Hypoprolactinemia

Hypoprolactinemia
Other names: Prolactin deficiency
Prolactin
SpecialtyGynecology
SymptomsInability to produce milk after childbirth[1]
ComplicationsInfertility, sexual dysfunction[2]
CausesSheehan syndrome, pituitary surgery, traumatic brain injury, genetics[1][3][2]
Diagnostic methodBlood tests[4]
TreatmentFormula feeding the baby[5]
Frequency8 per 100,000 (Spain, 1999)[2]

Hypoprolactinemia is a medical condition characterized by a lack of prolactin, a hypothalamic-pituitary hormone.[2] Symptoms include the inability to produce milk after childbirth.[1] Usually it occurs together with hypopituitarism.[1] Other complications may include infertility and sexual dysfunction.[2]

Causes include Sheehan syndrome, pituitary surgery, traumatic brain injury, and certain genetic mutations.[1][3][2] Diagnosis is by blood tests for prolactin, after being given thyrotropin.[4][6] Confirming the diagnosis; however, is not necessarily required as there is no specific treatment.[6]

While some evidence supports the use of recombinant human prolactin, it is not currently approved for medical use.[2][7] Treatment generally involves formula feeding the baby.[5] Prolactin deficiency alone is rare.[2] It occurs in about 17% of cases of hypopituitarism or about 8 per 100,000 people in Spain as of 1999.[2]

Signs and symptoms

Hypoprolactinemia is associated with ovarian dysfunction in women,[8][9] and, in men, metabolic syndrome,[10] anxiety,[10] arteriogenic erectile dysfunction,[11] premature ejaculation,[12] low concentration of sperm, reduced sperm motility, hypofunction of seminal vesicles, and hypoandrogenism.[13] In one study, normal sperm characteristics were restored when prolactin levels were brought up to normal values in men with hypoprolactinemia.[14]

Hypoprolactinemia can be a cause of lactation failure after childbirth.[1][15][16]

Causes

Hypoprolactinemia can result from autoimmune disease,[17] hypopituitarism,[1] growth hormone deficiency,[17] hypothyroidism,[17] excessive dopamine action in the tuberoinfundibular pathway and/or the anterior pituitary, and ingestion of drugs that activate the D2 receptor, such as direct D2 receptor agonists like bromocriptine and pergolide, and indirect D2 receptor activators like amphetamines (through the induction of dopamine release).[18]

Diagnosis

Guidelines for diagnosing hypoprolactinemia are defined as prolactin levels below 3 µg/L in women,[8][9] and 5 µg/L in men.[12][13][14]

Management

There are few treatments which increase prolactin levels in humans. Treatment differs based on the reason for diagnosis. Women who are diagnosed with hypoprolactinemia following lactation failure are typically advised to formula feed, although treatment with metoclopramide has been shown to increase milk supply in clinical studies. For subfertility, treatment may include clomiphene citrate or gonadotropins.[19]

