Hyperprolactinemia i nā mākua

ʻO ka Hyperprolactinemia ka loaʻa ʻana o kahi kiʻekiʻe kiʻekiʻe o ka prolactin i loko o ke koko. ʻO Prolactin kahi hormone i hana ʻia e ka pituitary gland. ʻO nā hana he nui o ka prolactin i loko o ke kino e pili pū ana me ka hāpai ʻana a me ka hana ʻana o ka waiū umauma no ke keiki hānau hou. Eia nō naʻe, hiki ke piʻi aʻe nā pae prolactin i ka wā ʻaʻole hāpai ka wahine a hānai ʻole paha, e hana ana i kekahi mau maʻi e hiki ke hoʻopilikia i ka hana menstrual maʻamau a me ka momona. Pono e ana ʻia ka serum prolactin i nā poʻe maʻi me kahi tumo pituitary a i ʻole nā ​​​​hōʻailona maʻi a me nā hōʻailona o ka hyperprolactinemia.

He aha ka hyperprolactinemia

Nui nā kumu o ka hyperprolactinemia, me kekahi mau lāʻau lapaʻau a me ka maʻi pituitary (prolactinoma). No ke kuhikuhi ʻana i ka lāʻau kūpono, pono e hoʻoholo i ke kumu kumu. Hiki i ka Hyperprolactinemia ke hoʻoulu i ka galactorrhea (ka hoʻokuʻu ʻana o ka waiū umauma ma waho o ka lactation) a keakea i ka hana hānau. Hiki i kēia ke hoʻolōʻihi i ka nalo iwi inā ma muli o ka hemahema o ka hormone sex.

ʻO ka hapa nui o nā prolactinoma he micro-prolactinoma. ʻAʻole lākou e ulu wikiwiki e hoʻopilikia i nā pilikia. Hoʻomaʻamaʻa maikaʻi ʻia nā maʻi me ka prolactinoma me nā agonists dopamine e like me cabergoline.

Nā kumu o ka hyperprolactinemia i nā mākua

ʻO kahi kiʻekiʻe o ka prolactin i loko o ke koko (hyperprolactinemia) kahi maʻi endocrine maʻamau. ʻO nā kumu mai nā kūlana maikaʻi ʻole i koi ʻia i ka mālama ʻana i nā pilikia olakino koʻikoʻi e pono ai ka mālama koke ʻana. Hiki i ka Hyperprolactinemia ke lilo i hopena ʻaoʻao o kekahi mau lāʻau. No ka hoʻomaopopo ʻana i ke ʻano o nā kaʻina hana, pono e wehewehe liʻiliʻi i ke kuleana o kēia hormone.

ʻO ka Prolactin kahi hormone polypeptide i hoʻohui ʻia a hūnā ʻia e nā ʻāpana lactotrophic o ka pituitary gland anterior. Hoʻoponopono mua ʻia ka hana huna prolactin e dopamine, ka mea i hana ʻia i loko o ka hypothalamus a kāohi i ka huna ʻana o ka prolactin. ʻO ka hormone hypothalamic thyrotropin-releasing hormone e hoʻoulu i ka huna o ka prolactin.

Hoʻohana ka Prolactin i kāna mau hopena ma ka hoʻopaʻa ʻana i nā mea loaʻa prolactin. Aia lākou ma ka membrane cell o nā pūnaewele he nui, ʻoi aku ka nui o ka umauma a me ka pituitary gland. I loko o ka umauma, hoʻoulu ka prolactin i ka ulu ʻana o nā glands i ka wā hāpai a me ka hana ʻana o ka waiū umauma i ka wā postpartum. I ka pituitary gland, hoʻopau ka prolactin i ka huna ʻana o ka gonadotropin.

Aia nā kumu physiological, pathological a me nā lāʻau pili i ka hyperprolactinemia (kiʻekiʻe kiʻekiʻe prolactin).

