• when drug therapy is not effective (tumor immunity to dopamine inhibitors);
• patient's resistance to dopamine inhibitors;
• threat of vision loss.

You need to know that the recurrence rate of prolactinoma in patients within 6 years after surgery is 50%. Currently, due to the effectiveness of drug therapy, surgical treatment is rarely resorted to.

Medication and surgical therapy are not mutually exclusive methods and can be used in complex therapy, for example, drug therapy prior to surgery to reduce the size of the tumor for more convenient surgical access.

The operation, if successful, has the advantage of a one-step procedure, but, like any other surgical intervention, it has its complications.

Sources:

1. G.A. Melnichenko, E.I. Marova, L.K. Dzeranova, V.V. Wax " Hyperprolactinemia in women and men."

2. S.Yu. Kalinchenko, I.A. Tyuzikov"Practical andrology".