Overview of hyperprolactinemia
Hyperprolactinemia (hyperprolactinemia), also known as hyperprolactinemia, is a group of reproductive endocrine disorders of the hypothalamic-pituitary axis caused by a variety of reasons, mainly characterized by elevated serum prolactin and its related clinical manifestations, and it is a general term for a group of disorders that can clinically involve the reproductive, endocrine, and neurological systems. Currently, serum prolactin levels higher than 1.14 nmol/L (25 μg/L) are generally used as a criterion, and the reference range of normal values for each unit varies slightly due to different testing methods. Patients can often present clinically with symptoms such as amenorrhea, lactation, frequent menstruation, scanty menstruation, infertility, hypogonadism, headache, obesity, etc. Patients may therefore consult obstetrics and gynecology, reproductive medicine, men’s medicine, breast medicine, neurology and neurosurgery. Hyperprolactinemia is still treated with pharmacological therapy, supplemented by surgical treatment and radiotherapy, and the choice of treatment is based on the principle of individualization. Epidemiology The currently reported population incidence varies widely and is most common in women of childbearing age. In general, it accounts for about 0.4% of women of childbearing age, 5% of women with menstrual abnormalities, and 17% of women with abnormal reproductive function.
Physiological regulation of prolactin secretion, prolactin is a polypeptide hormone secreted by the anterior pituitary cells, the main role is to promote breast development and maturation, lactation, luteal cell steroid hormone synthesis, regulation of immune function and promotion of bone metabolism and so on. Pituitary prolactin cells secrete prolactin, and the secretion is regulated by neuroendocrine regulation, mainly by the balance between inhibitory and stimulatory signals afferent to the hypothalamus and peripheral blood hormone regulation. Hypothalamic prolactin inhibitory factors include dopamine, prolactin, and γ-aminobutyric acid; prolactin-releasing factors include gonadotropin-releasing hormone, thyrotropin-releasing hormone, vasoactive intestinal peptide, and angiotensin Ⅱ, etc. Intracerebral neuromediators (catecholamines and 5-hydroxytryptamines) can also promote the release of prolactin. Peripheral hormones include glucocorticoids that inhibit prolactin gene transcription, vitamin D that inhibits prolactin mRNA accumulation and release, and estrogen and progesterone that induce prolactin synthesis and release.
Questions you may be concerned about
What is hyperprolactinemia?
Hyperprolactinemia is a disease in which the body’s prolactin is abnormally elevated due to a variety of factors.
The causes of the disease include physiological factors, such as breastfeeding, sexual intercourse, pregnancy, and stress; disease factors, such as pituitary prolactinoma, vacuolar butterfly saddle, hypothalamic disease, polycystic ovary syndrome, and cirrhosis of the liver; and medication influences, such as antipsychotics such as risperidone and a variety of other medications such as tricyclic antidepressants such as amitriptyline. In some patients, the cause of the disease cannot be specified and is called idiopathic hyperprolactinemia.
For adolescent patients, hyperprolactinemia can be manifested as delayed or no menstrual period in females, and testicular volume less than 3cm in males. in post-pubertal patients, females can be manifested as scanty menstruation, infertility, and shedding of pubic hairs; and males can be manifested as decreased libido and impotence, and other manifestations.
The choice of treatment for hyperprolactinemia is closely related to the cause of the patient’s condition, so the patient needs to consult a doctor in time to clarify the cause of the condition and follow the doctor’s instructions to carry out the appropriate treatment.
For most patients, medications can be taken, such as dopamine agonists, bromocriptine, etc.; hormonal drugs, such as estradiol, testosterone undecanoate and so on.
For patients with pituitary tumors, surgery to remove the pituitary gland is an option. For patients with hyperprolactinemia caused by kidney, lung and other diseases, radiotherapy and other methods of treatment can be chosen.
In addition, the use of all the above drugs should be under the guidance of a doctor.
Etiology
Under physiological circumstances, the regulation of prolactin is dominated by inhibitory regulation. Any factor that interferes with the synthesis and delivery of dopamine from the hypothalamus to the pituitary gland and the interaction of dopamine with its receptors can diminish the inhibitory regulation and cause hyperprolactinemia. The common causes of hyperprolactinemia can be summarized into four categories: physiological, pathological, pharmacological and idiopathic.
