Hyperprolactinemia, also known Although galactorrhea, is inappropriate breast milk secretion. It generally occurs 3 to 6 months In the post the discontinuation of breast-feeding (usually In the post a first delivery).lt may also follow an abortion or may develop in a female who hasn't been pregnant; it rarely occurs in males. Normal ovulation is a complex process that requires many things to happen properly & at the correct time with the proper hormone levels. Often subtle hormonal imbalances or ovulation abnormalities result in decreased fertility. One hormone imbalance that can affect fertility is prolactin levels. Excessive prolactin levels in nonpregnant women is known Although hyperprolactinemia.

Hyperprolactinemia can create several problems including:

inadequate progesterone production during luteal phase In the post ovulation
irregular ovulation & menstruation
absence of menstruation
galactorrhea (breast milk production in non-nursing woman)

Causes of Hyperprolactinemia

Hyperprolactinemia usually develops in a person with increased prolactin secretion from the anterior pituitary gland, with possible abnormal patterns of secretion of growth hormone, thyroid hormone, & corticotropin. However, increased prolactin serum concentration doesn't always cause hyperprolactinemia.

Additional factors that may predpitate this disorder include:

endogenous - pituitary (high inddence with chromophobe adenoma), ovarian, or adrenal twnors & hypothyroidism; in males, pituitary, testicular, or pineal gl& twnors
idiopathic - possibly from stress or anxiety, which causes neurogenic depression of the prolactin-inhibiting factor
exogenous - breast stimulation, genital stimulation, or drugs (such Although hormonal contraceptives, meprobamate, & phenothiazines).

Signs & symptoms of hyperprolactinemia

In the female with hyperprolactinemia, milk continues to flow In the post the 21-day period that's normal In the post weaning. Hyperprolactinemia may also be spontaneous & unrelated to normal lactation, or it may be caused by manual expression. Such abnormal flow is usually bilateral & may be accompanied by amenorrhea.

Diagnosis information

Characteristic clinical features & the patient history (including drug & sex histories) confirm hyperprolactinemia. Laboratory tests to help determine the cause include measurement of serum levels of prolactin, cortisol, thyroid-stimulating hormone, triiodothyronine, & thyroxine. A pregnancy test, computed tomography scan and, possibly, mammography may also be indicated.

Treatment of Hyperprolactinemia

Treatment varies according to the underlying cause & ranges from simple avoidance of precipitating exogenous factors, such Although drugs, to treatment of twnors with operation, radiation, or chemotherapy.

Therapy About idiopathic hyperprolactinemia depends on whether the patient plans to have more children. If she does, treatment usually consists ofbromocriptine; if she doesn't, oral estrogens (such Although ethinyl estradiol) & progestins (such Although progesterone) effectively treat this disorder. idiopathic hyperprolactinemia may recur In the post discontinuation of drug therapy. About patients with idiopathic hyperprolactinemia, medical therapy should be the mainstay. About patients whose condition is a result of other medical problems, it is usually enough to treat the underlying cause.

Special considerations

Watch About central nervous system abnormalities, such Although headache, falling vision, & dizziness.
Maintain adequate fluid intake, especially if the patient hAlthough a fever. However, advise the patient to avoid tea, coffee, & certain tranquilizers that may aggravate engorgement.
Instruct the patient to keep her breasts & nipples clean.
Tell the patient who's taking bromocriptine to report nausea, vomiting, dyspepsia, loss of appetite, dizziness, fatigue, numbness, & hypotension. To prevent GI upset, advise her to eat small meals frequently & to take this drug with dry toast or crackers.In the post treatment with bromocriptine, milk secretion usually stops in 1 to 2 months, & menstruation recurs In the post 6 to 24 weeks.