Hormones, as we have written before, are the chemical messengers of the body that control numerous functions and circulate through the blood to the organs and tissues. These components intervene in the processes of:
Hormones are created by the different glands (a set of cells whose function is to synthesize chemical substances) that humans have. One of them is the pituitary gland, which is located at the base of the skull and is responsible for controlling the activity of other glands and regulating certain functions of the body, such as development or sexual activity.
The pituitary produces several hormones that control the thyroid, ovaries, testicles, adrenal glands, and the hormone prolactin. Another hormone produced by the pituitary is PROLACTIN (PRL), which stimulates breast milk production during pregnancy and lactation. Prolactin secretion is controlled by a substance called dopamine that is produced in the brain.
In 1971, Dr. Henry G. Friesen demonstrated the identity of human prolactin (PRL) by isolating and purifying it, providing the basis for the development of a radioimmunoanalysis method that would allow the measurement of circulating PRL. It is appropriate to remember that at the beginning of the 1970s, the endocrinology laboratory, located at the Gynecology-Obstetrics Hospital 1 of the IMSS, implemented for the first time in Mexico the technique for determining PRL in serum. This was achieved thanks to the donation of PRL by the Pituitary Agency, NIH (Bethesda, USA) and the obtaining of the first antibody of the trial through the generosity of Professor Friesen as well as the technical recommendations during the visit made by doctors J. Soria and A. Zárate, to the laboratory in Manitoba, Canada.
In women, normal prolactin values are generally below 25ng/ml and in men it is less than 17ng/ml. It is called HYPERPROLACTINEMIA when the levels of prolactin in the blood are elevated.
There are two types of hyperprolactinemia:
The clinical manifestations of hyperprolactinemia are gender specific. Hyperprolactinemia is associated with hypogonadotropic hypogonadism in both sexes. Women generally present with oligo-amenorrhea and ANOVULATORY cycles (due to inhibition of pulsatile LH and FSH secretion), galactorrhea (due to the lactotropic effect of PRL), and infertility (caused by hypogonadotrophic hypogonadism).
Male hyperprolactinemia is generally characterized by impotence and loss of libido, gynecomastia, and galactorrhea (due to mammographic action of PRL), and infertility. However, in men, symptoms can be subtle and are often only diagnosed in advanced stages. Bone loss and progressive atherosclerosis due to an indirect decrease in estrogen secretion can also occur as a consequence of hypogonadism in both sexes. Furthermore, patients with hyperprolactinemia have altered body composition with increased fat mass and reduced lean mass. This latter finding is also in line with the known incidence of osteoporosis and osteopenia mainly due to secondary hypogonadism.
Elevated PRL levels, on the other hand, regulate the hypothalamic-pituitary-gonadal axis by directly inhibiting the release of GnRH leading to a decrease in LH, it also decreases estradiol levels in the middle of the follicular phase of the menstrual cycle, interrupting, the positive feedback of estrogen necessary for ovulation also directly decreases the production and secretion of progesterone and secretion of estradiol from the ovary, creating an anovulatory state that prevents the fertilization process.
Hyperprolactinemia has been reported to be responsible for 7-20% of female infertility. Even when menses are normal, infertility can occur due to luteal phase insufficiency. Noting that in those women with fertility problems with normal menstruation and hyperprolactinemia, a shortened luteal phase was the most commonly found. The goal in women with hyperprolactinemia who desire fertility is to achieve PRL in the normal range to allow ovulation.
In a study of 459 hyperprolactinemic women with more than 6 months of follow-up; Nearly three-quarters of women treated with cabergoline and just over half of them treated with bromocriptine began ovulating or became pregnant. Other studies have shown that approximately 90% of women with hyperprolactinemia will begin to ovulate with Dopamine Agonists.
There is no data to clarify whether achieving a PRL closer to the lower range than normal has an impact on fertility. It is important to know that the return of fertility can occur immediately, even before menstruation occurs.
There are also people who, despite receiving direct treatment for hyperprolactinemia and who reach the therapeutic goals of serum prolactin, will require assisted reproduction treatments to be able to have a baby.
At Instituto Ingenes we have the best group of specialists in Reproductive Biology, 18 years of experience solving the most complex fertility cases in Latin America, and a laboratory with cutting-edge technology to provide the patient with the precise diagnosis and appropriate treatment they need. Ingenes has branches in Mexico City, Guadalajara, Monterrey, Mérida, Puebla and Querétaro. Come with us and fulfill your greatest dream: your baby at home.
BIBLIOGRAFÍA
1.- Anne Klibanski Janet A. Schlechte. (01 ENERO 2010). Hyperprolactinemia. The Journal of Clinical Endocrinology & Metabolism, 95, E1. 23/062018, De www.hormone.org/Pituitary/overview.cfm Base de datos.
2.- Anna Capozzi, Giovanni Scambia, Alfredo Pontecorvi, and Stefano Lello. (6 Julio 2015). Hyperprolactinemia: pathophysiology and therapeutic approach. Gynecol Endocrinol, Early Online, 1, 1-5. 23/06/2018, De http://informahealthcare.com/gye Base de datos.
3.- Arturo Zárate. (abril-junio 2011). Hiperprolactinemia. Guía terapéutica y diagnóstica. Acta Médica Grupo Ángeles, 9, 92 - 95. 23/06/2018, De www.medigraphic.com/actamedica Base de datos.
4.- Cocks Eschler D, Javanmard P, Cox K, Geer EB. (2018). Prolactinoma through the female life cycle.. 23/062018, de PUBMED Sitio web: https://www.ncbi.nlm.nih.gov/pubmed/term=Prolactinoma+through+the+female+life+cycle
5.- Vilar L1, Freitas MC, Naves LA, Casulari LA, Azevedo M, Montenegro R Jr, Barros AI, Faria M, Nascimento GC, Lima JG, N'f3brega LH, Cruz TP, Mota A, Ramos A, Violante A, Lamounier Filho A, Gadelha MR, Czepielewski MA, Glezer A, Bronstein MD.. (MAYO 2008). Diagnosis and management of hyperprolactinemia: results of a Brazilian multicenter study with 1234 patients.. Journal Endocrinol Invest, 31, 5. 23/06/2018, De https://www.pituitarysociety.org/sites/all/pdfs/Pituitary_Society_Prolactinomas_ES.pdf Base de datos.
