Prolactin
Physiology, Pharmacology and Clinical Findings
1st Edition
Published on 1. December 1981
Book
Hardback
X, 226 pages
978-3-540-11071-2 (ISBN)
Description
Lactogenic hormone activity was first observed in bovine pituitary extracts by Stricker and Griiter in 1928, working in Bouin's laboratory in Strasbourg. Since that time prolactin has been shown to exist in anterior pituitary extracts of almost all vertebrate species investigated. Although its biology was extensively studied in many mammalian species, the existence of prolactin in the human was generally doubted, despite the positive evidence produced by such researchers as Pasteels. This can partly be explained by the fact that human growth hormone isolated in 1961, is itself a potent lactogen, in contrast to nonprimate growth hormones, and is present in the normal human pituitary in much greater amounts than prolactin. As a result there was a lag of nearly 10 years until prolactin was unanimously accepted as a hormone of the human pituitary, separate from human growth hormone. In 1970 new bioassay techniques permitted the demonstration of prolactin bioactivity in the serum of postpartum women and galactorrhea patients, and chromatographic methods led to the isolation and purification of human prolactin allowing the establishment of a specific radioimmunoassay for this hormone. This opened the road to the understanding of prolactin physiology and pathophysiology in the human, which has revolutionized clinical neuroendocrinology and reproductive endocrinology. Particularly hyperprolactinemia has turned out to be one of the most common endocrine syndromes.
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Content
1 Prolactin; Synthesis, Fate and Actions.- 1.1 Molecular Structure.- 1.2 Synthesis, Storage and Secretion by the Pituitary.- 1.3 Extrapituitary Sites of Prolactin Synthesis.- 1.4 Prolactin in the Body Fluids; Metabolic Clearance.- 1.5 Prolactin Receptors.- 1.6 The Spectrum of Actions.- 1.6.1 Effects on the Mammary Gland (Lactation).- 1.6.2 Prolactin and the Mammary Cancer Problem.- 1.6.3 Effects on the Ovary.- 1.6.4 Effects on the Testis.- 1.6.5 Prolactin and Hypogonadism.- 1.6.6 Accessory Glands.- 1.6.7 Effects on the Adrenal Cortex.- 1.6.8 Effects on the Excretory Kidney.- 1.6.9 Effects on Fluid Transport in Nonrenal Organs.- 1.6.10 Effects on the Liver.- 1.6.11 Prolactin and Vitamin D3 Metabolism.- 1.6.12 Effects on Carbohydrate and Fat Metabolism.- 1.6.13 Prolactin and Fetal Lung Maturation.- 2 Control of Prolactin Secretion.- 2.1 Physiologic Aspects.- 2.1.1 Patterns of Prolactin Secretion.- 2.1.2 Regulatory Factors.- 2.2 Pharmacologic Aspects.- 2.2.1 Inhibition by Dopaminergic Mechanisms.- 2.2.1.1 Directly Acting Drugs.- 2.2.1.2 Indirectly Acting Drugs.- 2.2.2 Inhibition by Serotoninergic Mechanisms.- 2.2.3 Inhibition by Cholinergic Mechanisms.- 2.2.4 Inhibition via Gaba-ergic Mechanisms.- 2.2.5 Miscellaneous Approaches to Prolactin Suppression.- 2.2.5.1 Inhibition of Prostaglandin Synthesis.- 2.2.5.2 Steroids and Antagonists.- 2.3 References (also for Chap. 1).- 3 Physiology and Pharmacology of Human Lactation.- 3.1 Preparation of Mammary Tissue for Lactation: Hormonal Mechanisms.- 3.2 Maternofetal Correlations; Concentration of Lactogens in a Three-Compartment System Throughout Pregnancy.- 3.3 Biologic Effects of Lactogenic Hormones During Pregnancy.- 3.4 Nyctohemeral PRL Rhythm During Pregnancy and Effect of TRH and Dopaminergic Blockade.- 3.5 Mechanisms of Milk Secretion (Lactogenesis); Maintenance of Lactation (Lactopoiesis).- 3.5.1 The Suckling Reflex: Effect on Prolactin and Milk Production.- 3.5.2 Role of Neurotransmitters in the Initiation and Maintenance of Lactation.- 3.6 Impact of Lactation on Fertility.- 3.6.1 The Hypothalamic-Pituitary-Ovarian Axis in the Early Postpartum.- 3.6.2 Lactation and Fertility in Late Puerperium.- 3.6.3 Mechanisms of Lactational Infertility: Effect of Suckling.- 3.7 Psychosomatic Aspects of Human Lactation.- 3.8 Postpartum Hypoprolactinemia.- 3.9 Suppression of Puerperal Lactation.- 3.9.1 Suppression of Milk Secretion by Physical Measures.- 3.9.2 Inhibition of Lactation with Estrogens.- 3.9.3 Specific Prolactin Suppression with Dopamine Agonists.