Dr. Margarita Vitkina: Over 50 types of drugs can raise prolactin

Dr. Margarita Vitkina: Over 50 types of drugs can raise prolactin
Dr. Margarita Vitkina: Over 50 types of drugs can raise prolactin

We talk with Dr. Vitkina about the reasons for raising the level of the hormone prolactin and how it can be affected in this problem. The doctor also gives valuable tips for dealing with excess weight.

Dr. Vitkina, we associate prolactin primarily with breastfeeding. What other important functions does it perform, not only in the body of women, but also in men?

- Prolactin is a protein hormone that is secreted by the pituitary gland. And indeed, its biological effect is to maintain lactation after pregnancy, during breastfeeding. It is also very high during pregnancy. But there are also many cases of elevated prolactin without these conditions being present. Often, for example, in polycystic ovary syndrome, prolactin may be elevated due to overstimulation of the ovary.

However, it is not clear which is the primary cause - the cerebral cortex, the hypothalamus or the pituitary gland itself. But, a high level of prolactin can also be associated with disorders in the menstrual cycle - irregular or disturbed. It is also possible for pituitary tumors, mostly benign, that produce the hormone prolactin, to have a lack of cycle or menstrual disorders. The treatment is with medication, but it must be diagnosed in time.

That we have a difference in hormones in men and women is a fact, but they are rather in a quantitative ratio than as a lack and presence of them. Men also secrete the hormone prolactin in lower amounts than women. The problem is that high prolactin in men is very often asymptomatic. Even if there are symptoms, they usually appear late and are difficult to detect.

In men, prolactinomas are also discovered later - the tumors that produce the hormone, because they do not have a menstrual cycle and lack this sign that would make us look for such a reason.So, prolactin can be tested in both men and women in certain situations, but it is good to be judged by a specialist, after an examination.

When is treatment given in the presence of prolactinoma?

- The therapy depends on whether we have macro- or microprolactinomas - up to 1 cm in size. Treatment for microprolactinomas is mandatory with tablets prescribed by a specialist. Macroprolactinomas, when they are large, press the optic nerves, there are symptoms of increased intracranial pressure. After an MRI examination, in addition to treatment with tablets, surgery is also recommended.

What factors influence prolactin secretion?

- There are many factors that influence the secretion of prolactin. Since there is a negative feedback relationship with the mammary glands, breastfeeding stimulates the production of prolactin, as well as breast irritation, surgical interventions, burns in the chest area.All of them can lead to an increase in its level.

Prolactin is also a stress hormone. If the test for its levels was taken in the morning on an empty stomach, the patient did not rest for 20-30 minutes in the laboratory before taking the blood, or is currently under stress, we may have false hyperprolactinemia. These are high prolactin values ​​without being associated with another disease. Over 50 types of medication can also cause prolactin to rise.

For example, deganan against nausea and vomiting, as well as many of the drugs that are taken as antiepileptics for depressive syndromes. Prolactin alone, unlike other hormones, has an inhibitory effect on the cerebral cortex and the hypothalamus. And when the connection between the brain and the pituitary gland is disrupted, this inhibition is lost, and the prolactin level can be raised by drugs or other processes in the brain that have to do with the release of this prolactin-inhibiting factor.

What is big-big prolactin?

- As I mentioned at the beginning, prolactin is a protein, a large molecule. Sometimes tumor processes in the pituitary gland can lead to the production of prolactin, which is not in an active form, is packed in many more proteins, is heavier and has no effect on the structures it is supposed to affect. In principle, when we have a release of a hormone, it should connect with the reflex organ and lead to some consequences of its overproduction.

All protein hormones bind to the cell wall and exert their effects, but do not enter the cell. There are also receptors in the cell wall that bind to prolactin. And the big-big prolactin as a level tested in the laboratory has high values, but it has no effect because it does not know how to bind to the receptor.

Is treatment necessary if such big-big prolactin is detected?

- An MRI of the pituitary gland must be done to see what is the reason for its presence in the body. Normally, such a large amount is not released in the human body. There may not be a clinic, but it is good to look for the reason for the production of such a hormone.

Do you have an impression in your practice whether the increased amounts of prolactin are detected in a timely manner?

- I don't think there is such a problem because gynecologists also think about elevated prolactin. For every woman or girl with an irregular menstrual cycle, it is mandatory to look for ultrasound cysts of the ovaries, because ovarian polycystosis has become quite common recently. And usually in this case there is mild hyperprolactinemia.

Prolactin is tested very often in women, it is included in the package of female hormones. And there are not always elevated values. We usually look for it less often and find it in men. It may be related to some disturbances in the libido, but it does not necessarily have any clinic. In men, it is really less often examined and more difficult to establish.

But in boys' puberty, when they grow up, there is a physiological growth of the mammary glands, which undergoes a reverse development after the age of 21. When teenagers come with such complaints, we necessarily examine their testosterone, cortisol and prolactin.Among endocrinologists, this is a problem that any specialist could recognize, prescribe tests and therapy, treat.

How common are prolactinomas?

- Not very common, more common are hyperprolactinaemia due to other causes. Lately I have a lot of cases, especially with this covid crisis and house arrest, of young people with depression

And treating them with some of the antidepressants leads to an increase in prolactin to thousands of units. But usually, when we find such a problem, we talk to their psychiatrists about changing the therapy to drugs that affect prolactin less. Because that messes up the cycle too. And changing therapy over time leads to normalization of prolactin values.

In such cases, it is not a matter of prolactinoma, but the problem lies in the antidepressants that block the release of the prolactin-inhibiting factor. And, escaping from the control of the brain, the pituitary gland starts producing as much prolactin as it wants without a tumor in it.

Apart from the stress of the covid pandemic, the lockdown has also led to weight gain. When is it good to have blood tests?

- When an overweight person comes to me, we always do blood tests to see if there is an endocrine cause - reduced thyroid gland function, insulin resistance. But the most common case turns out to be an incorrect lifestyle and diet. Then we work out a dietary eating regime, with which, based on the Food Detective research, we determine which foods are good for him to eat and which - to limit. When a person follows a strict regimen, for example, but still the result is not enough, we recommend to do the research, because a lot of strange things come out.

For example, a patient with insulin resistance, to whom we recommended mainly protein food, suddenly the test shows that he has antibodies and allergies against cow protein and we have to exclude cow cheese, yellow cheese, milk from his menu.I have had cases of patients who cannot consume peppers or have certain antibodies against foods they love and accept.

But the test does not mean that a person should stop taking this food for the rest of his life. When the patient has strong antibodies to a certain food, it must be excluded from the diet within three months. Then it can be gradually introduced - then it doesn't have this negative effect on nutrition.

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