txheem
Hyperprolactinemia yog qhov muaj qhov txawv txav ntawm qib prolactin hauv cov ntshav. Prolactin yog ib yam tshuaj uas tsim los ntawm lub caj pas pituitary. Ntau lub luag haujlwm ntawm prolactin hauv lub cev feem ntau cuam tshuam nrog kev xeeb tub thiab tsim cov kua mis rau cov menyuam mos. Txawm li cas los xij, cov qib prolactin tuaj yeem nce ntxiv thaum tus poj niam tsis xeeb tub lossis pub niam mis, ua rau muaj ntau yam mob uas tuaj yeem cuam tshuam rau kev coj khaub ncaws thiab fertility. Serum prolactin yuav tsum tsuas yog ntsuas hauv cov neeg mob uas muaj qog pituitary lossis cov tsos mob thiab cov tsos mob ntawm hyperprolactinemia.
Dab tsi yog hyperprolactinemia
Muaj ntau yam ua rau hyperprolactinemia, suav nrog qee cov tshuaj thiab cov qog pituitary (prolactinoma). Txhawm rau sau cov kev kho mob uas tsim nyog, nws yog ib qho tseem ceeb uas yuav tau txiav txim siab qhov laj thawj. Hyperprolactinemia tuaj yeem ua rau galactorrhea (kev tso tawm ntawm cov kua mis tawm sab nraum lactation) thiab cuam tshuam rau kev ua me nyuam. Qhov no tuaj yeem ua rau pob txha poob yog tias nws yog vim muaj kev sib deev tsis muaj zog.
Feem ntau cov prolactinomas yog micro-prolactinomas. Lawv feem ntau tsis loj hlob sai txaus ua rau muaj teeb meem loj. Cov neeg mob nrog prolactinoma feem ntau kho tau zoo nrog dopamine agonists xws li cabergoline.
Ua rau hyperprolactinemia hauv cov neeg laus
Qhov siab ntawm prolactin nyob rau hauv cov ntshav (hyperprolactinemia) yog ib qho teeb meem ntawm endocrine. Ua rau muaj ntau yam los ntawm cov xwm txheej zoo uas tsis xav tau kev kho mob mus rau kev kho mob loj uas yuav tsum tau kho tam sim. Hyperprolactinemia tuaj yeem ua rau muaj kev phiv ntawm qee yam tshuaj. Txhawm rau nkag siab lub ntsiab lus ntawm cov txheej txheem txuas ntxiv, nws tsim nyog piav qhia me ntsis lub luag haujlwm ntawm cov tshuaj hormone no.
Prolactin yog polypeptide hormone synthesized thiab secreted los ntawm lactotrophic hlwb ntawm lub anterior pituitary caj pas. Prolactin secretion feem ntau tswj los ntawm dopamine, uas yog tsim nyob rau hauv lub hypothalamus thiab inhibits prolactin secretion. Lub hypothalamic hormone thyrotropin-tso cov tshuaj hormones txhawb kev tso tawm ntawm prolactin.
Prolactin exerts nws cov teebmeem los ntawm kev khi rau prolactin receptors. Lawv nyob rau ntawm lub cell membrane ntawm ntau lub hlwb, tshwj xeeb tshaj yog nyob rau hauv lub mis thiab pituitary caj pas. Hauv lub mis, prolactin txhawb kev loj hlob ntawm cov qog thaum cev xeeb tub thiab tsim cov kua mis hauv lub sijhawm tom qab yug menyuam. Hauv cov qog pituitary, prolactin inhibits qhov tso tawm ntawm gonadotropin.
Muaj physiological, pathological thiab tshuaj-txog ua rau hyperprolactinemia (siab prolactin ntau ntau).
Yog vim li cas physiological. Cev xeeb tub, pub niam mis thiab lactation, kev tawm dag zog, kev sib deev thiab kev ntxhov siab tuaj yeem nce qib prolactin. Cov kev nce no yog ib ntus thiab feem ntau tsis pub dhau ob zaug ntawm qhov txwv ntawm qhov ib txwm muaj.
ua rau pathological. Prolactinomas yog cov qog uas tshwm sim los ntawm prolactin-secreting pituitary hlwb. Feem ntau cov prolactinomas (90%) yog microadenomas (<1 cm inch) uas muaj 10 npaug ntau dua rau cov poj niam dua li cov txiv neej. Microadenomas ua rau me ntsis nce qib ntawm prolactin, uas tej zaum yuav cuam tshuam nrog cov tsos mob ntawm hyperprolactinemia, tab sis lawv feem ntau tsis loj hlob.
Macroadenomas (> 1 cm inch) tsis tshua muaj, thiab loj prolactinomas (> 4 cm inch) yog tsawg. Piv nrog rau cov poj niam, cov txiv neej muaj cuaj npaug ntau dua los tsim macroadenoma. Cov qog no ua rau mob hnyav hyperprolactinemia - qhov ntau ntawm prolactin ntau dua 10 mIU / L yuav luag ib txwm qhia tias yog macroprolactinoma. Lawv tuaj yeem ua rau hypopituitarism, pom qhov tsis pom kev, lossis qhov muag tuag tes tuag taw los ntawm compressing lub optic chiasm lossis cranial paj nuclei.
