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Prolactin (PRL)

Presented by:
Taufiq RN

Biosynthesis
PRL synthesized
and secreted from
lactotrophs of
anterior pituitary
PRL is a 199 amino
acid polypeptide
hormone
Large PRL
secretory granules
(250-800 nm) are
present in the
evenly distributed

Occasional mammosomatotroph cells


cosecrete both PRL and GH, often stored
within the same granule
In animal models,
lactotroph cell
function is
heterogeneous. Thus,
dopamine or TRH
responsiveness, and
shifting proportions of
PRL versus GH
secreting cells, may
depend on cell
localization within the
pituitary, as well as

actotroph hyperplasia
The absolute
number does not
change with age
Lactotroph
hyperplasia does
occur during
pregnancy and
lactation and
resolves within
several months of
delivery

Function
Stimulate lactation in the post partum period
During pregnancy, PRL secretion increases in
concert with many other hormones
(estrogen, progesterone, hPL, insulin,
cortisol)
PRL promotes additional breast development
in preparation for milk production, but PRL
has not been demonstrated to play a role in
the development of breast tissue in human

Important about PRL during pregnancy


During pregnancy estrogen enhances breast
development but blunts the effect of PRL on
lactation; the decrease of both estrogen and
progesterone after parturition allows initiation
of lactation
Although basal PRL secretion falls in the post
partum period, lactation maintained by
persistent breast suckling
PRL level are very high in the fetus and in new
born infant, declining during the first few
months of life

Parturition
Delivery is associated with a surge in PRL which
is followed by rapid fall in serum concentration
over 7 14 days in the non lactating mother
In non lactating women: initial ovulation
occurred at average 9 -10 weeks postpartum
In lactating women PRL usually cause a
persistence of anovulation
The average time for ovulation in women who
have lactated for at least 3 months is about 17
weeks

Menstruation
The percentage of non lactating women
who have resumed menstruation
increase linearly up to 12 weeks, by
which time 70% will have restored
menses
The linear increase for lactating women
exhibits a shallower slope and 70% of
lactating women will have menstruated
by about 36 weeks

Lactation
Lactation requires PRL,
insulin, and adrenal
steroids
It does not occur until unconjugated estrogen fall
to non-pregnant levels at
about 36 48 hours
postpartum
PRL is essential to milk
production through
induced synthesis of large
numbers of PRL receptors

Lactation
Milk ejection occurs
in response to a
surge of oxytocin,
which induces a
contractile response
in smooth muscle
surrounding the
gland ductules
Oxytocin release is
occasioned by
stimuli of a visual,
psychologic, or

Aware to hyperprolactinemia!
Hyperprolactinemia in human leads to
hypogonadism
In women, PRL excess shorten luteal phase;
subsequently anovulation, oligomenorhae
or amenorhae, and infertility occur.
In men, hyperprolactinemia leads to
decrease testosterone synthesis and
decrease spermatogenesis, wich clinically
present as decrease of libido, importence,
and infertility.

PRL Decreases GnH


Basal LH and FSH levels usually are
normal; however their pulsatile secretion
is decreased and the midcycle LH surge
is supressed in women
Gonadotropin reserve, as assessed with
GnRH, is usually normal or exaggerated

Measurement
1. The PRL secretory rate is approximately 400
g/d (18.6 nmol/d)
2. The hormone is cleared by the liver (75%) and
kidney (25%), and its half time of
disapearance from plasma is about 50 minutes
3. Basal levels of PRL in adults vary considerably,
with mean of 13 ng/mL (0.6 nmol/L) in women
and 5 ng/mL (0.23 nmol/L) in men
4. The upper range of normal in most
laboratories is 15 20 ng/mL (0.7 0.9
nmol/L)

PRL Secretions
Increase
Physiologic
Pregnancy
Nursing
Nipple stimulation
Exercise
Stress (hypoglycemia)
Sleep
Seizure
Neonatal

Increase
Pharmacologic
TRH
Estrogen
Vasoactive intestinal
peptide
Dopamine antagonist
(phenothiazines,
haloperidol,
resperidone,
metoclopramide,
reserpin,
methyldopa,
amoxapine,
opioids)

Increase
Pathologic
Pituitary
tumors

Decrease

Dopamine agonist
(levodopa,
apomorphine,
bromocriptine,
Hypothalamic/pitu pergolide)
itary
GABA
stalk lesions
Neuraxis
Pseudohypoparath
irradiation
yroidism
Chest wall
Pituitary
lesions
distruction or
Spinal cord
removal
lesions
Lymphocytic