Nā kumu pili kino. ʻO ka hāpaiʻana, ka hānaiʻana a me ka lactation, ka hoʻoikaika kino, ka moe kolohe a me ke kaumaha hiki ke hoʻonui i ka nui o ka prolactin. ʻAʻole i ʻoi aku ma mua o ʻelua o ka palena kiʻekiʻe o nā pae maʻamau.

nā kumu pathological. ʻO nā prolactinomas nā maʻi koko e puka mai ana mai nā pūnae pituitary huna prolactin. ʻO ka hapa nui o nā prolactinomas (90%) he microadenomas (<1 knm ke anawaena) he 10 mau manawa maʻamau i nā wahine ma mua o nā kāne. ʻO nā microadenomas ke kumu i ka piʻi mālie o nā pae prolactin, hiki ke pili me nā hōʻailona o ka hyperprolactinemia, akā ʻaʻole lākou e ulu.

ʻAʻole maʻamau ka Macroadenomas (> 1 knm ke anawaena), a he kakaikahi ka prolactinomas nunui (> 4 knm ke anawaena). Ke hoʻohālikelike ʻia me nā wahine, ʻeiwa mau manawa e ulu ai nā kāne i ka macroadenoma. ʻO kēia mau maʻi koko ke kumu o ka hyperprolactinemia koʻikoʻi - kahi ʻoi aku ka nui o ka prolactin ma mua o 10 mIU/L kokoke i nā manawa a pau e hōʻike ana i kahi macroprolactinoma. Hiki iā lākou ke hoʻoulu i ka hypopituitarism, ka nalo ʻana o ka māla ʻike, a i ʻole ka maʻi maʻi ocular ma ke kaomi ʻana i ka chiasm optic a i ʻole ka nuclei nerve cranial.

Hiki i nā hana ʻē aʻe o ka hypothalamus a me ka pituitary gland ke hoʻoulu i ka hyperprolactinemia. Ma muli o ka hoʻopau ʻana o ka dopamine i ka huna ʻana o ka prolactin, hiki i kekahi neoplasm a i ʻole infiltrative lesion e hoʻopaʻa i ka ʻōpala pituitary hiki ke hoʻonāwaliwali i ka hana o dopamine a hoʻoulu i ka hyperprolactinemia. Eia naʻe, ʻoi aku ka maʻamau o ka hyperprolactinemia ma lalo o 2000 mIU/L, kahi e hoʻokaʻawale ai ia mai ka macroprolactinoma.

Hiki i kekahi mau maʻi ke hoʻoulu i ka hyperprolactinemia. Hoʻokuʻu mua ʻia ka prolactin e nā puʻupaʻa, no laila hiki ke hoʻonui i ka pae prolactin i ka hiki ʻole o ke kīkī. Ma muli o ka hoʻoulu ʻana o ka hormone hoʻokuʻu thyrotropin i ka huna ʻana o ka prolactin, hiki i ka hypothyroidism ke hoʻoulu i ka hyperprolactinemia. Hiki i nā hopu ke hoʻonui i ka manawa pōkole i nā pae prolactin.

Nā kumu pili i nā lāʻau lapaʻau. Hoʻopilikia ka nui o nā lāʻau i ka hoʻokuʻu ʻana o ka dopamine i ka hypothalamus, e alakaʻi ana i ka hoʻonui ʻana i ka huna ʻana o ka prolactin (prolactin 500-4000 mIU / l). Hoʻokumu ka Hyperprolactinemia i nā maʻi e lawe ana i nā lāʻau antipsychotic. Hiki iā ia ke hoʻomohala, i ka liʻiliʻi liʻiliʻi, ma muli o kekahi mau mea hoʻopaneʻe reuptake serotonin (nā lāʻau no ke kaumaha). Hiki i nā lāʻau ʻē aʻe ke hōʻemi pinepine i ka hyperprolactinemia. Inā hoʻokumu ʻia ka hyperprolactinemia e nā lāʻau lapaʻau, hoʻomaʻamaʻa maʻamau ka hoʻopaʻa ʻana inā pau ka lāʻau i loko o 72 mau hola.

