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Hyperprolaktinämie

Diagnostische und therapeutische Aspekte

Hyperprolactinemia

Diagnostic and therapeutic aspects

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Die Hyperprolaktinämie ist eine der häufigsten Ursachen für ovarielle Funktionsstörungen. Man muss zwischen der physiologischen Hyperprolaktinämie und der pathologischen Hyperprolaktinämie unterscheiden. Physiologischerweise kommt es beim Menschen während der Schlafes, der Schwangerschaft und Laktation zu einer Hyperprolaktinämie. Auf der anderen Seite gibt es pathologische Formen der Hyperprolaktinämie, die verschiedene Ursachen haben und sich vor allem durch eine Störung der Fortpflanzungsfunktion bemerkbar machen. Bei gesichertem Nachweis einer Hyperprolaktinämie muss durch gezielte Diagnostik zunächst die Ursache der Erkrankung ermittelt werden. Die Therapie sollte—wenn möglich—ursachenorientiert durchgeführt werden. In den meisten Fällen erfolgt die Behandlung durch Gabe von Dopaminagonisten. In bestimmten Fällen muss eine chirurgische Intervention oder eine Strahlentherapie erfolgen. Während der Schwangerschaft kann es bei Patientinnen mit Prolaktinom zu einer Größenzunahme des Tumors kommen. Auch in diesen Fällen kann meist eine konservative Therapie durchgeführt und die Schwangerschaft bis zum Endtermin ausgetragen werden.

Abstract

Hyperprolactinemia is one of the most frequent causes for ovarian insufficiency. Physiologic hyperprolactinemia should be distinguished from pathologic hyperprolactinemia. In humans hyperprolactinemia is a physiologic phenomenon during sleep, pregnancy, and lactation. However pathologic hyperprolactinemia can be induced by various factors and is notably manifest in fertility disorders. In cases of confirmed hyperprolactinemia, diagnostic work-up should be targeted at determining the disease origin and treatment performed accordingly. In most cases application of dopamine agonists is the treatment of choice. Surgical intervention or radiotherapy is required in certain cases. In patients suffering from prolactinoma, pregnancy can lead to significant growth of the tumor. Even then, in most cases conservative treatment can be performed and the pregnancy continued until the expected time of delivery.

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Literatur

  1. Amir LH (2003) Breast pain in latating women—mastitis or something else? Aust Fam Physician 32:141–145

    PubMed  Google Scholar 

  2. Arthur CR, Saenz R, Replogle WH (2003) Breastfeeding education, treatment, and referrals by female physicians. J Hum Lact 19:303–309

    Article  PubMed  Google Scholar 

  3. Bagheri-Yarmand R, Vadlamudi RK, Kumar R (2003) Activating transcription factor 4 overexpression inhibits proliferation and differentiation of mammary epithelium resulting in impaired lactation and accelerated involution. J Biol Chem 278:17421–17429

    Article  CAS  PubMed  Google Scholar 

  4. Barbosa-Cesnik C, Schwartz K, Foxman B (2003) Lactation mastitis. JAMA 289:1609–1612

    Article  PubMed  Google Scholar 

  5. Barcia C, Bautista V, Sanchez-Bahillo A et al. (2003) Circadian determinations of cortisol, prolactin and melatonin in chronic methyl-phenyl-tetrahydropyridine-treated monkeys. Neuroendocrinology 78:118–128

    Article  CAS  PubMed  Google Scholar 

  6. Bart G, Borg L, Schluger JH et al. (2003) Suppressed prolactin response to dynorphin A1–13 in methadone-maintained versus control subjects. J Pharmacol Exp Ther 306:581–587

    Article  CAS  PubMed  Google Scholar 

  7. Beck MT, Chen NY, Franek KJ et al. (2003) Prolactin antagonist-endostatin fusion protein as a targeted dual-functional therapeutic agent for breast cancer. Cancer Res 63:3598–3604