1. Physiological
Prolactin is a stress hormone, which is secreted in a pulsatile manner, and its secretion is higher at night than during the day. It reaches its peak in the luteal phase of the female menstrual cycle, and its level is low in the follicular phase. It is significantly elevated during full-term pregnancy and after delivery. In addition, prolactin secretion is significantly increased in stressful situations. High-protein diets, exercise, stressful and sexual intercourse activities, breastfeeding, nipple stimulation and sleep disorders can all lead to increased serum prolactin levels.
2. Pharmacological
Any drug that interferes with dopamine synthesis, metabolism, reabsorption or blocks the binding of dopamine to the receptor can cause hyperprolactinemia, but it is generally lower than 4.55 nmol/L. Common drugs include estrogen, dopamine receptor blockers (such as antipsychotics, sedatives, antihypertensives, lisdexamfetamine, monoamine oxidase inhibitors, such as phenelzine, alpha-methyldopa), H2 receptor blockers (such as gastric motility drugs, morphine, methotrexate), and other drugs. Morpholine, metoclopramide and cimetidine, etc.), drugs that inhibit the metabolism of dopamine (such as opioids), and so on.
3. Pathology
Mainly seen in hypothalamic-pituitary diseases, systemic diseases, ectopic prolactin production and other causes.
(1) Hypothalamic lesions: such as craniopharyngioma, glioma, tuberculosis, tuberculosis and other compression of the pituitary stalk; craniocerebral radiation therapy after the hypothalamic function is impaired.
(2) Pituitary diseases: prolactin-type pituitary microadenomas; pituitary growth hormone adenomas, adrenocorticotropic hormone adenomas; empty pterygoid saddle syndrome, nodular disease, sarcoidosis, inflammatory lesions.
(3) Systemic diseases: primary hypothyroidism; chronic renal failure; severe liver disease, cirrhosis, hepatic encephalopathy; certain tumors such as adrenal tumors, bronchial carcinoma, ovarian cystic teratoma.
(4) Neurogenic:Chest wall lesions, herpes zoster neuritis and breast surgery.
(5) Others:polycystic ovary syndrome.
4.Idiopathic
Idiopathic hyperprolactinemia refers to elevated serum prolactin, usually <4.55nmol/L, with negative pituitary, CNS and systemic tests, and accompanied by lactation, scanty menstruation, amenorrhea and other symptoms. The pathogenesis may be related to the presence of an allosteric structure of the prolactin molecule, and the course of the disease is self-limiting.
Symptoms
1. Lactation
The main clinical manifestation of hyperprolactinemia is lactation, which occurs during non-pregnancy and non-lactation period in about 2/3 of the patients, and breast development and lactation can also occur in male patients. The milk secreted is colostrum-like or watery, plasma-like, yellow or white, and in most cases the amount secreted is not large, and the milk usually comes out only when squeezed, or in severe cases it may come out on its own. Although lactation is closely related to increased blood prolactin levels, the amount of lactation is not related to the degree of increased prolactin levels. Lactation is most common in patients with pituitary microadenomas, accounting for about 70% of cases; only 30% of non-tumor-type hyperprolactinemia will have lactation.
2. Menstrual disorders and amenorrhea
Patients may manifest menstrual disorders, secondary amenorrhea, decreased libido, and in severe cases, genital atrophy and osteoporosis may occur. When the patient lactation, reduced menstrual flow or even amenorrhea, it is called amenorrhea-mastorrhea syndrome. Patients with polycystic ovary syndrome are often accompanied by hyperprolactinemia. In addition to elevated prolactin, blood androgen levels are also elevated, as well as obesity, hirsuteness, acne and scanty menstruation.
3. Infertility and sterility
Most hyperprolactinemia is caused by pituitary microadenomas. About 90% of the patients have hypomenorrhea or amenorrhea, and about 70% of them are infertile. In men, hyperprolactinemia may be characterized by decreased libido, decreased sperm quality and infertility.
4. Other
Patients with pituitary or intracranial tumor hyperprolactinemia may also have headache, blurred vision or visual field loss, blindness, diplopia, hypopituitarism; patients with growth hormone adenomas may have gigantism and acromegaly; patients with adrenocorticotropic hormone adenomas may have Cushing’s disease; and patients with thyrotropinomas may have hyperthyroidism and anaplastic tumors.
