Hyperprolactinemia is a disease caused by increased secretion of pituitary prolactin from a variety of causes. The main clinical symptoms in women are amenorrhea, overflow of milk, scanty menstruation, habitual abortion, infertility, etc. 1. Physiological: such as pregnancy, postpartum, breastfeeding, nipple stimulation, hypoglycemia, late sleep, sexual intercourse, etc. 2. Pathological: such as hypothalamic lesions (tumors, infiltrative diseases, cranial radiation injury), pituitary diseases (tumors of the vacuolated saddle, primary hypothyroidism, etc.), severe liver disease, chronic renal failure, certain types of hypothyroidism.
Chronic renal failure, certain rheumatic diseases, spinal cord injury, herpes zoster, stress, etc. 3, drug: such as estrogen or long-term oral contraceptive drugs, dopamine receptor antagonists (chlorpromazine, fenadine, methotrexate, haloperidol, etc.), anti-hypertensive drugs (reserpine, verapamil, etc.
), H2 receptor antagonists (cimetidine, ranitidine, etc.), opiates, monoamine oxidase inhibitors, etc. 4. Idiopathic: those who do not belong to the above three categories and whose causes are not known. Diagnosis 1.Laboratory test for PRL. 2.CT/MRI examination for pituitary adenoma. 3.Differential diagnosis depends on PRL level and CT/MRI; PRL>100g/L is mostly caused by prolactinoma, PRL>(500~1000)
g/L is usually a giant prolactinoma,
PRL<(50~100)g/L is mostly due to pituitary or parapituitary tumors rather than true prolactinoma. However, it is important to note that a PRL <100g/L does not completely exclude the possibility of a prolactin macroadenoma,
If the tumor is cystic, hemorrhagic or necrotic, PRL may be <100g/L. 4. Caution: Exclude elevated prolactin due to pregnancy, primary hypothyroidism and renal failure. Some drugs can also cause HPL, so for the diagnosis of HPL, it is necessary to ask in detail whether there is any recent drug that can cause
If HPL is suspected to be caused by drugs, it can be rechecked after 1 month of drug withdrawal. Because PRL is a stress hormone, its secretion increases under stressful conditions,
High protein diet, exercise, stress and sexual activity, breastfeeding, nipple stimulation and sleep disorders can all lead to increased serum PRL levels, so serum hormone tests should be avoided in these states to avoid misdiagnosis. According to Chinese medicine, the initial pathogenesis of this disease is liver qi stagnation, and the basic pathogenesis and the essence of the symptoms are deficiency of the root and the symptoms are real. The deficiency is kidney deficiency, yin deficiency, qi and blood deficiency; in fact, it is liver qi rebellion. The treatment should be based on the liver and kidney, in order to regulate the qi and cultivate the lower yuan, and finally achieve the purpose of restoring menstruation and improving fertility. 1.Adjust the axis of Kidney-Qi-Tiankui-Chongren-Uterus to restore the endocrine function of reproduction; 2.Lower the PRL level, improve or eliminate the systemic symptoms, and prevent the aggravation and transmission of the disease. 3.Adhere to the treatment until the menstrual cycle and period are normal. 4.Pregnancy to delivery. Western medicine treatment mainly adopts bromocriptine at present. In our clinical application, we use traditional Chinese medicine or the combination of Chinese and Western medicine to treat bromocriptine, which has less incidence of adverse reactions, lower recurrence rate, better long-term treatment effect, and cheaper than bromocriptine alone,
It is worthy of further promotion and research.