Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (259 page)

Suggested Reading

Davis J, Segars J. Menstruation and menstrual disorders: anovulation.
Glob Libr Women’s Med.
(ISSN: 1756–2228); 2009; doi: 10.3843/GLOWM.10296

HYPERPROLACTINEMIA

   Definition

   Hyperprolactinemia is an abnormally high serum prolactin concentration in women of reproductive age. Excluding pregnancy, it accounts for 10–20% of cases of amenorrhea.

   Who Should Be Suspected?

   In premenopausal women, hyperprolactinemia causes hypogonadism, manifested by infertility, oligomenorrhea, or amenorrhea, and less often by galactorrhea. The mechanism involves inhibition of LH, and possibly FSH as well, through inhibition of the release of GnRH. The symptoms of hyperprolactinemic hypogonadism in these patients directly correlate with serum prolactin concentration. In most laboratories, a serum prolactin concentration above 15–20 ng/mL (15–20 μg/L) is considered abnormally high for women of reproductive age.

   Laboratory Findings (Premenopausal Women)

   20–50 ng/mL (20–50 μg/L): Mild hyperprolactinemia, causing insufficient progesterone secretion and a short luteal phase of the menstrual cycle. Infertility may be present despite no abnormality of the menstrual cycle. These patients account for about 20% of those evaluated for infertility.

   50–100 ng/mL (50–100 μg/L): Moderate hyperprolactinemia, causing either amenorrhea or oligomenorrhea.

   100 ng/mL (>100 μg/L): Associated with overt hypogonadism, subnormal estradiol secretion, and its consequences, including amenorrhea, hot flashes, and vaginal dryness.

Suggested Reading

Corenblum B, Pairaudeau N, Shewchuk AB. Prolactin hypersecretion and short luteal phase defects.
Obstet Gynecol.
1976;47:486–488.

*
Written by Michael Mitchell, MD.

^‡
Written by Michael J. Mitchell, MD.

Chapter
8

Gynecologic and Obstetric Disorders

Juliana G. Szakacs

Gynecologic Disorders

Cancer of the Breast

Cancer of the Cervix

Cancer of the Endometrium

Cancer of the Ovary

Urinary Tract Infections

Pelvic Inflammatory Disease

Vaginosis and Vaginitis (Bacterial Vaginosis, Trichomoniasis, Vulvovaginal Candidiasis)

Pregnancy and Obstetric Monitoring of the Fetus and Placenta

Pregnancy

Infants at Increased Risk

Obstetric Disorders

Amniotic Fluid Embolism

Chorioamnionitis

Ectopic (Tubal) Pregnancy

Fetal Death In Utero

Postterm Pregnancy

Multiple Gestation Pregnancy

Placentae Abruptio and Previa

Preterm Delivery

Ruptured Membranes

Toxemia of Pregnancy (Preeclampsia/ Eclampsia)

Eclampsia

Trophoblastic Neoplasms

The 10th edition is updated to include the latest recommendations for cervical cancer screening and diagnostic testing for diseases of the female genital tract, including abnormalities related to menstruation. New genetic tests for the prenatal screening of heritable disorders are becoming available (see also Chapter
10
). Please see the e-book version for the figures referenced in this Chapter.

   
GYNECOLOGIC DISORDERS

CANCER OF THE BREAST

Definition