Examination
1. Laboratory examination
(1) Measurement of serum prolactin at rest ① Normal range of prolactin and diagnostic criteria for hyperprolactinemia Normal prolactin level ≤1.14nmol/L (25μg/L, 1μg=21.2mU/L), if more than 1.14nmol/L is hyperprolactinemia. ② Precautions Measurement of serum prolactin needs to take into account its pulsatile release and the property of food (especially high protein diet) to increase its secretion. Fasting should be done on the day of each examination, and sexual intercourse should be prohibited in the morning of the same day; rest for 1 hour after coming to the hospital, and blood should be collected around 9~11am; blood can be collected on 3 consecutive days or 3 consecutive times on the same day, except for the pulse peak, which is conducive to the judgment of hyperprolactinemia secretion. For patients with a history of drug application, under the premise of not affecting the treatment of the disease, the drug can be discontinued 48 to 72 hours of blood collection. If hyperprolactinemia is caused by drugs alone, the value of prolactin will decrease after stopping the drugs. ③ Etiological analysis Elevated prolactin but not more than 4.55nmol/L (about 2000mU/L), may be drug-induced, estrogenic or idiopathic hyperprolactinemia; more than 6.83nmol/L (about 3000mU/L, higher than the normal value of 5 times) when there may be prolactin adenomas; the typical prolactin macroadenoma prolactin more than 11.38nmol/L (about 5000mU/L), but prolactin adenomas can occur at various prolactin levels; non-prolactin type pituitary macroadenomas only cause mild elevation of prolactin levels.
(2) Prolactin dynamics test Includes pituitary excitation test and inhibition test. If prolactin is higher than 2.28nmol/L, thyroid function should be checked. Drugs that stimulate prolactin secretion (e.g., thyrotropin-releasing hormone, metoclopramide, cimetidine) or drugs that inhibit prolactin secretion (levodopa) can be selectively used to observe the dynamic changes of prolactin. In addition to the bromocriptine inhibition test, pituitary prolactin adenomas generally do not have significant changes in prolactin secretion to stimulant and inhibitor experiments, which can help to distinguish idiopathic hyperprolactinemia from pituitary adenomas.
(1) Excitation test: Thyrotropin-releasing hormone pituitary excitation test and chlorpromazine test are commonly used. ①Thyrotropin-releasing hormone pituitary excitation test: before applying thyrotropin-releasing hormone, blood is collected to determine the basal value of prolactin. Thyrotropin-releasing hormone is injected intravenously at 500 μg, and blood thyrotropin and prolactin are measured 30 minutes and 60 minutes after the drug is administered. In normal women, thyrotropin-releasing hormone application increased thyrotropin hormone by two to four times and prolactin by four times. In the case of prolactinoma, the releasing effect of thyrotropin-releasing hormone on prolactin is lower than normal. This test is suitable for patients with mildly elevated prolactin (2.28 nmol/L or less). ② Chlorpromazine test: Chlorpromazine 25-50mg intramuscular injection, 60-90 minutes to elevate 1 times, continued for 3 hours. Due to the inhibition of dopamine receptor function, promote prolactin secretion, make prolactin increase. Prolactin is not elevated in pituitary tumors.
(2) Inhibition test: Levodopa test and bromocriptine test are often used. (1)Levodopa test: Levodopa 500mg orally, prolactin decreases to <0.18nmol/L in 2-3 hours; levodopa is the precursor substance of dopamine, which decreases prolactin through the action of dopamine, and there is no fluctuation of prolactin in the case of pituitary tumor. ② Bromocriptine test: bromocriptine 2.5-5mg oral, 2-4 hours later, prolactin decreased by more than 50%, lasting 20-30 hours, suffering from hyperprolactinemia and pituitary microadenomas, after taking the drug, prolactin decreased significantly.
(3) Large molecule prolactin screening Prolactin chromatography, polyethylene glycol immunoprecipitation, gel filtration chromatography and other methods can be used to help exclude hyperprolactinemia caused by large molecule prolactin isomers.
(4) Measurement of reproductive endocrine hormones On the 3rd day of menstruation, the reproductive hormones follicle-producing hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and progesterone (P) are measured in serum at the same time as the examination of prolactin, in order to understand the function of the ovaries. Normal serum FSH value is 3-10 U/L, if FSH value is more than 11 U/L, it suggests low ovarian reserve capacity; if FSH value is more than 25 U/L, it suggests premature ovarian failure and normal or low estrogen level; sometimes accompanied by low LH and FSH or low E2 may be related to amenorrhea-masturbation syndrome. If T levels are elevated or the LH/FSH ratio is abnormal, this may help in the diagnosis of polycystic ovary syndrome. If T levels are elevated, attention should be paid to the combination of ultrasonography to exclude ovarian masculinizing tumors and testicular feminizing tumors.
