Prolactin (PRL) is a hormone that is closely linked to the gonadal axis, and therefore to a woman's reproductive life.
PRL acts mainly on the mammary gland by initiating and maintaining lactation. Excess secretion of PRL (hyperprolactinemia) is clinically manifested by sexual or reproductive dysfunctions and galactorrhea.
Hyperprolactinemia interferes at different levels of the hypothalamus-pituitary-ovarian axis and is the cause of a third of all cases of female infertility. Although the true prevalence of hyperprolactinemia is difficult to establish, it is estimated that among women with reproductive disorders, approximately 15% with anovulatory cycles and 43% suffering from galactorrhea present hyperprolactinemia. In cases where hyperprolactinemia is detected, the main objective is to demonstrate or rule out the presence of a pituitary adenoma secreting PRL (prolactinoma).
The most frequent causes are pharmacological (antidepressants, antipsychotics, hypotensives, hormones, etc.) and secondly physiological (sleep, stress, pregnancy, etc.). As for the group of those secondary to diseases (prolactinomas, acromegaly, enf. cushing, etc.), the most frequent cause is by hypophysial adenoma.
Once the cause has been determined, the PRL is normalised. With proper management, most women can become pregnant.
Bromocriptine and cabergoline are drugs used for treatment and are not teratogenic. They are generally suspended in the case of microadenoma gestation and can be maintained in macroadenomas with the risk of chiasmatic compression, as they prevent tumor expansion during pregnancy (20-30% of macroadenomas may present compressive symptoms in pregnancy). Dopamine agonists have been used to prevent tumor growth during pregnancy. During pregnancy, campimetries should be performed quarterly and PRL should be monitored at follow-up.
In case of having to perform any imaging technique, the choice is magnetic resonance imaging.
In the case of macroadenomas close to the optic chiasm and which do not present a significant reduction in tumor volume with dopamine agonists, the best therapeutic option prior to pregnancy is transsphenoidal surgery.