    CAS  PubMed  Google Scholar 

  8. Bernichtein S, Kayser C, Dilner K et al. (2003) Development of pure prolactin receptor antagonists. J Biol Chem 278:35988–35999

    Article  CAS  PubMed  Google Scholar 

  9. Bohnet HG (1986) Hyperprolaktinämie. Grosse, Berlin

  10. Clevenger CV, Ngo, W, Sokol DL et al. (1995) Vav is necessary for prolactin-stimulated proliferation and is translocated into the nucleus of a T-cell line: J Biol Chem 270:13246–13253

    Google Scholar 

  11. Contoreggi C, Herning RI, Koeppl B et al. (2003) Treatment-seeking inpatient cocaine abusers show hypothalamic dysregulation of both basal prolactin and cortisol secretion. Neuroendocrinology 78:154–162

    Article  CAS  PubMed  Google Scholar 

  12. Cosio G, Jeziorski MC, Lopez-Barrera F et al. (2003) Hypoxia inhibits expression of prolactin and secretion of cathepsin-D by the GH4C1 pituitary adenoma cell line. Lab Invest 83:1627–1636

    Article  CAS  PubMed  Google Scholar 

  13. Douchi T, Nakae M, Yamamoto S et al. (2001) A woman with isolated prolactin deficiency. Acta Obstet Gynecol Scand 80:368–370

    Article  CAS  PubMed  Google Scholar 

  14. Fahie-Wilson M (2003) In hyperprolactinemia, testing for macroprolactin is essential. Clin Chem 49:1434–1436

    Article  CAS  PubMed  Google Scholar 

  15. Fahie-Wilson M, Ahlquist JA (2003) Hyperprolactinaemia due to macroprolactins: some progress but still a problem. Clin Endocrinol 58:683–685

    Article  CAS  Google Scholar 

  16. Ginsburg E, Vonderhaar BK (1995) Prolactin synthesis and secretion by human breast cancer cells. Cancer Res 55:2591–2595

    CAS  PubMed  Google Scholar 

  17. Hankinson SE, Colditz GA, Hunter DJ et al. (1995) Reproductive factors and family history of breast cancer in relation to plasma estrogen and prolactin levels in postmnopausal women in the Nurses‘ Health Study (United States). Cancer Causes Control 6:217–224

    CAS  PubMed  Google Scholar 

  18. Janik J, Krupica T, Dengler L et al. (2003) Acetyl-RYYRIK-NH2, a purported orphanin FQ antagonist, does not block the orphanin FQ-induced prolactin secretory response in female rats. Neurosci Lett 345:149–152

    Google Scholar 

  19. Jenner C, Fishie J (2002) Galactorrhoea following acupuncture. Acupunt Med 20:107–108

    Google Scholar 

  20. Karagianis JL, Baksh A (2003) High-dose olanzapine and prolactin levels. J Clin Psychiatry 64:1192–1194

    CAS  PubMed  Google Scholar 

  21. Keck C, Breckwoldt M (1995) Physiologie und Pathophysiologie der Laktation—Therapie der Mastitis puerperalis. Geburtsh Frauenheilkd 55:M17–M19

    CAS  Google Scholar 

  22. Kinon BJ, Stauffer VL, Mcguire HC et al. (2003) The effects of antipsychotic drug treatment on prolactin concentrations in elderly patients. J Am Med Dir Assoc 4:189–194

    Article  PubMed  Google Scholar 

  23. Liby K, Neltner B, Mohamet L et al. (2003) Prolactin overexpression by MDA-MB-435 human breast cancer cells accelerates tumor growth. Breast Cancer Res Treat 79:241–252

    Article  CAS  PubMed  Google Scholar 

  24. Lissoni P, Barni S, Cazzaniga M et al. (1995) Prediction of recurrence in operable breast cancer by postoperative changes in prolactin secretion. Oncology 52:439–442

