What are prolactin and hyperprolactinemia?

️- Prolactin is a hormone secreted by lactotroph cells of the pituitary gland. Its main physiological functions include supporting lactation (milk production) and promoting “maternal behavior.”
️- An abnormally elevated level of prolactin in the blood is referred to as hyperprolactinemia.

What is considered a normal prolactin level in the blood?

️- Reference ranges may vary slightly between laboratories. Typically, a level of:
<15 ng/mL or <30 ng/mL is considered normal.
- In women, prolactin levels are physiologically slightly higher than in men due to the stimulatory effect of estrogens.
- Hyperprolactinemia is about 10 times more common in women than in men.
- It most often affects women of reproductive age.

Can hyperprolactinemia be physiological?

️- Yes.
️1) During pregnancy and lactation, elevated prolactin levels are considered normal.
️2) Prolactin levels can also rise during sleep, intense physical activity, and emotional stress (in such cases, the elevation is usually mild and does not exceed 50 ng/mL).

What are the causes of pathological hyperprolactinemia (hyperprolactinemic syndrome)?

️- The most common cause is a prolactin-secreting pituitary adenoma, or prolactinoma (a benign tumor).
- A prolactin level >200 ng/mL almost always indicates the presence of a prolactinoma.
- Other causes include:
- Disruption of the pituitary stalk (due to trauma, surgery, infiltrative diseases, or tumors in that area)
- Use of certain medications that increase prolactin levels
- Hypothyroidism
- hronic kidney failure, liver cirrhosis
and more.

What are the clinical manifestations of hyperprolactinemia?

️- In women, the earliest and most common clinical manifestation is menstrual irregularity of various types, which often prompts the patient to seek medical care and undergo hormonal testing—leading to early diagnosis.
️- In men, the first symptoms are usually decreased libido and erectile dysfunction, which are often overlooked or attributed to psychological stress, causing delayed diagnosis in males.
- Galactorrhea (discharge of a milk-like fluid from the breasts) may also occur, with severity ranging from spontaneous leakage to a few drops under firm pressure.
- It’s important to note that galactorrhea may be absent even in cases of severe hyperprolactinemia.
- The classic symptom triad (amenorrhea, infertility, galactorrhea) is most often seen in women with prolactinomas.

What are the treatment options?️

- Surgical
️- Radiation
️- Pharmacological
- The choice of treatment depends on the underlying cause of hyperprolactinemia and several other factors.
- Pharmacological treatment is often lifelong.

Can medication be continued during pregnancy and lactation?

️- Although many studies have confirmed the safety of these medications during pregnancy and breastfeeding, it is generally recommended to discontinue treatment as soon as pregnancy is confirmed. The patient should then be monitored closely with monthly check-ups.
If early signs of tumor regrowth appear, treatment can be resumed.
Lactation itself is not considered a risk factor for tumor growth, but close medical supervision is still required during this period.

Satenik Movsisyan, Endocrinologist

Satenik Movsisyan

 

Education

 

• 1997-2007 Secondary School No. 1 named after Grigor Narekatsi, Metsamor, Armavir Region.
• 1998-2005 Piano Department of the Art School named after Charles Aznavour, Metsamor
• 2007-2012 Bachelor's degree in the Faculty of Medicine, Yerevan State Medical University named after M. Heratsi.
• 2012-2015 Master's degree in the Faculty of Medicine, Yerevan State Medical University named after M. Heratsi.
• 2015-2018 Clinical residency in the specialty "Pediatric Endocrinology". Yerevan State Medical University named after M. Heratsi.

 

Professional activity

 

• 02.2019 - 10.2019 - endocrinologist at the RMC "Armenia"
• 10.2019 - present - endocrinologist at the MC "Cardiolife"
• 01.2023 - present - endocrinologist at the MC "VitaMed"

 

Trainings

 

• 11.12.2018 - 12.28.2018 - advanced training course "Modern issues of clinical endocrinology" (for endocrinologists and pediatric endocrinologists)
• 11.25.2024-12.06.2024 - advanced training course on the topic "Current issues of dietetics and nutrition"

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