galactorrhea amenorrhea syndrome
Introduction
Introduction to galactorrhea amenorrhea syndrome Lactation-emphasis syndrome, also known as galactorrhea-menopausal syndrome, refers to the pathological state characterized by lactation and amenorrhea. Strictly speaking, it is not a disease, but can be caused by different diseases, but Syndrome with common clinical features. When this condition occurs, in addition to paying attention to breast health, it should also identify the cause and target treatment. basic knowledge The proportion of illness: 0.03% Susceptible people: seen in women Mode of infection: non-infectious Complications: headache, acromegaly
Cause
Causes of galactorrhea amenorrhea syndrome
Physiological factors (35%):
Plasma prolactin is elevated during sleep, and increased PRL secretion begins after sleep and persists throughout the sleep process. The secretion of PRL also increased during pregnancy, which was more than 10 times higher than that during non-pregnancy. Sucking can temporarily increase the secretion of PRL, but after 3 months of breastfeeding, the rate of increase gradually decreases. During long-term lactation, the normal range of prolactin levels can cause milk secretion, physical activity, stress, mental stimulation and stimulation of the nipple, and the secretion of prolactin can be increased during the menstrual luteal phase.
Pathological factors (25%):
This type of high PRL accounted for 71.6% of all patients with hyperprolactinemia, of which prolactinoma accounted for 33% to 76.9% of amenorrhea-galactorrhea syndrome. Most were microadenomas (diameter <1cm, 66%), and a few were giant adenomas, accounting for 30%. Tumor cells are not inhibited by hypothalamic PIF and autonomously secrete large amounts of prolactin. Growth hormone (GH) tumors, GH/PRL mixed tumors, ACIH tumors, and chromoblastoma can also cause hyperprolactinemia. When tumor enlargement and compression of pituitary stalk, pituitary LH and FSH secreting cells or hypothalamic PIF and GnRH transport are blocked, prolactin is elevated with abnormal secretion of LH and FSH, and amenorrhea-galactorrhea syndrome occurs.
Other factors (20%):
Hypothyroidism and high PRL may be due to TRH-stimulated PRL release. In addition, Addison disease, chronic renal failure can also cause PRL secretion. Certain tumors (such as bronchial lung cancer, adrenal cancer, embryonic cancer) can also secrete ectopic PRL.
Prevention
Collapse and amenorrhea prevention
Non-pregnant and lactating women, or women who have had lactation for 1 year, have persistent galactorrhea with amenorrhea. Treatment of primary diseases (pituitary tumors, hypothyroidism, and Cushing's syndrome), to avoid adverse mental stimulation, reduce or avoid the use of elevated prolactin drugs. For patients with pituitary microadenomas, MRI should be actively treated.
Complication
Complications of galactorrhea amenorrhea Complications, headache, acromegaly
Others such as combined with larger pituitary tumors, or tumors have oppressed optic nerve crossing, headache, diplopia, hemianopia, vision loss and other symptoms, such as accompanied by other diseases, may appear hypothyroidism, acromegaly or Cushing Symptoms such as syndrome.
Symptom
Symptoms of galactorrhea amenorrhea syndrome Common symptoms Amenorrhea, diuretic diuretic, visual impairment, intracranial space-occupying lesion
Mainly manifested as amenorrhea, galactorrhea, increased blood prolactin and infertility. The vast majority were secondary amenorrhea (89%), but there were also reports of primary amenorrhea (4%) and delayed puberty with hyperprolactinemia. There are many menstrual periods before amenorrhea. 2/3 of the patients have galactorrhea, which can be bilateral or unilateral. More normal breasts or with lobular hyperplasia. Generally, amenorrhea occurs first, and galactorrhea is often discovered by doctors. There are also galactorrhea, and menstrual disorders and amenorrhea appear later. In hyperprolactinemia, ovarian corpus luteum function is insufficient, ovulation is rare or ovulation does not cause infertility. A mild increase in prolactin may be ovulatory menstruation, but the luteal phase is shortened, sometimes with progesterone withdrawal bleeding. Some women with hyperprolactinemia do not have galactorrhea and may be associated with a lack of estrogen. There are also a small number of women with galactorrhea who have normal prolactin levels.
Examine
Examination of galactorrhea amenorrhea syndrome
Prolactin stimulation test
1. Thyrotropin-releasing hormone test (TRHtest): normal women with intravenous injection of TRH100 ~ 400g, 15 ~ 30 minutes PRL increased 5 to 10 times before injection, TSH increased 2 times, pituitary tumors do not rise .
2. Chlorpromazine test: Chlorpromazine is transfused by the recipient to suppress norepinephrine absorption and transform dopamine function, promote PRL secretion, normal women with intramuscular injection of 25-50 mg after 60 to 90 minutes of blood PRL It is 1 to 2 times higher than that before injection, lasting for 3 hours, and it is not elevated when the pituitary tumor is present.
3. Metoclopramide test: This drug is a dopamine receptor antagonist to promote the synthesis and release of PRL. In normal women, 30 to 60 minutes after intravenous injection of 10 mg, PRL is more than 3 times higher than that before injection. Not rising.
Prolactin inhibition test
1. L-Dopa test: This drug is a dopamine precursor, which produces DA by dehydroxylase and inhibits PRL secretion. In normal women, PRL is significantly decreased 2 to 3 hours after oral administration of 500 mg, and pituitary tumors are not. reduce.
2. Bromocriptine test: This drug is a dopamine receptor agonist, which strongly inhibits the synthesis and release of PRL. In normal women, the PRL is reduced by 50% for 2 to 4 hours after oral administration of 2.5 to 5.0 mm for 20 to 30 hours. The functional HPRL and PRL adenomas decreased significantly, while the GH and ACTH decreased less than the former two.
Diagnosis
Diagnosis and diagnosis of galactorrhea amenorrhea syndrome
diagnosis
First, ask about the history of medication, because chlorpromazine, methyldopa, piperazine, perphenazine, haloperidol (fluoperidol), and blood and blood can cause prolactin increase. Most of the symptoms gradually disappeared after stopping the drug. Except for breast and chest wall disorders (such as surgery, trauma, herpes zoster, etc.), as well as nipple irritation, long-term sucking and so on.
Differential diagnosis
It should be differentiated from breast diseases, especially papilloma in the mammary duct, but the milk is mostly bloody, and can be distinguished by fat staining or measuring the concentration of alpha lactal.