- 3.9.4 Lactation Suppression with Nonergot Drugs.- 3.10 References.- 4 Nontumoral Hyperprolactinemia.- 4.1 Tests of Lactotrope Cell Function.- 4.1.1 Dopamine (DA) Antagonists and Effect of TRH.- 4.1.2 Dopaminergic Drugs.- 4.1.3 Insulin Hypoglycemia.- 4.1.4 Water Load Test.- 4.2 Factors Influencing Basal Prolactin Secretion in the Clinical Practice.- 4.2.1 Chronobiologic Fluctuations.- 4.2.2 Effect of Stress and Other Factors.- 4.3 Physiopathology of Functional Hyperprolactinemia.- 4.3.1 Effect of Hyperprolactinemia in Women.- 4.3.1.1 Mechanism of Cyclic Disturbances Induced by Hyperprolactinemia.- 4.3.1.2 Effect of Hyperprolactinemia on the Ovary.- 4.3.1.3 Effect of Hyperprolactinemia on Gonadotropin Release.- 4.3.1.4 Adrenal Function in Hyperprolactinemia.- 4.3.1.5 Hyperprolactinemia and the Polycystic Ovary Syndrome (PCO).- 4.3.1.6 Prolactin and Premature Menopause.- 4.3.1.7 Diabetogenic Effect of Prolactin.- 4.3.1.8 The Psychogenic Component of Hyperprolactinemia.- 4.3.2 Effect of Hyperprolactinemia in Male Subjects.- 4.4 Control of Lactotrope Cell Function in Pathologic Hyperprolactinemia.- 4.4.1 Effect of Dopaminergic Blockade and Stimulation with TRH.- 4.4.2 Orcadian Rhythm of Prolactin in the Galactorrhea Syndromes.- 4.5 Incidence of Hyperprolactinemia.- 4.6. Inappropriate Prolactin Secretion: A Classification Under Consideration of Etiologic Factors.- 4.6.1 Historical Background.- 4.6.2 Drugs as Causative Factors.- 4.6.3 Hyperprolactinemia Associated with Other Endocrinopathies.- 4.6.4 Association of Hyperprolactinemia with Nonendocrine Diseases.- 4.6.5 Hyperprolactinemia Through Disturbances of Neural Pituitary Control.- 4.7 Clinical and Biochemical Effect of Inappropriate Prolactin Secretion.- 4.8 Natural History of Galactorrhea Syndromes.- 4.9 Medical Therapy of Nontumorous Prolactin-Dependent Conditions.- 4.9.1 Dopaminergic Drugs: Bromocriptine.- 4.9.1.1 Galactorrhea-Amenorrhea Syndrome.- 4.9.1.2 Hyperprolactinemia and Inappropriate Luteal Phase.- 4.9.1.3 Hyperprolactinemic Anovulation Without Galactorrhea.- 4.9.1.4 Metrorrhagia with Elevated PRL: Response to Bromocriptine.- 4.9.1.5 Effect of Bromocriptine on the Anovulation of Polycystic Ovary Syndrome with Hyperprolactinemia.- 4.9.1.6 Miscellaneous Effects of Bromocriptine on Reproduction.- 4.9.2 Impact of Bromocriptine Treatment on Pregnancy and Fetal Development.- 4.9.3 Treatment of Male Hyperprolactinemia with Bromocriptine.- 4.10 Effect of Other Ergot Derivatives on Prolactin Secretion.- 4.11 Effect of Nonergot Dopamine Agonists on Prolactin Secretion.- 4.12 References.- 5 Pituitary Prolactinomas.- 5.1 Morphology of the Prolactin Secreting Cell.- 5.1.1 Normal Lactotroph.- 5.1.2 Prolactinomas.- 5.2 Pathophysiology of Prolactinomas.- 5.2.1 Prolactin Secretion.- 5.2.1.1 Basal Prolactin Levels.- 5.2.1.2 Hypothalamic Hypophyseotropic Hormones.- 5.2.1.3 Insulin Hypoglycemia.- 5.2.1.4 Dopamine Antagonists.- 5.2.1.5 Dopamine Agonists.- 5.2.2 Pituitary Function.- 5.2.2.1 Growth Hormone Secretion.- 5.2.2.2 Gonadotropin Secretion.- 5.2.2.3 Thyrotropin Secretion.- 5.2.2.4 ACTH Secretion.- 5.2.2.5 Posterior Pituitary Function.- 5.2.3 Local Tumor Symptoms.- 5.2.3.1 Sella Turcica.- 5.2.3.2 Chiasma Syndrome.- 5.3 Clinical Signs and Diagnosis of Hyperprolactinemia Due to Prolactinomas.- 5.3.1 Females with Hyperprolactinemia.- 5.3.1.1 Microprolactinomas.- 5.3.1.1.1 Incidence.- 5.3.1.1.2 Prolactin Secretion.- 5.3.1.1.3 Clinical Signs.- 5.3.1.2 Macroprolactinomas.- 5.3.1.2.1 Incidence.- 5.3.1.2.2 Clinical Signs.- 5.3.1.3 Mixed Adenomas.- 5.3.2 Male Patients with Hyperprolactinemia.- 5.3.2.1 Incidence and Clinical Signs of Macroprolactinomas.- 5.3.2.2 Mixed Adenomas.- 5.4 Therapy of Prolactinomas.- 5.4.1 Medical Treatment.- 5.4.1.1 Microprolactinomas.- 5.4.1.2 Macroprolactinomas.- 5.4.1.3 Antiproliferative Effect of Ergot Alkaloid Derivatives on Prolactinoma Growth.- 5.4.2 Operative Treatment.- 5.4.3 Radiotherapy.- 5.5 Pregnancy and Prolactinoma.- 5.5.1 Clinical Course of Prolactinomas During Pregnancy.- 5.5.2 Treatment of Females with Prolactinomas Seeking Fertility.- 5.5.2.1 Surgery.- 5.5.2.2 Medical Therapy.- 5.5.2.3 Treatment of Local Tumor Complications During Pregnancy.- 5.6 References.