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Hypoprolactinemia

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Hypoprolactinemia

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Flashcards

Hypoprolactinemia

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Content Reviewers:

Rishi Desai, MD, MPH

With hypoprolactinemia, hypo- means below, -prolactin refers to the hormone produced by the pituitary gland, and -emia refers to the blood, so hypoprolactinemia means lower than normal prolactin levels in the blood.

Normally, at the base of the brain, there’s a small pea-sized gland called the pituitary gland.

The anterior pituitary - which is the front of the pituitary gland - has a number of different cells, each of which secrete a different hormone.

One group, the lactotroph cells, secrete prolactin.

In men, prolactin decreases testosterone production.

In women, during pregnancy, elevated levels of estrogen stimulate the lactotroph cells to produce large amounts of prolactin which stimulates alveolar cells in the breasts.

In response to prolactin, the alveolar cells divide and enlarge - and once a baby is born, lactogenesis starts - which means that milk is produced.

Apart from milk production, high levels of prolactin also inhibit the release of gonadotropin releasing hormone from the hypothalamus, which results in decreased luteinizing and follicle stimulating hormone levels, which in turn, decreases estrogen levels.

In women, this can stop ovulation and menstruation, which is why women typically don’t have a menstrual period while breastfeeding.

In women that are not pregnant or breastfeeding, as well as in men, prolactin levels are usually kept in check by the hypothalamus in two ways.

The first way is the most important, and it’s when the hypothalamus secretes a constant stream of dopamine which in this setting is called prolactin inhibiting factor.

Dopamine binds to specific receptors on the lactotroph cells and inhibit the release of prolactin.

The second way is less significant, and it’s when the hypothalamus secretes thyrotropin releasing hormone, also called prolactin releasing hormone, which can stimulate prolactin release.

If the level of prolactin rises for any reason, then it signals the hypothalamus to release more dopamine, eventually decreasing its own production, a process called negative feedback or feedback inhibition.

The most common cause of hypoprolactinemia is Sheehan’s syndrome, a disorder where lactotroph cells die in a woman that has recently given birth and has postpartum hemorrhage - excessive blood loss during delivery.

Summary
Hypoprolactinemia is a medical condition characterized by serum prolactin levels below 3μg/L in women and 5μg/L in men. Hypoprolactinemia can result from autoimmune disease, hypopituitarism, growth hormone deficiency, hypothyroidism, and ingestion of drugs that activate the D2 receptor. Symptoms include ovarian dysfunction, anxiety symptoms, premature ejaculation, and oligozoospermia.
Sources
  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  5. "Hypoprolactinemia and ovarian function**Supported by grants from the Yrjö Jahnsson Foundation and the Paulo Foundation." Fertility and Sterility (1988)
  6. "Aetiology, diagnosis, and management of hypopituitarism in adult life" Postgraduate Medical Journal (2006)