(5) Pituitary, thyroid, adrenal gland and other related endocrine function tests Elevation of thyrotropin-releasing hormone, thyrotropin and prolactin suggests primary hypothyroidism; prolactin may also be elevated in hypoadrenalism; blood growth hormone and adrenocorticotropic hormone measurements may suggest growth hormone adenoma and adrenocorticotropic hormone adenoma.
(6) Others: Pregnancy test can be chosen to exclude pregnancy.
2. Imaging examination
Imaging of the pituitary gland and saddle region (MRI or CT) is the main method for identifying pituitary and saddle-occupying lesions. It is generally recommended that the above tests should be completed if the prolactin level is >4.55nmol/L and there is no clear etiology; if the serum prolactin level is persistently elevated >9.1nmol/L, then the possibility of pituitary prolactinoma is high. Dynamically enhanced MRI of the pituitary gland and saddle region has the advantages of high resolution, multi-directional imaging, no radiation damage, and can be repeated many times, and can diagnose the tiny adenomas of more than 3mm or even smaller; it is more sensitive to the larger foci, calcification of the lesion area and the change of the bony structure, which can help to differentiate with the craniopharyngioma and the selection of surgical access.
3.Neuro-ophthalmologic examination
For suspected saddle region tumors (e.g. pituitary tumor, craniopharyngioma, etc.), especially the larger lesions, the focus should be on visual acuity, visual field and fundus, to assess the size and direction of expansion of the tumor, and to understand the extent of the optic nerve and optic nerve intersection are affected. For pituitary microadenomas within 1cm, visual field examination is generally not necessary.
Diagnosis
The etiologic diagnosis of patients with hyperprolactinemia should distinguish between functional and organic tumors. Clinicians should exclude physiologic and pharmacologic factors through careful history taking, physical examination, and hormone level measurement and imaging, to clarify the source of hyperprolactinemia and whether there is a pathologic cause of hyperprolactinemia, and provide appropriate treatment.
1. History taking
Take a detailed history of the suspected patient, especially focusing on the three aspects of hyperprolactinemia: physiologic, pathologic, and pharmacologic, to understand the patient’s possible relevant medical history. Ask in detail whether there is scanty menstruation, amenorrhea and luteal insufficiency, etc., and find out the time of lactation, history of menstruation, childbirth and breastfeeding, surgical history and past medical history; ask whether there is a history of taking antipsychotics, sedative, antiemetic, gastric stimulant, antihypertensive or contraceptive pills; and whether there is any disease of the thyroid gland, kidney and chest wall. Hormone measurement blood collection with or without stress such as hypoxia exercise, exercise, sexual intercourse, anesthesia, pain, hypoglycemia, surgery, nipple stimulation, mental mood swings or pelvic examination.
2. Physical examination
Squeeze the breast to understand lactation, general examination should pay attention to vision, visual field changes, there is no hairy, obesity, hypertension, chest wall lesions.
Treatment
1. Treatment principle
In addition to the factors of physiological and pharmacological hyperprolactinemia, the selection should be made according to the serum prolactin level of pathologic hyperprolactinemia, clinical symptoms, and the presence or absence of fertility requirements. Ectopic prolactin secretion caused by ectopic pregnancy, malignant tumor, hypothyroidism, renal failure, etc. needs to be treated for the primary pathology; if prolactin is mildly elevated, menstruation is regular and those who do not want to have children can be temporarily observed; where there is amenorrhea, hypoestrogenism, infertility and pituitary microadenomas, or accompanied by headache, pharmacological treatment should be preferred. For pituitary macroadenomas causing compression symptoms with visual field defect, headache and vomiting, or poor effect of medication or those who cannot tolerate medication, surgery can be considered; for those who are not suitable for surgery, radiotherapy can be used.
2. Therapeutic goal
Inhibit prolactin secretion, restore normal menstruation, ovulation or fertilization, reduce breast milk secretion and improve visual impairment.
3. Drug therapy
Pharmacological treatment of hyperprolactinemia mainly includes ergot alkaloids, the most commonly used are dopamine agonists, as well as auxiliary ovulation stimulating drugs (for patients who wish to have children) and hormone replacement therapy. The principle is to start with a small dose and gradually increase the dose, mainly orally, or vaginally if oral administration is not tolerated. The patient should be closely monitored and followed up.
(1) Bromocriptine Bromocriptine is the first selective dopamine agonist, and is still the most effective drug for the clinical treatment of hyperprolactinemia, and can also be used as adjunctive therapy for acromegaly and Parkinson’s disease.