Lwm yam kev tsim ntawm hypothalamus thiab pituitary caj pas tuaj yeem ua rau hyperprolactinemia. Txij li thaum dopamine suppresses prolactin secretion, ib qho neoplasm lossis infiltrative lesion uas compresses pituitary stalk tuaj yeem ua rau tsis muaj zog ntawm dopamine thiab ua rau hyperprolactinemia. Txawm li cas los xij, stalk crush hyperprolactinemia feem ntau yog qis dua 2000 mIU / L, uas txawv ntawm macroprolactinoma.
Qee cov kab mob tuaj yeem ua rau hyperprolactinemia. Prolactin feem ntau yog tawm los ntawm ob lub raum, yog li lub raum tsis ua haujlwm tuaj yeem nce qib prolactin. Vim hais tias thyrotropin-tso cov tshuaj hormones nkoos prolactin secretion, hypothyroidism tuaj yeem ua rau hyperprolactinemia. Kev qaug dab peg tuaj yeem ua rau lub sijhawm luv luv ntawm cov qib prolactin.
Yog vim li cas hais txog tshuaj. Ib tug xov tooj ntawm cov tshuaj cuam tshuam kev tso tawm ntawm dopamine nyob rau hauv lub hypothalamus, uas ua rau ib tug nce nyob rau hauv secretion ntawm prolactin (prolactin 500-4000 mIU / l). Hyperprolactinemia tshwm sim nyob rau hauv cov neeg mob noj tshuaj antipsychotic. Nws kuj tuaj yeem txhim kho, rau qhov tsawg dua, vim qee qhov kev xaiv serotonin reuptake inhibitors (cov tshuaj rau kev nyuaj siab). Lwm cov tshuaj yuav ua rau hyperprolactinemia tsawg dua. Yog tias hyperprolactinemia tshwm sim los ntawm cov tshuaj, cov concentrations feem ntau normalize yog tias cov tshuaj raug tso tseg tsis pub dhau 72 teev.
Cov tsos mob ntawm hyperprolactinemia hauv cov laus
Hauv qee cov neeg mob, hyperprolactinemia yog asymptomatic, tab sis ntau dhau ntawm cov tshuaj hormones tuaj yeem cuam tshuam rau lub caj pas mammary thiab kev ua me nyuam. Hauv cov poj niam, nws tuaj yeem ua rau oligoamenorrhea (lub sijhawm luv thiab tsis txaus), tsis muaj menyuam, thiab galactorrhea. Hauv cov txiv neej, hyperprolactinemia tuaj yeem ua rau erectile kawg, infertility, thiab gynecomastia. Galactorrhea (ua kua mis los yog colostrum los ntawm lub mis) muaj tsawg dua rau cov txiv neej dua li cov poj niam.
Gonadal hormone deficiency tuaj yeem ua kom cov pob txha poob. Cov neeg mob tuaj yeem muaj cov tsos mob lossis cov tsos mob cuam tshuam nrog lub hauv paus ua rau hyperprolactinemia. Piv txwv li, mob taub hau thiab tsis pom kev nyob rau hauv ib tug neeg mob nrog ib tug qog pituitary, thiab qaug zog thiab txias intolerance nyob rau hauv tus neeg mob nrog hypothyroidism.
Kev kho mob ntawm hyperprolactinemia hauv cov neeg laus
Nws yuav tsum tau hais qhia tias qib prolactin yuav tsum tsuas yog ntsuas hauv cov neeg mob uas muaj cov tsos mob lossis cov tsos mob ntawm hyperprolactinemia lossis hauv cov neeg mob uas muaj cov qog pituitary paub. Kev kuaj mob ntawm hyperprolactinemia tuaj yeem ua raws li ib qho kev ntsuas ntawm cov ntshav prolactin saum toj kawg nkaus ntawm qhov qub. Kev kuaj ntshav yuav tsum tau ua yam tsis muaj kev ntxhov siab.
diagnostics
Kev kuaj ntshav yooj yim los ntsuas tus nqi ntawm prolactin hauv cov ntshav tuaj yeem lees paub qhov kev kuaj mob ntawm qib siab prolactin. Prolactin ntau dua 25 ng / mL yog suav tias yog nce hauv cov poj niam uas tsis cev xeeb tub. Txij li txhua tus neeg muaj kev hloov pauv txhua hnub hauv cov qib prolactin, nws yuav tsum tau rov kuaj ntshav yog tias qib ntawm cov tshuaj hormones nce me ntsis. Ntau tus poj niam tau txais qhov kev kuaj mob no tom qab kuaj kev xeeb tub lossis yws yws ntawm lub sijhawm tsis tu ncua, tab sis lwm tus tsis muaj tsos mob. Qee zaum cov neeg mob muaj cov kua mis tawm ntawm lub txiv mis, tab sis feem ntau tsis muaj cov tsos mob no.
