Mukati
Hyperprolactinemia ndiko kuvapo kwehuwandu hwepamusoro hweprolactin muropa. Prolactin ihomoni inogadzirwa nepituitary gland. Mabasa akawanda eprolactin mumuviri anonyanya kubatanidzwa nekuzvitakura uye kugadzirwa kwemukaka wezamu kune achangoberekwa. Zvisinei, mazinga eprolactin anogona kukwira kana mukadzi asina pamuviri kana kuyamwisa, zvichikonzera huwandu hwemamiriro ezvinhu anogona kukanganisa kushanda kwekuenda kumwedzi uye kubereka. Serum prolactin inofanirwa kuyerwa chete muvarwere vane bundu repituitary kana zviratidzo zvekiriniki uye zviratidzo zve hyperprolactinemia.
Chii chinonzi hyperprolactinemia
Pane zvikonzero zvakawanda zve hyperprolactinemia, kusanganisira mamwe mishonga uye pituitary bundu (prolactinoma). Kuti uronge kurapa kwakakodzera, zvakakosha kuziva chikonzero chinokonzera. Hyperprolactinemia inogona kukonzera galactorrhea (kubuda kwemukaka wezamu kunze kwekuyamwisa) uye kukanganisa basa rekubereka. Izvi zvinogona kukurumidzira kurasikirwa kwemapfupa kana zvichikonzerwa nekushaikwa kwehomoni yepabonde.
Mazhinji prolactinomas ane microprolactinomas. Kazhinji haakurumidzi kukura zvekukonzeresa matambudziko akanyanya. Varwere vane prolactinoma vanowanzobatwa zvinobudirira ne dopamine agonists se cabergoline.
Zvikonzero zve hyperprolactinemia muvanhu vakuru
Kuwanda kweprolactin muropa (hyperprolactinemia) inowanzoitika chirwere che endocrine. Zvikonzero zvinotangira kubva kumamiriro ekunze asingade kurapwa kune akakomba matambudziko ekurapa anoda kurapwa nekukurumidza. Hyperprolactinemia inogonawo kuva rutivi rwemimwe mishonga. Kuti unzwisise kukosha kwemaitiro anoenderera mberi, zvakakodzera kutsanangura zvishoma basa reiyi hormone.
Prolactin inonzi polypeptide hormone yakagadzirwa uye yakavanzwa nelactotrophic masero e anterior pituitary gland. Prolactin secretion inonyanya kugadziriswa ne dopamine, iyo inobudiswa mu hypothalamus uye inhibits secretion yeprolactin. Iyo hypothalamic hormone thyrotropin-releasing hormone inokurudzira kugadzirwa kweprolactin.
Prolactin inoshandisa migumisiro yayo nekusunga kune prolactin receptors. Iwo anowanikwa pane cell membrane yemasero akawanda, kunyanya muzamu uye pituitary gland. Muzamu, prolactin inokurudzira kukura kwezvipembenene panguva yekuzvitakura uye kugadzirwa kwemukaka wezamu munguva yekusununguka. Mune pituitary gland, prolactin inodzvinyirira secretion ye gonadotropin.
Kune zvikonzero zvemuviri, pathological uye zvinodhaka zvinokonzerwa ne hyperprolactinemia (yakakwirira prolactin mazinga).
Physiological zvikonzero. Kubata pamuviri, kuyamwisa uye lactation, kurovedza muviri, kuita zvepabonde uye kushungurudzika kunogona kuwedzera mazinga eprolactin. Kuwedzera uku kunogara kwenguva pfupi uye kazhinji hakupfuuri kaviri muganho wepamusoro wezvikamu zvakajairika.
pathological zvikonzero. Prolactinomas mamota anobva kuprolactin-secreting pituitary cells. Maprolactinomas akawanda (90%) mamicroadenomas (<1 cm mudhayamita) ayo anowanikwa ka10 muvakadzi kupfuura varume. Microadenomas inokonzera kuwedzera kunyoro kwemazinga eprolactin, ayo angave akabatanidzwa nezviratidzo zve hyperprolactinemia, asi kazhinji haakure.
Macroadenomas (> 1 cm mudhayamita) haanyanye kuwanda, uye hofori prolactinomas (> 4 cm mudhayamita) haiwanzo. Kuenzaniswa nevakadzi, varume vane mukana wakapetwa kapfumbamwe wekukura macroadenoma. Aya mapundu anokonzera hyperprolactinemia yakaoma - kuwedzera kweprolactin inopfuura 10 mIU / L inenge nguva dzose inoratidza macroprolactinoma. Zvinogona kukonzera hypopituitarism, kurasikirwa kwenzvimbo yekuona, kana kuremara kwemaziso nekumanikidza optic chiasm kana cranial nerve nuclei.