(1) Side effects Side effects are common, but are generally characterized by nausea, hallucinations, dizziness, headache, nasal congestion, constipation, etc. Serious side effects are postural hypotension. Because it is excreted through the bile, the liver and gallbladder function should be checked before using the drug.
(2) Dosage form At present, there are long-acting intramuscular injection preparations and oral extended-release agents. The injectable one can be used once a month, with fast onset of action, and can be used for the treatment of macroadenomas.
(3) Course of treatment Generally, blood prolactin decreases significantly after 4 weeks of treatment, and 70% to 90% of patients can resume ovulatory menstruation and stop lactation after 7 to 8 weeks of treatment (average 5 to 7 weeks). Usually, 3 months of treatment is 1 course of treatment.
(4) Treatment of pituitary tumors For pituitary macroadenomas, generally a larger daily dose of bromocriptine can make the tumor shrink rapidly, but individual patients need long-term high dose, if the dose is increased to 10mg/d can not make the tumor shrink (after 3 months of treatment), especially affecting the vision, it is advisable to consider surgical treatment. If the macroadenoma shrinks in the first 3 months of treatment and the serum prolactin rises ≥45.5nmol/L or more, local infiltration of the tumor should be thought of, and even if surgical treatment is still needed for long-term application of bromocriptine.
5）Pregnant patients The drug of choice for those preparing for pregnancy. For patients who wish to become pregnant, use bromocriptine in small doses until pregnancy and stop, or only in the follicular phase of the drug, to be discontinued after ovulation (ultrasound monitoring), in order to prevent overdose in early pregnancy.
(6) Discontinuation of the drug to be careful to avoid the withdrawal phenomenon caused by the recurrence of the disease, generally should be maintained at the lowest dose of the drug, if the serum prolactin level is normal and the patient is asymptomatic for more than 2 years, you can try to discontinue the drug or intermittent dopamine agonist therapy, after discontinuation of the drug 3, 6, 12 months, or every 6 months to detect the value of blood prolactin, the patient needs to pay attention to the symptoms of reoccurrence of timely access to medical care.
(2) Carbamazepine is a specific dopamine D2 agonist synthesized in recent years. It is administered orally with a long half-life, and can be taken once or twice a week, with stronger efficacy, less gastrointestinal reaction, and better tolerability. Oral 1 ~ 2mg / w and bromocriptine 5 ~ 10mg / d efficacy is comparable, and the former after stopping the drug prolactin can be stabilized in the normal range for a longer period of time, can be used as a first-line drugs for those who do not prepare for pregnancy or physiological breast milk overflow and men.
(3) Quinagolide is a non-ergot alkaloid dopamine agonist taken once a day at bedtime, and is mainly used for those who are allergic to ergot alkaloid drugs and those who are resistant to bromocriptine.
(4) Use of medication in special cases
(1) Infertility caused by hyperprolactinemia in women Bromocriptine is the first choice of therapeutic drug for hyperprolactinemic anovulation, and about 80% of patients ovulate after 6 months of treatment. Luteal insufficiency 40% to 47% of prolactin is mildly elevated, and some luteal insufficiency patients with normal prolactin levels may have “transient hyperprolactinemia”, and bromocriptine treatment is also effective. Some recurrent miscarriages are caused by hyperprolactinemia or “hidden hyperprolactinemia”, which can also be treated with bromocriptine.
(2) male infertility caused by hyperprolactinemia male hyperprolactinemia manifested by decreased libido, ejaculatory abnormalities, impotence and spermatogenic disorders, etc., decreased libido is more common, serum prolactin levels corrected some patients can restore normal libido. Infertile patients can take appropriate assisted reproductive technology to solve fertility problems according to semen and spouse.
3) Proposed pregnancy and medication during pregnancy Unless macroadenoma, the risk of pregnancy induced by medication is not significant for both mother and child, and there is no significant increase in the rate of miscarriage, fetal abnormality and twinning rate. In combined pregnancies with high prolactin levels, treatment with bromocriptine should be continued until the placenta establishes a replacement for the corpus luteum after pregnancy (approximately 12 weeks or more). With or without a prolactinoma, the test is usually repeated 10 to 12 weeks after delivery. If a sudden pituitary accident occurs during pregnancy, most patients can control their symptoms with bromocriptine, but sometimes surgery is still required. In addition, pregnancy may facilitate the return to normal in patients with hyperprolactinemia.