Ib qho kev nce me me ntawm prolactin, nyob rau hauv thaj tsam ntawm 25-50 ng / ml, feem ntau tsis ua rau muaj kev hloov pauv hauv kev coj khaub ncaws, txawm hais tias nws tuaj yeem txo qhov fertility tag nrho. Cov qib prolactin siab dua ntawm 50 txog 100 ng / mL tuaj yeem ua rau lub cev tsis muaj zog thiab txo tus poj niam txoj kev xeeb tub. Prolactin ntau dua 100 ng / mL tuaj yeem hloov pauv qhov kev ua haujlwm ntawm tus poj niam lub cev xeeb tub, ua rau cov tsos mob ntawm menopausal (tsis muaj txiv neej, kub flashes, qhov chaw mos dryness) thiab infertility.
Thaum kuaj pom tus mob hyperprolactinemia lawm, yuav tsum tau kuaj xyuas seb puas muaj qhov tshwm sim thiab cov teeb meem cuam tshuam. Cov poj niam thiab cov txiv neej yuav tsum ntsuas estrogen thiab thaum sawv ntxov testosterone, feem, nrog rau gonadotropins. Hauv cov poj niam cev xeeb tub, cov thyroid thiab lub raum ua haujlwm yuav tsum raug ntsuas thiab tsis suav nrog cev xeeb tub.
Yog tias tsis muaj lwm qhov laj thawj tseeb raug tsim, MRI ntawm lub qog pituitary tau qhia. Cov neeg mob uas muaj cov qog pituitary loj dua 1 cm nyob rau hauv txoj kab uas hla yuav tsum tau tshuaj xyuas los soj ntsuam lwm cov tshuaj hormones pituitary thiab xyuas qhov pom kev. Nws yog ib qho tseem ceeb los txiav txim siab pob txha pob txha pob txha hauv cov neeg mob hypogonadism.
Kev kho mob niaj hnub
Qee tus neeg mob tsis xav tau kev kho mob. Cov neeg mob uas muaj physiological hyperprolactinemia, macroprolactinemia, asymptomatic microprolactinoma, los yog tshuaj-induced hyperprolactinemia feem ntau tsis tas yuav kho. Yog tias hyperprolactinemia yog qhov thib ob rau hypothyroidism, kev kho tus neeg mob nrog thyroxine yuav tsum normalize prolactin.
Cov txheej txheem kho mob
Raws li cov txheej txheem kho mob, cov qib siab prolactin tau kho nrog kev sib xyaw ua ke ntawm ntau txoj hauv kev.
Cov tshuaj uas ua rau lub hlwb siv tshuaj dopamine tuaj yeem siv tau los kho cov neeg mob feem ntau nrog cov qib prolactin siab. Cov tshuaj no txwv tsis pub tsim cov prolactin los ntawm lub caj pas pituitary thiab ua rau muaj kev cuam tshuam ntawm prolactin-tsim hlwb. Ob hom tshuaj uas tau sau ntau tshaj plaws yog cabergoline thiab bromocriptine. Pib nrog ib koob tshuaj me me, uas yog maj mam nce, cov kev mob tshwm sim, suav nrog kev hloov ntshav siab thiab kev puas siab puas ntsws, tuaj yeem txo qis. Cov neeg mob feem ntau teb zoo rau cov tshuaj no thiab cov qib prolactin txo qis tom qab 2 mus rau 3 lub lis piam.
Thaum cov qib prolactin poob qis, kev kho mob tuaj yeem hloov kho kom tswj tau cov qib prolactin ib txwm, thiab qee zaum nws tuaj yeem raug tso tseg. Spontaneous qog regression feem ntau tshwm sim hauv ob peb xyoos yam tsis muaj qhov tshwm sim hauv chaw kho mob.
Hauv qee tus neeg mob, cov tshuaj tsis txo qis prolactin, thiab cov qog loj (macroadenomas) tseem nyob. Cov neeg mob no yog cov neeg sib tw rau kev kho mob phais (transsphenoidal adenoma resection) lossis kev kho hluav taws xob.
Kev tiv thaiv hyperprolactinemia hauv cov neeg laus hauv tsev
Hmoov tsis, rau hnub tim, tsis muaj txoj hauv kev zoo tau tsim los tiv thaiv cov kab mob no. Kev tiv thaiv tus qauv raug pom zoo, suav nrog kev tswj hwm lub neej noj qab haus huv, muab tus cwj pwm tsis zoo, kho txhua yam kab mob ntawm cov menyuam yaus thiab cov tshuaj hormonal metabolism.
Nrov lus nug thiab lus teb
Hais txog kev kuaj mob thiab kev kho mob ntawm qhov teeb meem ntawm lub caj pas pituitary thiab siab prolactin, cov yam ntxwv ntawm kev tiv thaiv, peb tau tham nrog urologist, kws kho mob tshwj xeeb hauv ultrasound diagnostics, kws kho mob ntawm qeb siab tshaj Yuri Bakharev.