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  • Title: Hyperprolactinemia and hypogonadism in the human female.
    Author: Rolland R, Corbey RS.
    Journal: Eur J Obstet Gynecol Reprod Biol; 1977; 7(5):337-48. PubMed ID: 400856.
    Abstract:
    Prolactin is a mammotropic hormone essential for the initiation of lactation. It also influences ovarian function; during hyperprolactinemia hypogonadism occurs. This is true for pathological forms of hyperprolactinemia but also for the early puerperium when there is physiological hyperprolactinemia. Amenorrhea is a better parameter of hyperprolactinemia than galactorrhea. The mechanisms by which prolactin disrupts ovarian function are not as yet fully understood; it probably alters hypothalamic neurotransmitter content through a direct feedback mechanism resulting in a decrease of Gn-RH. However, the direct effect of prolactin-producing pituitary tumors on the capacity of the gonadotrophs or a direct interference of prolactin at the gonadal level are also possibilities. Hyperprolactinemia can be treated very effectively with bromocriptine and this drug appears to have become the favorite form of treatment. In the case of obvious tumors hypophysectomy is indicated. When there are smaller tumors irradiation of the pituitary gland previous to bromocriptine treatment may prevent expansion of the gland during subsequent pregnancy. In 1937 pure preparations of ovine prolactin became available. It was not until 1970 that it was clearly shown that prolactin existed as a hormone in humans. During the second and third trimesters of human pregnancy, prolactin is present in both fetal and maternal plasma at levels above 50 ng/ml; the maximum at term is about 100 ng/ml. This increase parallels that of 17beta-estradiol. In the postpartum period prolactin remains elevated for a longer period in lactating women. Pituitary prolactin release is under tonic inhibition by the prolactin inhibiting factor (PIF) produced within the hypothalamus. Dopamine is the msot important catecholamine regulating PIF. Increased prolactin levels may interfere with follicular maturation leading to hypogonadism. Usually pathological hyperprolactinemia is a sign of hypothalamic disorder or pituitary tumor. Bromocriptine, a dopamine receptor agonist, is a potent inhibitor of puerperal lactation through its blockade of pituitary prolactin release. The incidence of hyperprolactinemia in patients with secondary amenorrhea is 13-20% regardless of the presence of galactorrhea. High prolactin with blunted response to thyrotropin releasing hormone but with thyroid stimulating hormone response preserved indicates that the patient will respond to bromocriptine. Lowering of pituitary prolactin secretion can be achieved surgically, medically, by irradiation, or by a combination of these methods. Bromocriptine, 2.5 mg twice daily, has been used. Oral contraceptives have not been used along with bromocriptine therapy. IUDs have been recommended.
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