垂体泌乳素测定的临床应用

对２１１例闭经，溢乳患者采用放射免疫分析检测血清中泌乳素（ＰＲＬ），促卵泡激素，促黄体激素，雌二醇及睾酮水平，对高泌乳素血症者加行蝶鞍Ｘ线摄片或ＣＴ检查。结果，ＰＲＬ〈１０００ｍＩＵ／Ｌ者１４５例，ＰＲＬ〉１０００ｍＩＵ／Ｌ者６６例，其中垂体腺瘤５例，可疑垂体微胶瘤４例，非肿瘤性高泌乳素血症５７例，溴隐亭治疗垂体微腺瘤和功能性高泌乳素血症疗效较佳。提示，垂体泌乳素测定对闭经，溢乳的病因检查具有重要     

高泌乳素血症患者筛查巨泌乳素的临床意义

目的探讨高泌乳素血症患者中巨泌乳素（M-PRL）血症的检出率,比较M-PRL血症患者和高单体泌乳素血症患者的临床表现和激素水平。方法使用Architect i2000免疫分析仪测定185例泌乳素（PRL）超过35μg/L的女性患者血清PRL、黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇（E2）和经聚乙二醇（PEG）6000沉淀后的PRL水平。记录临床症状用作回顾性分析。结果 M-PRL检出率为21%,月经过少、闭经和溢乳等症状在高单体泌乳素血症患者中的出现率（88%）高于M-PRL血症患者（47%）（P〈0.05）。M-PRL血症患者E2、LH水平和LH/FSH比值明显高于高单体泌乳素血症患者（P〈0.05）。结论 M-PRL在高泌乳素血症患者中经常发生,但仅部分患者有相关症状,建议所有高泌乳素血症患者筛查M-PRL。     

高泌乳素血症的中医治疗及护理验案

正高泌乳素血症[1]是多种原因引起垂体泌乳素分泌增加而产生的一种常见妇科疾病,临床表现主要有月经失调、月经稀发或闭经、不孕、溢乳及习惯性流产[2-3]。同时患者常伴恐惧、不安等心理,如长期得不到治疗会出现头痛、视力下降,或因长期缺乏雌激素而导致骨质疏松[4-5]。随着临床关于泌乳素(PRL)的生理生化研究取得较大进展,PRL放免测定、颅脑     

高泌乳素血症合并不孕52例临床分析

泌乳素（prolactin，PRL）是由垂体前叶PRL细胞合成与分泌的一种多肽类激素，参与机体的多种生理功能，其主要作用为促进乳腺发育、乳汁生成分泌、调节生殖活动。高泌乳素血症是指各种原因致外周血PRL异常升高，常导致女性月经紊乱及不育、异常溢乳、多毛、性功能减退，是不孕症的原因之一。本文收集高PRL合并不孕患者52例资料，作一总结分析，报告如下。     

卵巢早衰患者泌乳激素水平测定的临床意义

卵巢早衰(premature ovarian failure,POF)是发生于40岁以前的由于卵巢功能衰竭所致的高促性腺激素性闭经。当某些病理因素使血清泌乳素(PRL)的水平超出正常的生理范围时,就称为高PRL血症。有90%垂体泌乳激素微腺瘤患者有高PRL血症。如果育龄妇女血清PRL水平增高,可进一步确诊有无垂体泌乳激素微腺瘤存在。但对于POF妇女来说,测定血清PRL水平是否也同样具有重要的意义为探讨这个问题,我们测定了481例POF患者血清PRL的水平,现报告如下。1对象和方法1.1对象回顾性分析2000年~2006年在我院内分泌科就诊的POF患者481例,年龄20~39岁(…     

溴隐亭治疗48例高泌乳血症的临床疗效观察

目的探讨溴隐亭治疗高泌乳血症的临床疗效。方法对48例高泌乳血症患者的临床资料进行回顾性分析,所有患者均予口服溴隐亭,治疗前及治疗6周、12周、24周复查PRL,非功能性高泌乳血症患者治疗12周复查CT或MRI。结果泌乳素治疗12周大多降至正常,用药后有生育要求的34例患者,有26例妊娠,占76．4％,20例泌乳者17例停止泌乳,3例泌乳明显减少;32例闭经或月经紊乱者28例恢复正常月经;8例垂体微腺瘤患者,复查CT或MRI,3例明显缩小,3例已消失;2例大腺瘤行手术,术后服用药物,无复发及头痛等症状。结论溴隐亭治疗高泌乳血症的临床疗效显著。     