See also

References

  1. 1 2 3 4 5 6 7 Jerome F. Strauss III; Robert L. Barbieri (28 August 2013). Yen & Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management. Elsevier Health Sciences. pp. 53–. ISBN 978-1-4557-5972-9. Archived from the original on 21 March 2017. Retrieved 13 March 2016.
  2. 1 2 3 4 5 6 7 8 9 Tritos, Nicholas A.; Klibanski, Anne (2019). Prolactin Disorders: From Basic Science to Clinical Management. Springer. p. 104. ISBN 978-3-030-11836-5. Archived from the original on 2021-05-18. Retrieved 2021-02-02.
  3. 1 2 Bondanelli, M; Ambrosio, MR; Zatelli, MC; De Marinis, L; degli Uberti, EC (May 2005). "Hypopituitarism after traumatic brain injury". European journal of endocrinology. 152 (5): 679–91. doi:10.1530/eje.1.01895. PMID 15879352.
  4. 1 2 "Hypopituitarism - Hormonal and Metabolic Disorders". Merck Manuals Consumer Version. Archived from the original on 5 May 2021. Retrieved 2 February 2021.
  5. 1 2 "Prolactin Deficiency Treatment & Management: Medical Care, Consultations". 9 November 2019. Archived from the original on 7 October 2017. Retrieved 2 February 2021.
  6. 1 2 "Prolactin Deficiency Workup". Emedicine. Archived from the original on 15 August 2017. Retrieved 2 February 2021.
  7. ↑ "Prolactin Deficiency Medication: Antidopaminergic agents". emedicine.medscape.com. Archived from the original on 19 January 2021. Retrieved 2 February 2021.
  8. 1 2 Kauppila A, Martikainen H, Puistola U, Reinilä M, Rönnberg L (Mar 1988). "Hypoprolactinemia and ovarian function". Fertil. Steril. 49 (3): 437–41. doi:10.1016/s0015-0282(16)59769-6. PMID 3342895.
  9. 1 2 Schwärzler P, Untergasser G, Hermann M, Dirnhofer S, Abendstein B, Berger P (Oct 1997). "Prolactin gene expression and prolactin protein in premenopausal and postmenopausal human ovaries". Fertil. Steril. 68 (4): 696–701. doi:10.1016/S0015-0282(97)00320-8. PMID 9341613.
  10. 1 2 Corona, Giovanni; Mannucci, Edoardo; Jannini, Emmanuele A; Lotti, Francesco; Ricca, Valdo; Monami, Matteo; Boddi, Valentina; Bandini, Elisa; Balercia, Giancarlo; Forti, Gianni; Maggi, Mario (2009). "Hypoprolactinemia: A New Clinical Syndrome in Patients with Sexual Dysfunction". Journal of Sexual Medicine. 6 (5): 1457–1466. doi:10.1111/j.1743-6109.2008.01206.x. ISSN 1743-6095. PMID 19210705.
  11. ↑ Pituitary Hormones—Advances in Research and Application: 2013 Edition. ScholarlyEditions. 21 June 2013. pp. 62–. ISBN 978-1-4816-7922-0. Archived from the original on 21 March 2017. Retrieved 13 March 2016.
  12. 1 2 Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, Boddi V, Bandini E, Balercia G, Forti G, Maggi M (May 2009). "Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction". J. Sex. Med. 6 (5): 1457–66. doi:10.1111/j.1743-6109.2008.01206.x. PMID 19210705.
  13. 1 2 Gonzales GF, Velasquez G, Garcia-Hjarles M (1989). "Hypoprolactinemia as related to seminal quality and serum testosterone". Arch. Androl. 23 (3): 259–65. doi:10.3109/01485018908986849. PMID 2619414.
  14. 1 2 Ufearo CS, Orisakwe OE (September 1995). "Restoration of normal sperm characteristics in hypoprolactinemic infertile men treated with metoclopramide and exogenous human prolactin". Clin Pharmacol Ther. 58 (3): 354–9. doi:10.1016/0009-9236(95)90253-8. PMID 7554710.
  15. ↑ Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.
  16. ↑ Robert F. Dons; Frank H. Wians, Jr. (17 June 2009). Endocrine and Metabolic Disorders: Clinical Lab Testing Manual, Fourth Edition. CRC Press. pp. 103–. ISBN 978-1-4200-7936-4. Archived from the original on 21 March 2017. Retrieved 13 March 2016.
  17. 1 2 3 Andrew S. Davis (25 October 2010). Handbook of Pediatric Neuropsychology. Springer Publishing Company. pp. 1134–. ISBN 978-0-8261-5737-9. Archived from the original on 21 March 2017. Retrieved 13 March 2016.
  18. ↑ Trevor W. Stone (9 May 1996). CNS Neurotransmitters and Neuromodulators. CRC Press. pp. 214–. ISBN 978-0-8493-7632-0. Archived from the original on 21 March 2017. Retrieved 13 March 2016.
  19. ↑ "Prolactin Deficiency Medication: Antidopaminergic agents". emedicine.medscape.com. Archived from the original on 2021-01-19. Retrieved 2017-11-25.
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