Zusammenfassung
Sekundäre Amenorrhö und Infertilität sind ein häufiger Konsultationsgrund. Eine Hyperprolaktinämie muss ätiologisch immer ausgeschlossen werden. Prolaktinome stellen die häufigste Ursache einer symptomatischen Hyperprolaktinämie dar. Therapeutisch werden hier primär Dopaminagonisten eingesetzt, die meist zu einer Normalisierung von Prolaktin und daraufhin zur Wiederherstellung von ovulatorischen Zyklen führen. Ebenfalls häufig ist die medikamentös bedingte Hyperprolaktinämie, die am häufigsten durch Neuroleptika (D2-Antagonisten) bedingt ist, aber auch durch andere Medikamentenklassen verursacht werden kann. Das Ausmaß der Hyperprolaktinämie kann auch bei neueren Neuroleptika unterschiedlich sein. Nach Ausschluss eines Prolaktinoms und bei negativer Medikamentenanamnese sollte an seltenere Ursachen einer Hyperprolaktinämie gedacht werden. Schließlich sollten gewisse labortechnische Fallen bei der Interpretation von Prolaktinwerten in Betracht gezogen werden (Makroprolaktin, Hook-Effekt).
Abstract
Secondary amenorrhea and infertility are frequent reasons for consultation. Hyperprolactinemia must always be ruled out as a possible etiology. Prolactinomas represent the most common cause of symptomatic hyperprolactinemia and dopamine agonists are the first line therapy, mostly leading to a normalization of prolactin levels and restoration of ovulatory cycles. Drug-induced hyperprolactinemia is also common, particularly with neuroleptic drugs (D2 antagonists) but also with other mainly psychotropic drug classes: however, the degree of prolactin elevation can vary considerably even with the use of newer neuroleptic drugs. If a prolactinoma has been ruled out and medication history is not contributory, rarer causes of hyperprolactinemia should be considered. Finally, analytical pitfalls should be taken into account in the interpretation of prolactin levels (e.g. macroprolactin and the hook effect).
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S. Bervini, L. Valente und E. Christ geben an, dass kein Interessenkonflikt besteht.
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W. Rossmanith, Baden-Baden/Bühl
C. Schöfl, Herzogenaurach
T. Strowitzki, Heidelberg
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Bervini, S., Valente, L. & Christ, E. Neues von Prolaktin. Gynäkologische Endokrinologie 14, 239–244 (2016). https://doi.org/10.1007/s10304-016-0093-z
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DOI: https://doi.org/10.1007/s10304-016-0093-z