HYPERPROLACTINEMIA AND

HYPERANDROGENEMIA
Prof.Hamonangan Hutapea
Departement of Obstetrics and Gynecology
Medical Faculty
University of Sumatera Utara

Hyperprolactinaemia.
Introduction.
Prolactine (PRL) is secreted from the
Anterior Hypophisis.
Normal blood level of PRL: 150-500 IU/L
or 12.5 25 ng/ml.
During pregnancy,a tenfold increase in
serum PRL level.

There are at least 4 basic molecular types of PRL

hormone circulating in the normal womens blood :

~ Little Prolactin (native PRL), MW 23 kDa.
~ Big Prolactin, MW 50 kDa.
~ Big-big Prolactin, MW 150 kDa.
~ Glycosilated Prolactin, MW 25 kDa.

Definition.
Hyperprolactinaemia is inapropriately
increased PRL level occuring when the
woman is non-pregnant, and may cause
amenorrhoea or galactorrhoea or both.

Aetiology
Pituitary(Hypophisis) tumor;
1.Microadenoma :<10mm diameter
2.Macroadenoma:>10mm diameter.
Hypothyroidism.
Primary hypothyroidismTRH PRL production.
Drugs :
Dopamine agonist:
Phenothiazines,Butyrephenones,
Benzamides,Cimetidine,Methyldopa
Other drugs: antidepressants,opiates,cocaine etc
Idiopathic

Diagnosis
The diagnosis of hyperprolactinaemia can
be made on a single serum measurement.
A serum PRL of 800 IU/L in the presence
of oligo-or amenorrhoea, pathological
significance.
CT-scanning or MRI should be done to
exclude a hypophysis tumor.

Mechanism of amenorrhoea.
Raised PRL Disturbance of normal
hypothalamic GnRH releaseLHpulsatility
suppressed Anovulation/Amenorrhoea.
Control of PRL release:
1.TRHHypothalamushypophysisPRL
2.DopaminehypophysisPRL
3.EstrogenhypophysisPRL
4. Breast sucklingTRH.PRL

Treatment.
1. Medicament.

a. Bromocriptine;2,5mg orally 2-3 X daily

with meals.Or by vaginal administration.
b. Quinagolide.(A new dopamine
agonist),once a day,tolerated better.
c. Cabergoline ( a new dopamine
agonist, long half-life.Administered
weekly.

2. Surgical treatment.
* Trans-sphenoidal surgery is usually
done to resect both micro-and or
macroadenomas.
* The results of treatment vary greatly
between centres,50%
3. Radiotherapy (very rare)

IS THERE ANY QUESTION?

Pituitary Adenoma
Pituitary adenomas secreting hormones other
than prolactin may also affect menstrual
function.
* ACTH secreting tumorcortisol Cushings
disease.
* Adenoma or adenocarcinoma of the adrenal
cortex maycortisol.
* Ectopic production of ACTH by other tumors
such as Bronchial carcinoma or carcinoid tumors
cortisol.

CUSHINGS SYNDROME
Cortisol excessprotein catabolism
gluconeogenesisconversion to fat
deposition to face,neck and trunk.
Cortisol excessdepression of immune reaction.
Cortisol excessprotein catabolism
wasting of limbs.
Excess of other steroids:
Estrogen amenorrhoea
Androgen mild virilism

NOW

PAUSE

HYPERANDROGENEMIA
Hyperandrogenemia is a condition that the
circulating level of testosterone, dehydrotestosterone and adrostenedion, is high,
and may stimulate the derangement of
physical condition.
Normal Androgen level: depends on the
phase of the menstrual cycle.
Increase LH level androgen.

CLINICAL APPEARANCES
PCOS is Functional derangement of the
Hypothalamo-pituitary-ovarian axis
associated with anovulation.
LH levels relatively high, FSH
levels are relatively low.
LH:FSH ratio elevated.
LH levels of Testosterone,Androstene
dione and DHA from Ovarium

Clinical appearances
Some of these androgens estrogen
(estone) in fatty tissues (Aromatization)
High androgen levels SHBG by 50%
unbound, active androgens
The pathophysiology of PCOS is not clear
(Genetic element?)

Clinical features of PCOS

Variable
The classic Stein Leventhal syndrome,:
* oligomenorrhea
* hirsutism
* obesity
* infertility.

Diagnosis of PCOS
No specific features of PCOS are
diagnostic of the condition. on clinical
grounds supported by :
1.Ultrasound *follicular cysts(:6-8mm)
*ovarian volume
( 25% of normal women)
Eleveted LH:FSH ratio.
Eleveted free testosterone levels.
Decreased SHBG.

Diagnosis of PCOS
2. Infertilityovulation disorders.
3. Amenorrhea,
4. Obesity
5. Hirsutism

Long- term effects of PCOS

Increased risk of endometrial cancer(3X)
Increased risk of Diabetes Mellitus
(Hyperinsulinemia due to insuline
resistance)
Increased risk of hypertension and
cardiovascular disease.

Treatment of PCOS
Aimed at relieving symptoms and preventing
long term effects.:
* Infertility :1. Treat cause if known eg.PRL.
2. Ovulation induction.
* Amenorrhea :1. need contraception
combined OC Pills
2. need no contraception
cyclical gestogens

Treatment of PCOS
* Hirsutism 1.Local treatment
2.Medicament treatment.:
* Low dose oral contraceptives
* Medroxyprogesterone acetate
* Cyproterone acetate
* Dexamethasone
* GnRH analoque (addback HRT)
* Ovarian Drilling,and etc.

THANK YOU.

THANK YOU