Amenorrhea by hyperprolactinemia

J. Calaf Alsina, C. Vanrell Barbat

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Hyperprolactinemia is the most frequent disturbance of the hypothalamic and hypofiso-ovarian axis. It can present with a clear symptomatology such as amenorrheagalactorrea or be completely asymptomatic. This is due to the fact that hyperprolactinememia produces an alteration of the follicular development steroidogenesis, leading to chronic anovulation. Although the exact mechanism is still unknown it seems that the action takes place basically at the hypothalamus: the dopaminergic activity secondary to hiperprolactinemia, blocks the secretion of GnRH an therefore of the gonadal axis. The ethiology can be very diverse: 1) yatrogenic by the administration of antidopaminergic substances; 2) tumoral: prolactinomas; 3) reflex: stimulation of the reflex arc of lactation; 4) thyroidal in hypothyroidism; 5) secondary to hepatic or renal pathologies; 6) idiopathic or functional, in which the cause is till unknown. Although less frequent due to the improvement in the diagnostic techniques, is still the most frequent cause. The initial diagnosis of Hyperprolactinemia is based on the determination of prolactin. To elucidate its ethyology it is essential a precise anamnesis, other hormonal determinations (such as TSH) and image complementary studies (TAC or MRN) among others. The treatment will be selected mainly according to the ethiology. The majority of causes can be treated medically with dopaminergic drugs. The surgical treatment can be appropriate in some types of tumoral hyperprolactinemias, depending on the reproductive expectancies of the patients as well as the ethiology, size and location of the reproductive expectancies of the patient as well as the ethiology, size and localisation of the tumour. The possibilities are diverse and have to be individualised in each case. Hyperprolactinemia has a high incidence, the ethiologies are multiple and the possibilities of treatment wide and the majority effective, therefore it is a pathology that should be ruled out in every women in reproductive age with amenorrhea.
Original languageEnglish
Pages (from-to)97-119
JournalCuadernos de Medicina Reproductiva
Volume6
Issue number1
Publication statusPublished - 1 Jan 2000

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