4. Treatment of hyperprolactinemia due to saddle region lesions
(1) Treatment purpose ①Control or remove the tumor or lesion, eliminate or reduce the compression, and promote the functional recovery; ②Reduce the high secretion of hormones, and correct the metabolic disorders; ③Restore and protect the function of pituitary gland and the surrounding sensitive structures; ④Properly deal with the comorbidities.
(2) Treatment Depending on the choice of drugs, surgery, radiosurgery, chemotherapy and other treatment strategies.
(3) Treatment strategies for various types of lesions
(1) Prolactin adenoma At present, drug treatment is mostly advocated as the first choice; surgery is mainly applicable to macroadenomas with nerve compression symptoms, tiny adenomas with obvious endocrine symptoms, prolactin adenomas that are unresponsive to or intolerable to dopamine agonists, and is also suitable for patients with psychiatric and other systemic diseases who need to take long-term medications that can lead to hyperprolactinemia. In addition, X-knife, γ-knife and proton knife have also become effective treatments for prolactin adenoma.
(2) Adrenocorticotropic hormone adenomas may have more serious systemic damage and higher resistance to radiation therapy, and surgical treatment is advocated.
3）Nonfunctional adenomas are mostly diagnosed with compression symptoms, and the tumor size is relatively large, with more surgical treatments; radiosurgery can also be performed for patients with no visual pathway compression.
(4) Craniopharyngioma Surgical treatment is the mainstay, and according to the specific location, growth direction, volume and composition of the lesion, transfrontal, pterygoid point, end plate, transsphenoidal, corpus callosum and cortical approaches can be selected. Microsurgery, endoscopy and neuronavigation guidance are used in the operation, which can better protect the hypothalamus and peripheral neural blood vessels, and isolate and resect the tumor more thoroughly. For recurrent substantial tumors far away from the neural structures, radiosurgery can be used; stereotactic radiotherapy can be chosen for those close to sensitive structures. Intracapsular radiotherapy is appropriate for single cystic tumors without significant optic nerve compression or loss of vision for many years, but not for substantial, cystic-solid, thin-walled with multicystic tumors. Intracapsular chemotherapy for cystic tumors may have better efficacy.
(5) Saddle region germ cell tumor Surgical total excision can reduce the dose of radiotherapy and chemotherapy, reduce its side effects, and delay the time of tumor recurrence. As it is very sensitive to radiotherapy, most of the total dose of 50Gy, 5-6 weeks of divided radiotherapy in the whole tumor field and wider peritumor are irradiated in stages; those with multiple foci, positive tumor cells in the cerebrospinal fluid, spinal cord, and ventricular metastasis need total central nervous system radiotherapy. Ohno radiation therapy for younger children has obvious complications and needs to be chosen carefully, often combined with chemotherapy or postponing radiotherapy through chemotherapy.
(6) Other saddle region lesions such as meningioma, sarcoidosis, optic cross section glioma, malignant tumor, metastatic tumor, nodular disease, sarcoidosis lesions, cerebrovascular disease, empty pterygoid saddle and inflammatory lesions, etc. Hyperprolactinemia is only for the manifestation of the damage of the hypothalamus or pituitary stalks, which should be actively dealt with the primary pathology through surgical treatment; those with residual or malignant tumors need to be combined with radiotherapy, and the younger children need to combine with chemotherapy or postpone radiotherapy by chemotherapy when necessary; those who do not constitute a tumor need to combine with radiation treatment, and those who do not constitute a tumor need to postpone radiotherapy through chemotherapy. In younger children, chemotherapy should be combined with or delayed by chemotherapy; small tumors that do not constitute optic pathway compression, (arteriovenous malformations) AVMs can be treated with radiosurgery.
Questions you may be concerned about
Do you have to take bromocriptine for life for hyperprolactinemia?
Bromocriptine for hyperprolactinemia usually requires lifelong bromocriptine.
Bromocriptine is a relatively common clinical peptide ergot alkaloids, can act on the hypothalamus, inhibit the secretion of prolactin, so as to achieve the efficacy of relieving hyperprolactinemia, if the patient’s condition is not serious can be controlled by long-term use of bromocriptine to control the disease, if the situation is more serious, with pituitary gland tumors, may need to be surgical treatment.
Bromocriptine can be used to treat hyperprolactinemia, pituitary prolactinoma and other diseases, the need to determine its dosage and whether the dosage can be reduced according to the condition, the usual use of medication must be consulted with a doctor to avoid blind use of drugs.