Data di Pubblicazione:
2006
Citazione:
Current treatment issues in female hyperprolactinemia / P.G. Crosignani. - In: EUROPEAN JOURNAL OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE BIOLOGY. - ISSN 0301-2115. - 125:2(2006), pp. 152-164. [10.1016/j.ejogrb.2005.10.005]
Abstract:
High prolactin levels can occur as a physiological condition in females who are pregnant or lactating. As a pathological condition,
hyperprolactinaemia is associated with gonadal dysfunction, infertility and an increased risk of long-term complications including
osteoporosis. The most frequent cause of persistent hyperprolactinaemia is the presence of a micro- (<10 mm diameter) or macroprolactinoma
( 10 mm). These pituitary tumours may produce an excessive amount of prolactin or disrupt the normal delivery of dopamine from
the hypothalamus to the pituitary; prolactin secretion from the pituitary is inhibited by dopamine released from neurones in the hypothalamus.
Medications including anti-psychotics can induce hyperprolactinaemia, while idiopathic hyperprolactinaemia accounts for 30–40% of cases.
The prevalence of hyperprolactinaemia is difficult to establish as not all sufferers are symptomatic or concerned by their symptoms and may
remain undiagnosed. Symptoms of hyperprolactinaemia include signs of hypogonadism, with oligomenorrhoea, amenorrhoea and
galactorrhoea frequently observed. Pharmacological intervention should be considered the first line therapy and involves the use of
dopamine agonists to reduce tumour size and prolactin levels. Bromocriptine has the longest history of use and is a well-established,
inexpensive, safe and effective therapy option. However, bromocriptine requires multiple daily dosing and some patients are resistant or
intolerant to this therapy. The two newer dopamine agonists, quinagolide and cabergoline, provide more effective and better tolerated
treatments compared with bromocriptine and may offer effective therapies for bromocriptine-resistant or intolerant patients. Quinagolide can
be used until pregnancy is confirmed and may result in improved compliance in females wishing to become pregnant. For patients with
hyperprolactinaemia, pregnancy is safe and can frequently be beneficial, inducing a decrease in prolactin levels. There does not appear to be
any increased risk of abortion, malformations or multiple births in pregnancies achieved with bromocriptine and this dopamine agonist can be
used safely during pregnancy. Surgery should be considered only in certain circumstances, and for the majority of patients, dopamine agonists
will be sufficient to alleviate symptoms and restore normal prolactin levels.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Hyperprolactinaemia ; Prolactin ; Bromocriptine ; Quinagolide ; Cabergoline
Elenco autori:
P.G. Crosignani
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