ABSTRACT
Background: Hyperprolactinemia is a condition of elevated serum prolactin.
Prolactin is a 198-amino acid protein (23-kD) produced in the lactotrophs cells of the
anterior pituitary gland. Hyperprolactinemia is the most common hypothalamo-
pitiutary disorder; it can also occur secondary to use of some drugs, chronic illnesses
like hypothyroidism, chronic liver and kidney disease, stress and neurogenic
disorders. Idiopathic Hyperprolactinemia refers to elevation of serum prolactin in the
absence of the above conditions.
Objective: The aim of this study is to explain scientifically hyperprolactinemia as a
cause of female primary infertility and its prevalence in Gezira State, Central Sudan.
Method: Serum prolactin, FSH and LH levels were estimated using commercially
specific enzyme immunoassay (EIA) technique in serum from 200 women (150
primary infertile and 50 fertile non-pregnant and non-lactating) attending Wad
Medani teaching hospital in Wad Medani city, Central Sudan, from 2011 till 2013.
Results: Hyperprolactinemia was found in 33.3%, irregular menstrual cycle 66%,
amenorrhea 6.7%, oligomenorrhoea 59.3%, normal menorrhea (33,3%) and
galactorrhoea 3.3% of primary infertile women.
Conclusion: The prevalence of hyperprolactinemia was about one-third of primary
infertile women in Gezira State (Central Sudan). The main aetiology of primary
infertility was anovulatory cycle due to high level of prolactin.
for the disorder needs to be sought. This Serum prolactin, FSH and LH
involves a careful history and levels has been estimated by using
examination, followed by laboratory tests commercially specific enzyme
and diagnostic imaging of the sella immunoassay (EIA) kits, the procedure
turcica (Mah and Webster, 2002). for hormonal estimation has been
Hyperprolactinemia may occur due followed as given in the EIA kits
to physiological, pharmacological, or (Kalsum and Jalali, 2002).
pathological causes. The most relevant The diagnostic evaluation first
physiological causes of the disorder are requires exclusion of other causes of
pregnancy and breastfeeding. Drug hyperprolactinemia, such as pregnancy,
induced hyperprolactinemia may be primary hypothyroidism and numerous
caused by neuroleptics, tricyclic medications. The second step in the
antidepressants, some antihypertensive diagnostic evaluation is to perform a
drugs, gastrointestinal-acting drugs and head scan, preferably a Magnetic
oral contraceptives, among others Resonance Imaging (MRI) (Biller, 1999).
(Molitch, 2005). Prolactinomas, i.e., Dopamine agonists are the
pituitary adenomas that express and treatment of choice for the majority of
secrete prolactin to variable degrees, are hyperprolactinemic women wishing to
the main pathological cause of conceive. Cabergoline has been shown to
hyperprolactinemia (Casanueva et al., be more effective and better tolerated
2006). than bromocriptine. (Mah and Webster,
The clinical features of 2002).
hyperprolactinemia are shortened luteal
phase, oligomenorrhoea, amenorrhoea MATERIALS AND METHODS
and galactorrhoea. Mild Five ml of peripheral venous blood
hyperprolactinemia can cause infertility were collected from infertile women
even when there is no abnormality in the patients of the study population by
menstrual cycle. Women with venipuncture. Blood samples were placed
amenorrhoea due to hyperprolactinemia in plain containers and allowed to clot at
have lower bone mineral density BMD room temperature before centrifugation
(Wing-bun, 2008). for three minutes at 3000 rpm. Serum
Hyperprolactinemia affecting about separated and stored in an Eppendorf
one-third of infertile women (Rebar, tubes at -20C until analyzed for
1997). It has been suggested that reproductive function test. Blood
hypogonadism seen in specimens also collected from fertile
hyperprolactinemic women is due to high non-pregnant and non-lactating women
circulating levels of prolactin interfering with no past history of hypothyroidism or
with the action of the gonadotrophin at depression.
the ovarian level and impaired gonadal Collected samples were matched
steroid secretion, which in turn alters with age, tribes, menstrual cycle,
positive feedback effects at the menorrhoea and galactorrhoea. Patients
hypothalamic and pituitary levels. This were categorized according to the stock
leads to lack of gonadotrophin cyclicity of Sudanese tribes into 9 groups, which
and to infertility (Thorner and Besser represent all the ethnic groups of
1978). In a study performed in Sudan the Sudanese.
hyperprolactinaemic patients were For the determination of serum
mostly from Central Sudan (Sinar, White Prolactin, FSH and L.H levels, enzyme
Nile and Gezira region + Khartoum); immunoassay (EIA) technique used.
57% (Satti, 2007). Serum and standards into 200 tubes.
Then working suspension of Magnetic
Hyperprolactinemia as a cause of female primary infertility and its prevalence 33
Antibody, Wash Buffer, diluted Enzyme group and 50 (25%) were fertile non-
Labelled Antibody, Substrate and Stop pregnant and non-lactating women taken
Buffer were added to each tubes at room as control group. The initial finding
temperature. Each assay includes a revealed that 50 (33.3%) out of 150
calibration (six) and substrate blank. infertile women were hyperprolactinemic
Finally the colored products were read and 100 (66.7%) were normoprol-
using spectrophotometer (BioSystems). actinemic. Menstrual cycle was devided
into two types; regular and irregular
RESULTS menstrual cycle. The regular were 50
A total of 200 women, of whom (33.3%) and the irregular were 100 (66.7
150 (75%) were infertile taken as case %) infertile women (Table 1).
Table 1: Frequency and Percent of the study group, prolactinemia in the infertile group and the
regularity of the menstrual cycle in the case group.
Samples Frequency Percent
Study group: Case 150 75.0
Control 50 25.0
Total 200 100.0
Prolactin: Hyperprolactinemia 50 33.3
Normal 100 66.7
Total 150 100
Menstrual Cycle: Regular 50 33.3
Irregular 100 66.7
Total 150 100.0
Table 3: Group Statistics of Menstrual Cycle by mean, Std. Deviations and p. value.
Menstrual Cycle N Mean Std. Deviations p. value
Prolactin level Regular 50 306.34 168.114 0.000
mU/L Irregular 100 490.10 414.332
FSH level Regular 50 10.1200 7.72127 0.000
mU/L Irregular 100 22.2100 28.77334
LH level Regular 50 7.6400 4.32251 0.000
mU/L Irregular 100 23.2100 24.26216
ARABIC SUMMARY
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3
2 1
. -1
.- - - -2
. -3
.
.( Lactotrophs) ( 23-kD) 198
( T4) ( T3)
.
-
.
150) 200 ( EIA) LH FSH
( 50
.2013 2011 -
( 66) Irregular menstrual cycle (33.3) Hyperprolactinemia
( 3.3) Galactorrhoea (33.3) Normal menorrhoea oligomenorrhoea (59.3) (6.7) Amenorrhoea
.
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