Nā hōʻailona o ka hyperprolactinemia i nā mākua

I kekahi poʻe maʻi, he asymptomatic ka hyperprolactinemia, akā hiki i ka nui o ka hormone ke hoʻopilikia i ka mammary gland a me ka hana hānau. I loko o nā wāhine, hiki iā ia ke hoʻoulu i ka oligoamenorrhea (nā manawa pōkole a liʻiliʻi), infertility, a me ka galactorrhea. I nā kāne, hiki i ka hyperprolactinemia ke alakaʻi i ka erectile dysfunction, infertility, a me ka gynecomastia. ʻO Galactorrhea (ka hoʻokuʻu ʻana o ka waiū a i ʻole colostrum mai ka umauma) ʻaʻole maʻamau i nā kāne ma mua o nā wahine.

Hiki i ka nele o ka hormone Gonadal ke hoʻolalelale i ka nalo iwi. Loaʻa paha i nā maʻi nā hōʻailona a i ʻole nā ​​hōʻailona e pili ana i ke kumu kumu o ka hyperprolactinemia. No ka laʻana, headache a me ka nalowale o ka hihio i loko o ka mea maʻi me ka pituitary koko, a me ka luhi a me ke anu intolerance i loko o ka mea maʻi me ka hypothyroidism.

Ka mālama ʻana i ka hyperprolactinemia i nā pākeke

Pono e hoʻoikaika ʻia e ana wale ʻia nā pae prolactin i nā mea maʻi me nā hōʻailona lapaʻau a i ʻole nā ​​​​hōʻailona o ka hyperprolactinemia a i ʻole i nā maʻi me kahi maʻi pituitary i ʻike ʻia. Hiki ke hoʻokumu ʻia ka hōʻailona o ka hyperprolactinemia ma kahi ana hoʻokahi o ka serum prolactin ma luna o ka palena kiʻekiʻe o ka maʻamau. Pono e hana ʻia ke koko me ke kaumaha ʻole.

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ʻO nā hoʻāʻo koko maʻalahi e ana i ka nui o ka prolactin i loko o ke koko hiki ke hōʻoia i ka hōʻoia ʻana o nā pae prolactin kiʻekiʻe. ʻO nā pae prolactin ma luna o 25 ng / mL i manaʻo ʻia he kiʻekiʻe i nā wahine hāpai ʻole. Ma muli o ka ʻike ʻana o kēlā me kēia kanaka i nā loli i kēlā me kēia lā i nā pae prolactin, pono paha e hana hou i ke koko inā piʻi iki ke kiʻekiʻe o ka hormone. Loaʻa nā wahine he nui i kēia maʻi ma hope o ka hoʻāʻo ʻia ʻana no ka infertility a i ʻole ka hoʻopiʻi ʻana i ka wā maʻamau, akā ʻaʻohe hōʻailona ʻē aʻe. I kekahi manawa, ho'oku'u wale 'ia ka waiu o ka po'e ma'i mai ka nipples, akā 'a'ole loa'a kēia hō'ailona ka hapa nui.

ʻO kahi hoʻonui liʻiliʻi o ka prolactin, ma ka laulā o 25-50 ng / ml, ʻaʻole ia e hoʻololi i nā loli i ʻike ʻia i ka pōʻai menstrual, ʻoiai hiki ke hōʻemi i ka momona holoʻokoʻa. ʻO nā pae kiʻekiʻe o ka prolactin o 50 a 100 ng/mL hiki ke hoʻoulu i nā manawa menstrual ʻole a hoʻemi nui i ka momona o ka wahine. Hiki i nā pae prolactin i ʻoi aku ma mua o 100 ng/mL ke hoʻololi i ka hana maʻamau o ka ʻōnaehana hānau o ka wahine, e hōʻike ana i nā hōʻailona menopausal (ka hele ʻole ʻana o ke kāne, ka wela wela, ka maloʻo o ka wahine) a me ka ʻike ʻole.

Ke hana ʻia kahi hōʻailona o ka hyperprolactinemia, pono e hana ʻia kahi hoʻokolokolo e ʻike i ke kumu kumu a me nā pilikia pili. Pono nā wāhine a me nā kāne e ana i ka estrogen a me ka testosterone kakahiaka, kēlā me kēia, me nā gonadotropins. I nā wahine o ka hānau keiki, pono e loiloi ʻia ka hana thyroid a me ka ʻōpū a haʻalele ʻia ka hāpai ʻana.

