Hyperprolactinemic Hypogonadism

What is Hyperprolactinemic Hypogonadism?

Hyperprolactinemic hypogonadism was isolated in a separate form of central hypogonadism only in recent years by the development of laboratory radioimmunological diagnostics in endocrinology.

Causes of Hypogonadism of Hyperprolactinemic

Syndrome of lactorrhea, gynecomastia and testicular hypoplasia in men with pituitary adenoma is known as O’Connell syndrome. Lactorrhea in men is most often a symptom of pituitary prolactinoma, rarely – the latter is not accompanied by lactorrhea and gynecomastia.

In recent years, special attention has been paid to the significant role of prolactin in the male body, whose hypo- and hyperproduction negatively affect the functions of the generative system. Hyperprolactinemia is associated with infertility and sexual disorders, and occurring in the pre- and puberty period leads to a delay in sexual development and hypogonadism.

The cause of hyperprolactinemia can be a pituitary gland tumor – prolactinoma, tumor processes in the hypothalamus (hypothalamic hyperprolactinemia), often hypothyroidism (dishormonal Hyperprolactinemia), very rarely – Itsenko-Cushing’s disease, the use of certain drugs (drug hyperprolactinemia-related hyperprolactinemia), and the pituitary gland with the shutdown of the mechanism that inhibits the factors of inhibition of prolactin. The absence of a tumor processor in the pituitary gland with hyperprolactinemia in some patients suggests the presence of microadenomas that secrete prolactin.

Pathogenesis during Hyperprolactinemic Hypogonadism

In the pathogenesis of hyperprolactinemic hypogonadism lies a violation under the influence of a prolonged excess of prolactin secretion and T metabolism, its transformation into DHT in the prostate gland and other target tissues, the gradual suppression of the secretory activity of testicular interstitial endocrinocytes, and in the future, violation of spermatogenesis. An essential link in hypoandrogenism in prolactinemia is the suppression of gonadotropin secretion. primarily LG. It is believed that in infertile men with hypogonadism and hyperprolactinemia, the nervous mechanism that regulates the pulse-like secretion of gonadotropin-releasing hormone is impaired.

Symptoms of Hyperprolactinemic Hypogonadism

Hyperprolactinemia that occurs in childhood and adolescence leads to delayed sexual development, underdevelopment of the genitals, secondary sexual characteristics and is accompanied by common symptoms that occur with T. deficiency. Lactorrhea is characteristic. Gynecomastia is optional. Hyperprolactinemia that occurs in an adult leads to a regression of primary, secondary and tertiary sexual characteristics, typical symptoms of hypoandrogenization, varying degrees of severity of lactorrhea, loss of sexual activity, infertility develop.

Diagnosis of Hyperprolactinemic Hypogonadism

In patients with hypogonadism, lactorrhea, it is necessary to determine the level of prolactin in the blood, which can be increased several times (and with prolactinoma, hundreds of times). The prolactin content can be increased with acromegaly, Itsenko-Cushing’s disease, some visceropathies, and in some cases of primary hypogonadism. However, this increase is not as high as with hyperprolactinemic syndrome.

Radiography of the skull and the study of visual fields are required. Identification of an increase in the Turkish saddle with a sharp increase in the level of PRL indicates a pituitary tumor (prolactinoma). A pituitary tumor leads to a narrowing of the visual fields.

In the diagnosis of hyperprolactinemia, a detailed history plays an important role: previous diseases and the nature of the treatment. The drugs that promote the development of hyperprolactinemia are the following: anti-depressants (imipramine, amitriptyline), antihypertensive drugs (reserpine, methyldopa), phenothiazine group (chlorpromazine, haloperidol).

Hyperprolactinemic Hypogonadism Treatment

The treatment method is determined by the cause of hyperprolactinemic hypogonadism. With drug hyperprolactinemia, doses are reduced or the drugs that caused the pathology are canceled, parlodel (bromocriptine), metergoline, pergolide, L-DOPA are prescribed under the control of the level of PRL in the blood plasma 2-3 tablets per day with a preliminary check for drug tolerance (1/2 tablet at night) and subject to a decrease under its influence the level of PRL. With severe hypogonadism, the simultaneous use of hCG or androgens is useful. Patients usually restore sexual activity and fertility. With hyperprolactinemia associated with hypothyroidism, Itsenko-Cushing’s disease, the underlying disease should be treated first. With pituitary tumors, they initially resort to remote radiation therapy and parlodel. In the absence of effect, especially with narrowing of the eyes, surgical removal of the tumor is indicated. The signs of hypopituitarism that arise after this are corrected by hormone replacement therapy in accordance with a deficiency of one or another hormone.