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Referring to histopathology and pathophysiology, hyperprolactinemia and prolactionoma of course are the same diseases in Syria and in Germany. Clinical symptoms are comparable, even if there might be culturally determinded differences in spontaneaous reporting of an asking for symptoms. In both cultural situations, males are older at diagnosis and then have larger tumors than females.
Differences in use of diagnostic and therpeutic strategies may be related to available resources of each health care system and the countries economic situations.
Even if one might assume in general diagnostic delays in Syria due to deficits of quality and availability of the health care system, furthermore influences from tabooization of sexuality, low individual socioeconomic status and level of education in Syria as compared to western standards, hyperprolactinemia and prolactinoma are diagnosed much earlier in Syria than in Germany. This can be attributed to cultural differences in sexual and reproductive behaviour. There is more frequent use of oral cotraceptives - especially in youth and early adulthood - associated to sexual intercourses of young, unmarried girls and women, high maternal age at first delivery and low birth frequency in Germnay as an industrialised, liberal western country compared to the situation of Syrian girls and women living in a cultural context determinded by a strong Islamic tradition.