    CAS  PubMed  Google Scholar 

  25. McNatty KP, Sawers RS, McNeilly AS (1974) A possible role for prolactin in control of steroid secretion y the human Graafian follicle. Nature 250:653–655

    CAS  PubMed  Google Scholar 

  26. McPherson H, Walsh A, Silverstone T (2003) Growth hormone and prolactin response to apomorphine in bipolar and unipolar depression. J Afect Disord 76:121–125

    Article  CAS  Google Scholar 

  27. Mendelson JH, Sholar MB, Mutschler NH et al. (2003) Effects of intravenous cocaine and cigarette smoking on luteinizing hormone, testosterone, and prolactin in men. J Pharmacol Exp Ther 207:339–348

    Article  Google Scholar 

  28. Michie C, Lockie F, Lynn W (2003) The challenge of mastitis. Arch Dis Child 88:818–821

    Article  CAS  PubMed  Google Scholar 

  29. Olivar AC, Chaffkin LM, Kates RJ et al. (2003) Is it necessary to obtain serum levels of thyroid stimulating hormone and prolactin in asymptomatic women with infertility? Conn Med 67:393–395

    PubMed  Google Scholar 

  30. Pena KS, Rosenfeld JA (2001) Evaluatin and treatment of galactorrhea. Am Fam Physician 63:1763–1770

    CAS  PubMed  Google Scholar 

  31. Reynolds C, Montone KT, Powell CM et al. (1997) Expression of prolactin and ist receptor in human breast carcinoma. Endocrinology 138:550–555

    Google Scholar 

  32. Rose-Hellekant TA, Arendt LM, Schroeder MD et al. (2003) Prolactin induces Eralpha-positive and Eralpha-negative mammary cancer in transgenic mice. Oncogene 22:4664–4674

    Article  CAS  PubMed  Google Scholar 

  33. Schroeder MD, Brockman JL, Walker AM et al. (2003) Inhibition of prolactin (PRL)-induced proliferative signals in breast cancer cells by a molecular mmic of phosphorylated PRL, S179D-PRL. Endocrinology 144:5300–5307

    Article  CAS  PubMed  Google Scholar 

  34. Strungs I, Gray RA, Rigby HB, Strutton G (1997) Two case reports of breast carcinoma associated with prolactinoma. Pathology 29:320–323

    CAS  PubMed  Google Scholar 

  35. Suliman AM, Smith TP, Gibney J et al. (2003) Frequent misdiagnosis and mismanagement of hyperprolactinemic patients before the introduction of macroprolactin screening: application of a new strict laboratory definition of macroprolactinemia. Clin Chem 49:1504–1509

    Article  CAS  PubMed  Google Scholar 

  36. Volm MD, Talamonti MS, Thangavelu M, Gradishar WK (1997) Pituitary adenoma and bilateral male breast cancer: anunusual association. J Surg Oncol 64:74–78

    Article  CAS  PubMed  Google Scholar 

  37. Wang DY, Stepniewska KA, Allen DS et al. (1995) Serum prolactin levels and their relationship to survival in women with operable breast cancer. J. Clin Epidemiol 48:959–968

    Article  CAS  Google Scholar 

  38. Winter P, Schilcher F, Fuchs K et al. (2003) Dynamics of experimentally induced Staphylococcus epidermidis mastitis in East Friesian milk ewes. J Dairy Res 70:157–164

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universitäts-Frauenklinik Freiburg

    C. Keck, C. Kissel & D. Denschlag

  2. Universitäts-Frauenklinik, Hugstetter Straße 55, 79106 , Freiburg

    C. Keck

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  1. C. Keck
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  2. C. Kissel
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Correspondence to C. Keck.

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Keck, C., Kissel, C. & Denschlag, D. Hyperprolaktinämie. Gynäkologische Endokrinologie 2, 133–138 (2004). https://doi.org/10.1007/s10304-004-0071-8

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