Mamwe maitiro e hypothalamus uye pituitary gland anogonawo kukonzera hyperprolactinemia. Sezvo dopamine ichidzvanya kuvharirwa kweprolactin, chero neoplasm kana infiltrative lesion inomanikidza pituitary stalk inogona kunetesa chiito che dopamine uye kukonzera hyperprolactinemia. Zvisinei, stalk crush hyperprolactinemia inowanzova pasi pe2000 mIU/L, iyo inoisiyanisa kubva kune macroprolactinoma.
Zvimwe zvirwere zvinogona kukonzera hyperprolactinemia. Prolactin inonyanya kubudiswa neitsvo, saka kukanganisa kwetsvo kunogona kuwedzera mazinga eprolactin. Nemhaka yokuti thyrotropin-releasing hormone inokurudzira prolactin secretion, hypothyroidism inogonawo kukonzera hyperprolactinemia. Kubata kunogona kukonzera kuwedzera kwenguva pfupi mumazinga eprolactin.
Zvikonzero zvine chekuita nezvinodhaka. Mishonga yakawanda inovhiringidza kusunungurwa kwe dopamine mu hypothalamus, iyo inotungamirira kuwedzera kwekugadzirwa kweprolactin (prolactin 500-4000 mIU / l). Hyperprolactinemia inokura muvarwere vanotora antipsychotic zvinodhaka. Inogonawo kukura, kusvika pamwero muduku, nekuda kweimwe yakasarudzwa serotonin reuptake inhibitors (zvinodhaka zvekuora mwoyo). Mimwe mishonga inogona kukonzera hyperprolactinemia zvishoma. Kana hyperprolactinemia inokonzerwa nemishonga, kuisa pfungwa kunowanzoitika kana mushonga wacho wakamira mukati maawa 72.
Zviratidzo zve hyperprolactinemia kuvanhu vakuru
Mune vamwe varwere, hyperprolactinemia is asymptomatic, asi kuwandisa kwehomoni kunogona kukanganisa mammary gland uye basa rekubereka. Muvakadzi, inogona kukonzera oligoamenorrhea (nguva pfupi uye shoma), kusabereka, uye galactorrhea. Muvarume, hyperprolactinemia inogona kukonzera kusagadzikana kwe erectile, kusabereka, uye gynecomastia. Galactorrhea (kubuda kwemukaka kana colostrum kubva pazamu) haina kunyanya kuwanda muvarume pane vakadzi.
Gonadal hormone kushomeka kunogona kukurumidza kurasikirwa nemapfupa. Varwere vanogona kunge vane zviratidzo kana zviratidzo zvinosanganiswa nechikonzero chinokonzera hyperprolactinemia. Semuenzaniso, musoro uye kurasikirwa kwekuona mumurwere ane bundu repituitary, uye kuneta uye kusashivirira kutonhora mumurwere ane hypothyroidism.
Kurapa kwe hyperprolactinemia muvanhu vakuru
Zvinofanira kusimbiswa kuti mazinga eprolactin anofanira kuyerwa chete kune varwere vane zviratidzo zvekliniki kana zviratidzo zve hyperprolactinemia kana kune varwere vane chirwere chinozivikanwa chepituitary. Kuongororwa kwe hyperprolactinemia kunogona kuve kwakavakirwa pachiyero chimwe cheserum prolactin pamusoro pemuganho wepamusoro wezvakajairwa. Ropa sampling inofanira kuitwa pasina kushushikana zvisina kufanira.
Diagnostics
Kuongororwa kweropa kuri nyore kuyera huwandu hweprolactin muropa kunogona kusimbisa kuongororwa kwemazinga akakwirira eprolactin. Mazinga eprolactin pamusoro pe25 ng / mL anoonekwa seakakwirira kune vakadzi vasina pamuviri. Sezvo munhu wese achiona kuchinja kwezuva nezuva mumazinga eprolactin, zvingave zvakakosha kudzokorora kuongororwa kweropa kana chiyero chehomoni chikakwira zvishoma. Vakadzi vazhinji vanowana kuongororwa uku mushure mekuongororwa kushaya mbereko kana kunyunyuta kwekuenda kumwedzi kusina nguva, asi vamwe havana zviratidzo. Dzimwe nguva varwere vanongoerekana vabuda mukaka kubva muminyatso, asi vazhinji havana chiratidzo ichi.
