prolactinIt is a hormone whose main function in the body is to produce milk and is secreted from the region of the brain called the pituitary. Its normal value in blood is 10-25 ng/ml. Apart from the pituitary gland, prolactin is also secreted in small amounts from the endometrium and myometrium (the inner lining of the uterus and the uterine muscle).
The release of prolactin depends on many factors. However, a substance called dopamine is mainly responsible for the release of prolactin. There are 5 different types of prolactin with different activities in the body. Another hormone called oxytocin is responsible for the release of produced milk from the nipples. Excess prolactin in the body causes milk secretion and menstrual irregularity. Sometimes, even if there are clinical complaints, hormone levels may be found to be normal in blood tests. Or the opposite may also be the case. In other words, although blood hormone levels are high, the patient has no clinical findings. Excess prolactin causes menstrual delay in one third of women. Again, 1/3 of women with high prolactin experience galactorrhea, that is, milk discharge from the breasts. Menstruation is normal in 1/3 of women with galactorrhea. Prolactin may cause menstrual delays and infertility by disrupting the release of hormones called GnRH, which play a role in menstruation. Prolactin level and clinical findings often do not parallel each other. Some women with high prolactin have a tumor called adenoma in the pituitary. However, this tumor is malignant, that is, it is not cancer. Tumors less than 10 mm in size are called microadenoma, and larger ones are called macroadenoma.
symptoms
The most common symptom of hyperprolactinemia is breast milk discharge and menstrual irregularity. There may also be complaints such as amenorrhea and infertility. Very large tumors may cause severe headaches and visual disturbances. Galactorrhea: Galactorrhea means inappropriate fluid discharge from the breasts. Most of the time, the fluid from the chest is white or colorless, but in some cases the fluid is yellow or green. In order for the fluid called galactorrhea to come out of the chest, pressure should be applied to the entire chest from the lower part of the nipple. It can be seen in one breast or both breasts. When the discomfort occurs in only one breast, it should be examined.
Conditions that cause galactorrhea include:
Excess estrogen (birth control pills, estrogen-secreting cysts, etc.)
long-term breastfeeding
some medications
stress
brain lesions
Thyroid hormone deficiency
pituitary adenoma
Pathological prolactin secretion such as myoma etc.
Amenorrhea: Absence of menstruation. It occurs in approximately 33% of women with high prolactin levels.
Infertility: High prolactin disrupts GnRH secretion, causing ovulation disorders and therefore infertility.
diagnosis The diagnosis of hyperprolactinemia, that is, excess prolactin in the blood, is made by examining the level of this hormone in the blood. When the level is found to be high, a head x-ray is first taken to determine whether there is an adenoma. If no deformation is detected in the bone structures, tomography or magnetic resonance imaging may be required. This is how the diagnosis is made. If hormone levels are not very high, there is no need for an additional diagnostic method other than blood hormone determination.
treatment If galactorrhea is the only problem, it usually does not require treatment. If prolactin is also found to be high, its level is important. If it is lower than 100 ng/ml, no further diagnostic method is required. It benefits from drug treatment. 80% of patients in whom the cause of infertility is determined to be high prolactin and the value is lower than 100, become pregnant with drug treatment. If the value is higher than 100 ng/ml, further examination is required. If microadenoma is found as a result of the films taken, drug treatment and follow-up alone are recommended. If values are greater than 100, surgery may be necessary.
Pregnancy and Prolactin
Starting from the 8th week of pregnancy, prolactin levels begin to increase in the blood and reach their highest level at term (200-400 ng/ml). Prolactin stimulates the growth of the breast and ensures the production of the substance called claustrum, also popularly known as the mouth, from the milk ducts during pregnancy. The progesterone hormone, which is found in high levels in the blood during pregnancy, literally prevents milk production. After birth, milk production begins as progesterone disappears from the environment. For this reason, it may take up to 72 hours for milk to come out after birth. In mothers who do not breastfeed, blood levels drop to normal pre-pregnancy levels within 7 days after birth. It is claimed that prolactin during pregnancy plays a role in the baby's lung development and prevents the baby from being perceived as a foreign body by the mother and expelled.