Diagnostic Aspects Of Hyperprolactinemia Syndrome

Hyperprolactinemia syndrome is one of the most common neuroendocrine disorders. In the structure of endocrine pathology, it ranks third after diabetes mellitus and thyroid diseases. The article is devoted to the topical issues of diagnosing hyperprolactinemia syndrome depending on the cause of the development of this syndrome.


INTRODUCTION
Hyperprolactinemia syndrome, characterized by excessive pathological secretion of prolactin, accompanied by the development of hypogonadism in men and women, and possibly pathological discharge from the mammary glands, is a very common pathology [1]. In women aged 25-34 years, the incidence of hyperprolactinemia is 23.9 per 100,000 population per year [2, 3]. The incidence of hyperprolactinemia in women of reproductive Diagnosis of hyperprolactinemia is a difficult task, requiring not only the determination of the content of prolactin (PRL), but also its isoforms with high biological activity, a thorough study of the anamnesis, the exclusion of various somatic, endocrine and neuroendocrine disorders [5, 12,14].

OBJECTIVE
To evaluate the results of laboratory and instrumental research methods in women with hyperprolactinemia of various origins.  [8,9,15]. Level RLP above rules confirm diagnosis provided hours the venipuncture made without undue stress to the patient and taking into account all the possible physiological effects on the secretion of prolactin [10,16,17].

MATERIALS AND METHODS
According to the literature, with hyperprolactinemia of tumor genesis, the level of prolactin in the blood serum is significantly higher than with hyperprolactinemia of nontumor genesis, since according to international expert recommendations published in 2006, basal prolactin levels can be used to judge the genesis of hyperprolactinemia [11, 18,19]. The content of the basal level of total prolactin in the total group of examined patients is presented in Table 1. An increased level of prolactin is observed in all patients with prolactinoma (30, 100%), in 21 with PCOS (70%) and in 24 with hypothyroidism (80%).
When assessing the dependence of the level of total prolactin on the cause of hyperprolactinemia, between tumor hyperprolactinemia (prolactinoma) and To obtain a comprehensive hormonal characterization of patients, we used the spectrum of hormonal studies. The serum hormone levels of the examined women are presented in Table 2.
When assessing the dependence of testosterone levels in women with hyperprolactinemia on its cause, significant differences were obtained between 2 (PCOS) and 1 (prolactinoma) (Kruskal -Wallis criterion, p1-2 <0.001) and between 2 (PCOS) and 3 (hypothyroidism) groups (p2-3 <0.001), that is, testosterone levels in women with PCOS are much higher compared to women with prolactinoma and hypothyroidism.
Statistical analysis of the level of FSH, LH and progesterone in tumor and non-tumor hyperprolactinemia did not reveal significant differences, p > 0.05.  It was noted that in 9 women with prolactinoma, in 18 women with PCOS and in 3 women with hypothyroidism, the ratio of LH to FSH exceeds the reference values (LH/FSH>1.5).
14 women with prolactinoma, 23 with PCOS, and 18 with hypothyroidism have low progesterone levels in the middle of the luteal phase of the menstrual cycle, which means chronic anovulation in women with hyperprolactinemia syndrome.
Increased testosterone levels are mainly found in patients with PCOS (observed in 17 patients).
In 3 patients with prolactinoma, this indicator is higher than the reference values.
A low level of free T 4 is observed in 14 women with hypothyroidism (overt hypothyroidism).

Study of the hypothalamic -pituitarygonadal function in women with hyperprolactinemia syndrome
Hyperprolactinemia is one of the most common causes of ovulation disorders, menstrual irregularities and infertility in women.
Hyperprolactinemia is a heterogeneous group of neuroendocrine disorders from a clinical and pathogenetic point of view [13,14,20].
To study structural changes in the ovaries and uterus, to assess ovulatory function and to diagnose gynecological diseases, tumors of the uterus, appendages, to identify abnormalities in the development of the uterus, the patients underwent ultrasound of the pelvic organs on days 14 and 16 of the menstrual cycle.
An ultrasound examination of the pelvic organs (n = 90) showed signs of sexual infantilism in 43 patients. These were mainly patients with tumor-induced hyperprolactinemia (prolactinoma). Twenty-one patients had signs of polycystic ovary (an increase in ovarian volume >10 ml, the number of antral follicles in one cut ≥ 12, with dimensions of 2-9 mm, thickening of the ovarian stroma) (PCOS-21), 16 had signs of a multifollicular structure of the ovaries (prolactinoma -5, PCOS -8, hypothyroidism -3). Among patients with hyperprolactinemia of non-neoplastic genesis, 3 had small uterine fibroids, 2 had signs of adenomyosis, 4 patients had signs of chronic inflammatory disease of the pelvic organs without exacerbation, and one patient had a dermoid cyst of the right ovary. LH and FSH levels are presented in Table 2.
Evaluating the clinical signs in patients with tumor-induced hyperprolactinemia, depending on the level of total prolactin, it was shown that in women with amenorrhea the prolactin level was significantly higher (Kruskal-Wallis criterion p = 0.01). Thus, evaluating the clinical signs, the levels of prolactin, FSH, LH and progesterone, as well as on the basis of ultrasound of the pelvic organs, it can be concluded that in hyperprolactinemia of tumor genesis, the severity of menstrual irregularities depends on the level of prolactin (with the exception of the phenomenon of macroprolactinemia).

MRI of the hypothalamic -pituitary region in the diagnosis of prolactinomas
MRI of the hypothalamic -pituitary region was performed in all patients with prolactinoma to visualize and determine the size of the tumor, the state of chiasm, and to exclude other changes in the hypothalamic-pituitary region. The characteristics of the MRI results are presented in Table 3.  [21].

2.
Testosterone levels in women with PCOS are much higher compared to women with prolactinoma and hypothyroidism.

3.
Evaluating clinical signs, levels of prolactin, FSH, LH and progesterone, as well as on the basis of ultrasound of the pelvic organs, it can be concluded that with hyperprolactinemia of tumor genesis, the severity of menstrual irregularities depends on the level of prolactin (with the exception of the phenomenon of macroprolactinemia). 4.