Lactation disorder
Introduction
Introduction Breast milk secretion is called lactation. Breastfeeding is called breastfeeding for young children. Lactation is caused by various hormones acting on the mammary glands that develop. In addition to nutritional conditions, the development of the mammary gland requires the action of estrogen (emotional hormone and progesterone). After the spring period, the secretion of these hormones is increased, so that the development of the mammary gland can be accelerated. During pregnancy, the concentration of estrogen in the blood increases, and the synergistic effect of pituitary hormones, the development of the mammary gland is more significant. After delivery, prolactin, corticotropin, and auxin secreted from the anterior pituitary gland act on the developed mammary gland, causing milk secretion. The maintenance of lactation requires breast stimulation. Through the nerve path, the lower part of the thalamus acts on the anterior pituitary gland to promote the secretion of the above hormones, and at the same time release the oxytocin in the posterior lobe. Oxytocin reaches the mammary gland, causing contraction of myoepithelial cells surrounding the mammary cells that produce milk to promote milk discharge. If the breast does not discharge the milk, the internal pressure of the breast rises and the secretion function of the breast cells will appear to be impaired.
Cause
Cause
1. Postpartum pituitary necrosis and atrophy: It is easy to cause ischemia and necrosis when the pituitary is physiological hypertrophy during pregnancy, which may be an important condition for the occurrence of this disease. Secondly, the blood supply to the anterior pituitary is from the portal system. Major bleeding or infection can cause shock and DIC, which can cause microthrombus formation in the pituitary vessels, leading to tissue ischemic necrosis.
2. Pituitary tumor and pituitary tumor compression.
3. Injury such as surgery, radioactivity and other physical factors.
4. Infection or inflammation: such as tuberculosis, syphilis, fungi, meningitis caused by pyogenic bacteria and meningoencephalitis.
5. Brain surgery: Clinical symptoms may occur when the anterior pituitary is damaged by more than 50%.
6. Cerebrovascular disease: arteriosclerosis can cause pituitary necrosis; iliac arteritis, cavernous sinus thrombosis can cause pituitary ischemia.
7. Others: Hemophilia patients with excessive hemosiderin in the pituitary; and pituitary autoimmune diseases can cause this disease, but less common.
Examine
an examination
Related inspection
Breast examination breast examination
(1) medical history
According to postpartum hemorrhage, serious infection and brain trauma, tumor, inflammation and other medical history.
(B) accompanied by the following performance of the surrounding target gland
1. Hypogonadism: amenorrhea.
2. Hypothyroidism: fear of cold, dry skin, slow response, slow movement, hoarseness and so on.
3. Decreased adrenal function: fatigue, loss of appetite, orthostatic hypotension, hypoglycemia, etc.
4. PRL deficiency: reduced milk or no milk secretion.
5. The skin is pale, body hair, mane and pubic hair are rare or absent, genital atrophy, bradycardia.
(C) The following symptoms of glandular hormones often appear in this disease
1. Pituitary hormone: serum GH, ACTH, PRL, FSH, LH, TSH, MSH (melanocyte stimulating hormone) water is low.
2. Thyroid hormone: total T3 (TT3, normal value is 1.23-3.08nmol/L), total T4 (TT3, normal value is 65156nmol/L) free T3 (FT3, normal value is 2.0-9.5SPmol/L) free T4 (FT4, the normal value is 9.5-25.5 pmol/L (normal value is l-10 mU/L, radioimmunoassay) is low.
3. Decreased levels of adrenocortical hormones, including
(1) Plasma cortisol: normal value 8:275.9+66.2 nmol/L at 4 am and 129+52.4 nmol/L/L at 4:00 pm. The disease is reduced.
(2) Urine 17-KS: normal adult, male 28.4-mol/d, female 20.8-34.6mol/d decreased.
(3) urinary 17-OHCS: normal adult, male 25.1-41.3 mol / d, female 22.3-33.3 mol / d, the disease is reduced.
(4) urinary free cortisol: normal value is 206.9 + 44.1nmol / d, the disease is reduced.
(5) Gonadal hormone: blood and urine estradiol (E2 progesterone (P) level is low.
(6) Functional test
1ACTH stimulation test: ACTH 25U was dissolved in 5% glucose solution 500 ml intravenously for 8 h for 2 consecutive days. Plasma cortisol and 24 h urine 17-OHCS, 17-KS were measured before and after instillation. The patient showed a delayed response.
2 methadone (Su-885) test: taking ketone 500-750 mg, every 4 hi times, and even taking 6 times, urine 17-0HCS was detected before and after the monthly drug. There was no significant increase in urinary 17-OHCS after taking the drug, suggesting that the ACTH reserve function was insufficient (for those suspected adrenal insufficiency and debilitation, this test was banned.
3TRH stimulation test: TSH, PRL or GH rise before and after intravenous injection of TRH 33g was not significant, which was helpful for the diagnosis of pituitary dysfunction (normal TSH rise >10 mU/L).
4 Gonadotropin Re-leasing Hormone (GnRh) stimulation test: FSH, LH levels did not increase significantly.
5 chlorpromazine test: chlorpromazine 25mg intramuscular injection, serum PRL did not increase significantly (normal people increased 2-3 times).
5 vaginal smear cytology: showing low hormone levels.
(4) X-ray, CT, MRI examination
Brain tumors and the like can be found.
Diagnosis
Differential diagnosis
Increased intramammary pressure
Latex does not work, the name of the disease. See "Xiaoshan Zhulin Temple Gynecology". That is, the milk is not good, also known as the milk veins. "Three-in-one-one disease syndrome": "There are two kinds of breast milk in the mother's body: there is a bloody blood and can not be closed, there is blood and less gas and weak sputum, and the vain often fills it up.
The milk of a woman is funded by the pulse. If the primipara is not produced, it should be passed. If you are tired of production and no milk, you are also responsible for the benefits of the disease. If there is milk, but not many, the medicine that passes through the medicine is still moved, and it should be dominated by the spleen and stomach.