Inā ʻaʻohe kumu ʻē aʻe i hoʻokumu ʻia, hōʻike ʻia kahi MRI o ka pituitary gland. ʻO ka poʻe maʻi me kahi maʻi pituitary ʻoi aku ka nui ma mua o 1 knm ke anawaena e pono ke nānā ʻia e loiloi i nā hormones pituitary ʻē aʻe a nānā i ke kahua ʻike. He mea nui e hoʻoholo i ka nui o ka mineral iwi i nā maʻi me ka hypogonadism.

Nā lāʻau lapaʻau hou

ʻAʻole pono kekahi mau maʻi i ka lāʻau lapaʻau. ʻO ka poʻe maʻi me ka hyperprolactinemia physiological, macroprolactinemia, asymptomatic microprolactinoma, a i ʻole hyperprolactinemia i hoʻohana ʻia i ka lāʻau, ʻaʻole pono e mālama ʻia. Inā ʻoi aku ka lua o ka hyperprolactinemia i ka hypothyroidism, ʻo ka mālama ʻana i ka mea maʻi me thyroxine pono e hoʻomaʻamaʻa i nā pae prolactin.

Nā alakaʻi lapaʻau

Wahi a nā alakaʻi alakaʻi, mālama ʻia nā pae prolactin kiʻekiʻe me ka hui pū ʻana o kekahi mau ala.

Hiki ke hoʻohana maikaʻi ʻia nā lāʻau lapaʻau e hoʻohālike i ka dopamine kemika o ka lolo e mālama i ka hapa nui o nā maʻi me nā pae prolactin kiʻekiʻe. Hoʻopili kēia mau lāʻau i ka hana ʻana o ka prolactin e ka pituitary gland a ke hoʻopau nei i nā cell prolactin-producing. ʻO nā lāʻau lapaʻau ʻelua i kuhikuhi pinepine ʻia he cabergoline a me bromocriptine. E hoʻomaka me ka liʻiliʻi liʻiliʻi, e hoʻonui mālie ʻia, hiki ke hōʻemi ʻia nā hopena ʻaoʻao, me ka hoʻololi ʻana i ke koko a me ka fogging noʻonoʻo. Hiki i nā maʻi ke pane maikaʻi i kēia mau lāʻau lapaʻau a emi iho ka pae prolactin ma hope o 2 a 3 mau pule.

Ke hāʻule ka pae prolactin, hiki ke hoʻoponopono ʻia ka mālama ʻana e mālama i nā pae prolactin maʻamau, a i kekahi manawa hiki ke hoʻōki loa. ʻO ka hoʻihoʻi ʻana o ka maʻi maʻamau i loko o kekahi mau makahiki me ka ʻole o nā hopena lapaʻau.

I loko o kahi helu liʻiliʻi o nā maʻi, ʻaʻole hoʻohaʻahaʻa nā lāʻau lapaʻau i nā pae prolactin, a hoʻomau nā maʻi nui (macrodenomas). He mau moho kēia mau maʻi no ka lapaʻau ʻana (transsphenoidal adenoma resection) a i ʻole radiation therapy.

Ka pale ʻana i ka hyperprolactinemia i nā pākeke ma ka home

ʻO ka mea pōʻino, a hiki i kēia lā, ʻaʻohe ala kūpono i kūkulu ʻia e pale ai i kēia pathology. Manaʻo ʻia nā hana pale maʻamau, me ka mālama ʻana i ke ola olakino, ka haʻalele ʻana i nā hana maikaʻi ʻole, ka mālama ʻana i nā maʻi o ka reproductive sphere a me ka metabolism hormonal.

Nā nīnau a me nā pane kaulana

E pili ana i ka hōʻailona a me ka mālama ʻana i ka pilikia o ka pituitary gland a me ka prolactin kiʻekiʻe, nā hiʻohiʻona o ka pale ʻana, ua kamaʻilio mākou me urologist, loea i ka ultrasound diagnostics, kauka o ka waeʻano kiʻekiʻe Yuri Bakharev.