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Some patients do not demonstrate an obvious etiology for their amenorrhea; however, the diagnostic evaluation should lead to the correct diagnosis if the problem is approached in a logical, stepwise manner.
Hyperprolactinemia is frequently due to a prolactinoma, a benign tumor of the pituitary gland that results in excess production of prolactin. However, the most common cause of hyperprolactinemia is the use of prescription drugs. In diagnosing the underlying cause of amenorrhea, the first step should always be to rule out pregnancy with a negative urine or serum hCG result. Drugs that block the effects of dopamine or decrease dopamine stores can cause the pituitary to secrete prolactin.
These drugs include estrogen therapies, tricyclic antidepressants, opiates, amphetamines, hypertension drugs e. Different laboratories may use immunoassays utilizing different antibodies with differing specificities, leading to discordant results. Patients may also have circulating heterophilic antibodies, resulting in false-positive results in some serum assays. It can also lead to irregular or missed periods.
Some women have high prolactin levels without any symptoms. In men, high prolactin levels can cause galactorrhea, impotence inability to have an erection during sex , reduced desire for sex, and infertility.
A man with untreated hyperprolactinemia may make less sperm or no sperm at all. Blood tests can measure levels of prolactin. Levels are sometimes higher if you have eaten recently or are under stress.
Your doctor may also perform a physical exam to find any obvious causes or any breast discharge. If levels are still high after the second check, your doctor may order a magnetic resonance imaging MRI scan of the brain to check for a tumor of the pituitary gland. The treatment depends on the cause. If no cause is found or you have a tumor of the pituitary gland, the usual treatment is medicine.
Hypothyroidism is treated with thyroid replacement medicine, which should also make prolactin levels return to normal. If your regular medicine is the reason for your high prolactin levels, your doctor will work with you to find a different medicine or add one to help your prolactin levels go down.
The most commonly used medicines are cabergoline and bromocriptine. Your doctor will start you on a low dose of one of these medications and slowly increase the dose until your prolactin levels go back to normal.
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