Prolactin is a hormone synthesized and secreted by the anterior pituitary gland, and its main role in the physiological state is to promote the growth and development of mammary secretory tissue, initiate and maintain lactation, and in men it also has the role of promoting the growth of prostate and seminal vesicles. However, long-term chronic hyperprolactinemia can lead to suppression of ovarian function, ovulation disorders, menstrual disorders, amenorrhea and lactation; in men, it causes low sexual function, reduced spermatogenesis, impotence and infertility, obesity and osteoporosis.
Causes of increased prolactin
1, physiological increase: such as overwork, mental stress, hypoglycemia, lactation, etc., characterized by a small increase, the cause will recover after lifting, and generally does not cause pathological symptoms.
2, drug-increased: some drugs can cause increased prolactin, but generally below 100ng/ml, and can be relieved after stopping the drug.
3, idiopathic increase: the cause is unknown, hypothalamic pituitary dysfunction is more likely, mild increase can be observed.
4, pathological increase: hypothalamic or pituitary stalk lesions, causing insufficient secretion of hypothalamic prolactin inhibitory factor or blockage of downward transport pathways.
5, low thyroid function.
6, some chest wall or breast diseases.
7, chronic renal failure.
8, gynecologic surgery.
9, pituitary prolactin adenoma adenoma, mixed pituitary adenoma, or some other body part tumor secretion.
Diagnosis of pituitary prolactin adenoma
Hyperprolactinemia + imaging support + clinical symptoms
Treatment recommendations
Drug: Bromocriptine Reversibly shrinks tumor and inhibits tumor cell growth. Fibrosis occurs after long-term treatment and causes tumor growth to resume after stopping the drug, so long-term or even lifelong medication is required, and only a few cases can achieve cure. The adverse reactions are mainly nausea, dizziness, vomiting and other reactions.
Surgical treatment: Indications.
1.Ineffective drugs.
2.Inability to tolerate drugs.
3, huge adenoma tumor shrinkage is not obvious after taking drugs, and the compression symptoms are not released.
4, invasive appear nasal leakage. It should be noted that if there is a tumor stroke, surgery is recommended. If surgery is chosen after long-term administration of bromocriptine, the cure rate of surgery may be reduced due to tumor fibrosis, etc. For some complex tumors, the integrated treatment of surgery and drug radiotherapy should be advocated.
Radiotherapy is not recommended as the first choice of treatment.
Pregnancy in patients with pituitary prolactin adenoma
If drug therapy is used, regular menstruation, normal prolactin and gynecologic examination should be followed by ovulation, and pregnancy should be discontinued under medical supervision. For pituitary prolactin macroadenoma, pregnancy after surgery is recommended.