高泌乳激素血症演示文稿.ppt

Pregnancy with prolactinoma Microadenoma 5% progress to macroadenoma Macroadenoma 25% expand and produce symptoms (15-35%) Primary hypothyroidism 常有 breast tenderness, 偶而 galactorrhea PRL 大部份正常 但也可能上昇，通常 100 ng /ml long-standing hypothyroidism 時 可能出現 sellar enlargement 如果又加上 PRL↑，易誤為 prolactinoma PRL response to TRH↑ CRF PRL↑in 60-70% ( 150ng/ml) PRL response to TRH ↓ receptor or postreceptor defect in the lactotroph not altered by HD reversed by renal transplantation D.D. of hyperprolactinemia Prolactinoma Primary hypothyroidism (TSH) CRF (BUN/Cr) Liver cirrhosis (GOT/GPT, A/G) Cushings syndrome (cortisol) Acromegaly (GH) Drug-induced (history taking) Pregnancy (β-HCG) Pseudoprolactinoma Physiologic hyperprolactinemia Treatment of microadenoma Disadvantage of untreated microadenoma loss of libido dyspareunia, hypogonadism BMD ↓ premature CAD enlargement of tumor mass Microadenoma Indication of treatment desire of becoming pregnant 須 eliminate galactorrhea 須 relieve symptoms of hypogonadism 如果上述 concern 不存在 periodically follow up 即可 Prolactinoma Therapeutic decision making Microadenoma desire for pregnancy (-) → periodically follow up desire for pregnancy (+) → surgery recurrent after surgery → pharmacotherapy Macroadenoma Ⅰ: PRL 200-500 ng/ml, invasiveness (-): surgery Ⅱ: PRL 500-1000 ng/ml, 或 invasiveness (+) pharmacotherapy or surgery Ⅲ: PRL 1000 ng/ml, invasiveness (+) pharmacotherapy 高泌乳激素血症(Hyperprolactinemia) 白永河 內分泌暨新陳代謝科 彰化基督教醫院 PRL Regulated by the hypothalamus 主要是 tonic inhibition Hypothalamus 分泌 2 種 hypothalamic factors PIF (PRL-inhibiting factor) Dopamine PRF (PRL-releasing factor) TRH, VIP PRL Stimulate breast development Initiate and maintain lactation PRL receptor alveolar surface of mammary cell liver, kidney ovary, testes, prostate Estrogen synergistic in promoting breast development antagonize in effect of lactation Breast development 須要多種 hormone 的 coordinated action 包括 major stimuli: estro