Menstrual cycle abnormalities in patients with prolactinoma and drug-induced hyperprolactinemia

Abstract

Background and Objective:Hyperprolactinemia affects the reproductive endocrine axis; however, the degree of dysfunction may vary depending on etiology. The aim of the present study was to analyze menstrual cyclicity in patients with prolactinoma and drug-induced hyperprolactinemia (DIH).Methodology:Patients with prolactinoma and DIH were retrospectively analyzed for menstrual cyclicity at presentation and response to therapy.Results:Of 128 females with hyperprolactinemia, 58 had prolactinoma (41 microadenoma and 17 macroadenoma) and 39 had DIH. Patients with prolactinoma had higher prolactin levels and increased frequency of oligomenorrhea (77.5% vs. 46%) as compared to DIH. Patients with macroprolactinoma had more severe menstrual disturbances compared to microprolactinoma. A higher percentage of patients with microprolactinoma and DIH achieved regular menstrual cycles compared to macroprolactinoma postcabergoline treatment (85% and 90% vs. 65%). There was no correlation between time to regularization of menstrual cycles with age, menstrual cycle length, duration of menstrual irregularity, or initial prolactin level in patients with prolactinoma. Linear regression analysis showed a significant association between time to regularization of menstrual cycles with time to normalization of prolactin levels (P = 0.001).Conclusion:There is a prompt restoration of menstrual cycles in patients with microprolactinoma and DIH. Patients with macroprolactinoma have more severe menstrual disturbances and lesser frequency of cycle restoration postcabergoline treatment compared to microprolactinoma and DIH.

Clinical Profile and Changing Etiological Spectrum of Hyperprolactinemia at a Tertiary Care Endocrine Facility

“…Pituitary adenoma has been mentioned in the literature to be the most common cause of HP (7). Recent studies have found drugs to be commonly associated with HP, which contrasts with our previous study (8,9). With the easy availability of over-thecounter drugs as well as the use of herbal medication in this part of the world and easy availability of the tests for prolactin estimation, we intended to study the impact on the etiology of hyperprolactinemia.…”

“…This shows a change in the trend of the etiology of HP with drugs overtaking pituitary adenoma. In a recent study conducted in North India by 'Kulshreshtha et al', 30.4% of HP patients had drugs as etiology (8). Prokinetics were taken by 52 of our patients, either alone or in combination with other drugs, including neuroleptics (Figure 1), whereas previous studies have shown that neuroleptics were the most common cause (14).…”

Prolactin and thyroid stimulating hormone affecting the pattern of LH/FSH secretion in patients with polycystic ovary syndrome: A hospital-based study from North East India

“…in his review of 128 females with hyperprolactinemia reported oligomenorrhea and amenorrhea in 44% and 35% of patients, respectively. [23] Berinder et al . in a study on 271 women with hyperprolactinemia (71% of whom had prolactinomas) observed that 26% had oligomenorrhea and 61% had amenorrhea.…”

Prolactin selectively transported to cerebrospinal fluid from blood under hypoxic/ischemic conditions

“…PRL secretion is usually regulated by PRL suppressors such as dopamine from the hypothalamus [ 2 – 4 ]. PRL secretion increases, when dopamine production and transportation are impaired as a result of hypothalamic dysfunction resulting from drugs, hypoxic conditions, except in prolactinoma of the pituitary [ 5 ]. PRL has a wide variety of effects, for example, it is known that PRL participates in the immune response, controls osmotic pressure and vascularization, and promotes neurogenesis in maternal and fetal brains [ 6 – 9 ].…”