prolactinoma
Introduction
Introduction to prolactinoma Prolactinoma is the most common pituitary tumor, an endocrine disease caused by excessive prolactin (PRL) secreted by pituitary prolactinoma. Women presented with galactorrhea, amenorrhea (blood PRL>50ug/L, normal menstruation with idiopathic hyperprolactinemia), infertility and sexual dysfunction, delayed development of adolescents, hairy and acne, osteoporosis , obesity, water retention, male symptoms, mainly impotence, infertility, a small number of galactorrhea, breast development, thin hair, and more because of pituitary adenoma compression symptoms and seek medical treatment. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: hyperprolactinemia
Cause
Prolactinoma etiology
Disease factor (35%)
Pathologically high PRL pathologically high PRL is more common in hypothalamic-pituitary disease, with PRL tumors being the most common. In addition to PRL tumors (or mixed tumors containing PRL tumors), other hypothalamic-pituitary tumors, invasive or inflammatory diseases, sarcoidosis, granuloma, and trauma, radiation damage, etc. are due to obstruction or obstruction of dopamine in the hypothalamus. The blood flow to the pituitary gland causes the prolactin release inhibitor (PIF) such as dopamine to fail to reach the pituitary gland.
Drug factor (25%)
Drug-induced high PRL can cause high PRL blood, including dopamine receptor antagonists, estrogen-containing oral contraceptives, certain antihypertensives, opiates and H2 blockers (such as West Mitidine) and so on.
Hormone factor (15%)
It has been thought that long-term administration of estrogen may be the cause of PRL neoplasia, but large-scale studies have shown that oral contraceptives, especially low-dose estrogens, are not associated with the formation of PRL tumors. It is now believed that the pituitary self-defect is the starting cause of PRL tumor formation, and the hypothalamic regulatory disorder only plays a role of allowing and promoting.
Prevention
Prolactinoma prevention
The disadvantage of taking bromocriptine is that once the drug is stopped, the tumor will increase and the PRL value will increase. This "rebound" phenomenon makes the patient have to take the drug for a long time or switch to surgery or radiotherapy.
The operation of PRL adenoma is basically through the nasal-sphenoidal keyhole approach, with fewer complications, increased surgical and safety factors, and retrograde intracranial infection and cerebrospinal fluid rhinorrhea after surgery must be prevented.
The disadvantage of gamma knife treatment of PRL adenoma is that the decrease of PRL value is slower, and the tumor shrinkage will not be immediate. Some patients need to take bromocriptine to assist.
Complication
Prolactinoma complications Complications hyperprolactinemia
Often leads to hyperprolactinemia.
Hyperpro-lactinemia (HPRL) refers to a syndrome characterized by elevated internal and external environmental factors, elevated PRL (25 ng/ml), amenorrhea, galactorrhea, anovulation and infertility. In the past 20 years, the physiological and biochemical research on PRL has made great progress, and the advancement of PRL radioimmunoassay, brain CT and MRI diagnostic techniques has improved the diagnostic level of HPRL, and its incidence has also increased.
Symptom
Prolactinoma Symptoms Common symptoms Watery stagnation, septic milk, osteoporosis, male infertility, male sexual dysfunction, galactorrhea, hyperprolactinemia
One. History, symptoms and signs:
Women presented with galactorrhea, amenorrhea (blood PRL>50ug/L, normal menstruation with idiopathic hyperprolactinemia), infertility and sexual dysfunction, delayed development of adolescents, hairy and acne, osteoporosis , obesity, water retention, male symptoms, mainly impotence, infertility, a small number of galactorrhea, breast development, thin hair, and more because of pituitary adenoma compression symptoms and seek medical treatment.
Examine
Prolactinoma examination
First, PRL >100ug/L is highly considered prolactinoma; >200ug/L is mostly prolactinoma; RL<100ug/L is considered hyperprolactinemia. The PRL inhibition test was orally administered with L-dopa 500mg. The PRL was measured before 1, 2, 3 and 6 hours after taking the drug. The normal level of PRL was inhibited below 4ug/L or more than 50% of the baseline value after 1-3 hours of normal administration. Patients with prolactinoma are not inhibited.
Second, the TRH excitatory test under the state of intravenous injection of TRH200ug, 30 minutes before the injection, 15, 30, 60, 120 and 180 minutes after the injection of PRL, the peak of normal and hyperprolactinemia patients mostly appeared 30 minutes after injection, peak / The base ratio was >2, and the peak of prolactinoma patients was delayed, with a peak/base ratio of <1.5.
3. Excitatory test of chlorpyrifos before and after taking the sputum and 1, 2 and 3 h after taking the drug, respectively, PRL, normal and hyperprolactinemia patients peak at 1-2h, peak / base ratio > 3, prolactinoma patient peak / base ratio <1.5.
Fourth, other hormone testing; gonadotropin normal or low, enhanced response to GnRH stimulation test; female patients with low estradiol; male testosterone decreased.
Fifth, imaging examination: Sella X tablets are mostly normal, pituitary CT scan or MRI can be found micro adenoma.
Diagnosis
Prognosis diagnosis of prolactinoma
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Hyperprolactinemia caused by other causes should be distinguished
1. Physiological factors such as pregnancy, postpartum, nipple irritation, neonatal, mid-menstrual (increased by estrogen), sleep, sexual intercourse, etc.
2. Pathological factors: other pituitary tumors; hypothalamic disease; empty sella syndrome; ectopic prolactinoma; primary hypothyroidism; renal failure; chest and breast disease.
3. Drugs: contraceptives such as estrogen; morphine and hypnotics; tricyclic antidepressants, reserpine and chlorpromazine; anti-dopamine drugs; phenothiazine, isoniazid, isopulp, cyproheptadine , cimetidine and the like.
4. Idiopathic hyperprolactinemia.
