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Prolactin (PRL)

Prolactin (PRL) is a polypeptide hormone (molecular weight 20,000 Da) secreted by the pituitary gland, which plays a key role in the development of the mammary gland, the production and secretion of milk and the control of male and female gonadal functions. Prolactin secretion is under hypothalamic control exerted directly by dopamine, several prolactin releasing factors (PRF) and perhaps VIP (vasoactive intestinal polypeptide) or a closely related peptide. TRH also acts directly at the pituitary level to stimulate prolactin release but its physiological role in the control of prolactin
secretion has not been established yet. Several neuroendocrine factors, involving serotoninergic or noradrenergic pathways are also involved in the control of prolactin secretion. The plasma concentration of prolactin increases in various physiological situations such as stress, pregnancy and
lactation. Physiological levels fluctuate according to a nycthemeral rhythm, a significant rise being observed at night. Drugs with anti-dopamine activity (psychotropic agents) and ovulatory supressants, increase prolactin secretion.

Clinical applications

  • Prolactinoma : Circulating prolactin levels are elevated in patients with a prolactin secreting pituitary adenoma. Amenorrhea and impotence are characteristic clinical symptoms in such cases
  • Other pituitary diseases : Increased prolactin levels are also observed in 5% to 20% of patients with acromegaly and when pituitary control by the hypothalamus is suppressed (pituitary stalk section) . Decreased PRL levels may be observed in cases of complete destruction of the pituitary as in Sheehan's syndrome.
  • Galactorrhea and amenorrhea : The measurement of the prolactin levels in serum is a useful test in
    the differential diagnosis of galactorrhea and amenorrhea.
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