Infertility hyperprolactinemia

Endocrine signs Amenorrhea, galactorrhea, infertility, impotence Dj-receptor block resulting in hyperprolactinemia... 

All antipsychotics except clozapine and perhaps olanzapine produce hyperprolactinemia by removing the inhibitory actions of dopamine on prolactin secretion. This results in amenorrhea, galactorrhea, and infertility in women and in loss of libido and impotence in men. Inhibition of the release of follicle-stimulating and luteinizing hormones may also play a role. In addition, weight gain is common, and food intake must be monitored. 

Human prolactin is similar in structure to human growth hormone, and both are good lactogens. In women, prolactin acts with other hormones on the mammary gland during pregnancy to develop lactation and after birth to maintain it. Hyperprolactinemia causes impotence in men and amenorrhea and infertility in women. Chronically elevated levels of circulating prolactin are associated with suppression of 17-p-estradiol and testosterone production in the ovaries and testes. 

Hyperprolactinemia in women results in the amenorrhea-galactorrhea syndrome and infertility in men, loss of libido, impotence, and infertility may result. Hyperprolactinemia may cause osteoporosis, particularly in women. If dose reduction is not indicated, or ineffective in controlling this pattern, switching to one of the atypicals that do not raise prolactin levels, eg, aripiprazole, may be indicated. 

Dopamine agonists are useful for treating problems induced by hyperprolactinemia amenorrhea, galactorrhea, breast tenderness (mastodynia), infertility, and hypogonadism. 

The most common secretory neoplasm of the anterior pituitary gland is a prolactin-secreting adenoma (prolactinoma). An early symptom of prolactin excess is a milky discharge from the breasts. Because hyperprolactinemia may suppress the secretion of gonadotropic hormones (e.g., LH, FSH), menstrual irregularity, amenorrhea, and infertility may occur in women. In men, gonadotropic hormone dysfunction may lead to reduced libido, sexual impotence, and infertility. 

Pituitary insufficiency or failure can also cause infertility and is primarily caused by adenomas, but can also be caused by trauma, infiltration, metastases, or hemochromatosis. Hyperprolactinemia is a cause of secondary testicular dys-... 

Kletzky OA, Davajan V. Hyperprolactinemia. In Mishell DR, Davajan V, eds. Infertility, contraception and reproductive endocrinology. 3rd ed. Boston Blackwell Scientific Publications, 1993 372-95. 

Elevated prolactin serum concentrations inhibit gonadotropin secretion and sex-steroid synthesis. Because prolactin concentrations higher than 60 mcg/L are associated with anovulation, women with hyperprolactinemia typically present with menstrual irregularities such as ohgomenorrhea or amenorrhea and infertility. In addition, approximately 40% to 80% of women with hyperprolactinemia will have galactorrhea. The clinical presentation of patients with hyperprolactinemia is summarized in Table 75-5. ... 

Prolactin has no therapeutic uses. Hyperprolactinemia is a relatively common endocrine abnormality that most often is caused by prolactin-secreting pituitary adenomas. Hyperprolactinemia also can result from hypothalamic or pituitary diseases that interfere with the delivery of inhibitory dopaminergic signals primary hypothyroidism associated with increased TRH levels renal failure treatment with dopamine receptor antagonists. Manifestations of prolactin excess in women include galactorrhea, amenorrhea, and infertihty. in men, hyperprolactinemia causes loss of libido, impotence, and infertility. 

Endocrine and metabolic effects Endocrine and metabolic effects include hyperprolactinemia, weight gain, gynecomastia, the amenorrhea-galactorrhea syndrome, and infertility. These effects are predictable manifestations of dopamine receptor blockade in the pituitary dopamine is the normal inhibitory regulator of prolactin secretion. 

As many as 25% of infertile women have hyperprolactinemia. In women, hyperprolactinemia causes galactorrhea, oligomenorrhea, or amenorrhea as well as infenility (the amenorrhea-galactorrhea syndrome). While prolactin-secreting tumors are the most common cause of hyperprolactinemia, the condition can also be precipitated by treatment with dmgs that interfere with the control of prolactin release. 

Prolactin-producing hypophyseal adenoma (prolactinoma) is the most common functional pituitary adenoma. Its prevalence peaks in women between 20 and 30 years of age. Hyperprolactinemia can be a cause of infertility and is associated with diminished gonadotropin secretion, secondary amenorrhea, and galactorrhea. The patient should first be examined for drug-induced hyperprolactinemia before any infertility work-up is initiated. For example, antidepressants, cimetidine, dopamine antagonists, reser-pine, sulpiride, verapamil, methyldopa, and estrogen therapy are known to interface with prolactin secretion. 

Fig. 16.11a,b. Pituitary adenoma. Unenhanced (a) and contrast-enhanced (b) Tlw MR images show a small right-sided pituitary prolactinoma (arrow) leading to hyperprolactinemia with consecutive infertility... 

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