Kuwedzera kuduku kweprolactin, muhuwandu hwe25-50 ng / ml, kazhinji haikonzeri kuchinja kunooneka mukufamba kwekuenda kumwedzi, kunyange zvazvo inogona kuderedza kubereka kwese. Kukwira kweprolactin kwe50 kusvika ku100 ng/mL kunogona kukonzera kuenda kumwedzi kusina kujairika uye kuderedza mbereko yemukadzi zvakanyanya. Prolactin inopfuura 100 ng/mL inogona kushandura mashandiro enhengo yesikarudzi yemukadzi, zvichikonzera zviratidzo zvekuenda kumwedzi (kusaenda kumwedzi, kupisa kupenya, kuoma kwemukadzi) uye kushaya mbereko.
Pane imwe nguva kuongororwa kwe hyperprolactinemia kwaitwa, kuongororwa kunofanira kuitwa kuti uone chikonzero chinokonzera uye zvinetso zvinosanganiswa. Vakadzi nevarume vanofanira kuyera estrogen uye mangwanani testosterone, zvichiteerana, pamwe chete negonadotropins. Muvakadzi vezera rekubereka, thyroid uye itsvo basa rinofanira kuongororwa uye pamuviri usabatanidzwa.
Kana pasina chimwe chikonzero chakajeka chinogadziriswa, MRI yepituitary gland inoratidzwa. Varwere vane bundu repituitary rakakura kudarika 1 cm muhupamhi vanofanira kuongororwa kuti vaongorore mamwe mahomoni epituitary uye kutarisa nzvimbo yekuona. Izvo zvakakosha kuti uone mapfupa emaminerari density kune varwere vane hypogonadism.
Mishonga yemazuva ano
Vamwe varwere havadi kurapwa. Varwere vane physiological hyperprolactinemia, macroprolactinemia, asymptomatic microprolactinoma, kana zvinodhaka-induced hyperprolactinemia kazhinji hazvidi kurapwa. Kana hyperprolactinemia iri yechipiri kune hypothyroidism, kurapwa kwemurwere ne thyroxine kunofanira kuenzanisa mazinga eprolactin.
Mirayiridzo yekliniki
Zvinoenderana nemirairo yekiriniki, mazinga akakwira eprolactin anorapwa nekusanganiswa kwemaitiro akati wandei.
Mishonga inotevedzera kemikari yeuropi dopamine inogona kubudirira kushandiswa kurapa varwere vazhinji vane prolactin yakakwirira. Iyi mishonga inoderedza kubudiswa kweprolactin nepituitary gland uye inokonzera kudzvinyirirwa kwemasero anobudisa prolactin. Mishonga miviri inonyanya kunyorerwa ndeye cabergoline uye bromocriptine. Kutanga nediki diki, iro rinowedzera zvishoma nezvishoma, mhedzisiro, kusanganisira shanduko yeropa uye kuputika kwepfungwa, inogona kuderedzwa. Varwere vanowanzopindura zvakanaka kumishonga iyi uye mazinga eprolactin anoderera mushure memavhiki maviri kusvika matatu.
Kamwe mazinga eprolactin adonha, kurapwa kunogona kugadziridzwa kuchengetedza yakajairika mazinga eprolactin, uye dzimwe nguva inogona kumiswa zvachose. Kuzviitira bundu regression kunowanzoitika mukati memakore mashoma pasina mhedzisiro yekiriniki.
Mune nhamba shomanana yevarwere, zvinodhaka hazvidzikisi mazinga eprolactin, uye mazamu makuru (macroadenomas) anopfuurira. Varwere ava vanokodzera kurapwa (transsphenoidal adenoma resection) kana radiation therapy.
Kudzivirirwa kwe hyperprolactinemia muvakuru kumba
Nehurombo, kusvika parizvino, hapana nzira dzinoshanda dzakagadzirwa kudzivirira iyi pathology. Matanho ekudzivirira akajairwa anokurudzirwa, anosanganisira kuchengetedza mararamiro ane hutano, kurega tsika dzakaipa, kurapa chero zvirwere zvechikamu chekubereka uye hormonal metabolism.
Mibvunzo nemhinduro dzakakurumbira
Nezve kuongororwa uye kurapwa kwedambudziko repituitary gland uye yakakwira prolactin, maitiro ekudzivirira, takataura nawo. urologist, nyanzvi mune ultrasound diagnostics, chiremba wepamusoro chikamu Yuri Bakharev.