血清PRL水平及肿瘤体积对垂体泌乳素瘤疗效的影响

目的：观察血清泌乳素（prolactin,PRL)水平及瘤体MRI测量对垂体泌乳素瘤（prolactionoma)诊治的价值。方法：回顾分析32例垂体泌乳素瘤的诊断与治疗。全部病例均在初诊和治疗6个月后标记免疫法测定血清PRL水平,并同时做MRI垂体扫描。记录测量值并作统计学处理。结果：（1）内科治疗6个月后血清泌乳素下降至正常有29例,占90．6％,垂体MRI显示瘤体体积缩小21例,占65．6％,（2）大腺瘤患者及血PRL水平大于100ng/L患者疗效较好。结论：血清泌乳素水平测定及MRI垂体扫描均可作为垂体瘤临床疗效判断的观察指标,MRI垂体扫描同时可作为诊断定位指标。     

中西医结合治疗高泌乳素血症

泌乳素是垂体前叶嗜酸细胞、妊娠子宫蜕膜和免疫细胞等分泌的一种蛋白激素。高泌乳素血症是指各种原因引起的外周血泌乳素异常升高,临床上出现月经量少,稀发,甚至闭经、溢乳、不孕或习惯性流产等症状的临床综合征。据有关文献报道,高泌乳素血症占女性不孕的15．2％。自2009年1月至2009年12月来我院就诊的高泌乳素血症患者32例,采用溴隐亭联合中药二仙汤加减取得了较好的疗效,现报告如下：     

调冲任方治疗高泌乳素血症的疗效观察及护理

目的观察调冲任方治疗高泌乳素血症的疗效及总结护理要点。方法对2003年6月～2004年6月到妇产科门诊就诊的30例高泌乳素血症患者,采用调冲任方治疗,并观察患者治疗前后月经周期、经量、血清泌乳素、血红蛋白等的变化,并给予针对性的心理护理与健康指导。结果调冲任方可明显降低高泌乳素血症患者高泌乳素水平,其中显效14例,好转12例,无效4例,总治疗有效率为86.7%。结论调冲任方对下丘脑、垂体、性腺轴各个层次均可发挥良性调节作用,可抑制垂体功能血清泌乳素(PRL)的合成与分泌,改善临床症状。同时治疗过程护理人员根据患者的心理状态给予指导,调整了患者不良的心理状态,增强了患者治疗的信心,有利于患者身心健康的恢复。     

一例高泌乳素血症合并妊娠的护理

高泌乳素血症(Hyperpro-Lactinemia,HPRL),是指各种原因所致外周血中催乳素水平的异常增高,一般认为血催乳素浓度高于30 ng/mL或880~1 000 mIU/L时应视为高泌乳素血症。其中一些症状是闭经、溢乳、不孕、性欲减退等。如长期得不到治疗,会出现头痛、视力下降,同时由于长期雌激素     

Evaluation and management of galactorrhea

Galactorrhea is commonly caused by hyperprolactinemia, especially when it is associated with amenorrhea. Hyperprolactinemia is most often induced by medication or associated with pituitary adenomas or other sellar or suprasellar lesions. Less common causes of galactorrhea include hypothyroidism, renal insufficiency, pregnancy, and nipple stimulation. After pathologic nipple discharge is ruled out, patients with galactorrhea should be evaluated by measurement of their prolactin level. Those with hyperprolactinemia should have pregnancy ruled out, and thyroid and renal function assessed. Brain magnetic resonance imaging should be performed if no other cause of hyperprolactinemia is found. Patients with prolactinomas are usually treated with dopamine agonists (bromocriptine or cabergoline); surgery or radiation therapy is rarely required. Medications causing hyperprolactinemia should be discontinued or replaced with a medication from a similar class with lower potential for causing hyperprolactinemia. Normoprolactinemic patients with idiopathic, nonbothersome galactorrhea can be reassured and do not need treatment; however, those with bothersome galactorrhea usually respond to a short course of a low-dose dopamine agonist.     

Diagnosis and management of galactorrhea

After infancy, galactorrhea usually is medication-induced. The most common pathologic cause of galactorrhea is a pituitary tumor. Other causes include hypothalamic and pituitary stalk lesions, neurogenic stimulation, thyroid disorders, and chronic renal failure. Patients with the latter conditions may have irregular menses, infertility, and osteopenia or osteoporosis if they have associated hyperprolactinemia. Tests for pregnancy, serum prolactin level and serum thyroid-stimulating hormone level, and magnetic resonance imaging are important diagnostic tools that should be employed when clinically indicated. The underlying cause of galactorrhea should be treated when possible. The decision to treat patients with galactorrhea is based on the serum prolactin level, the severity of galactorrhea, and the patient's fertility desires. Dopamine agonists are the treatment of choice in most patients with hyperprolactinemic disorders. Bromocriptine is the preferred agent for treatment of hyperprolactin-induced anovulatory infertility. Although cabergoline is more effective and better tolerated than bromocriptine, it is more expensive, and treatment must be discontinued one month before conception is attempted. Surgical resection rarely is required for prolactinomas.     

Treatment of galactorrhea-amenorrhea

A patient complaining of abnormal lactation and amenorrhea should be evaluated for a pituitary tumor. The work-up includes a thorough history and physical examination, serum prolactin and thyroid-stimulating hormone (TSH) determinations, and radiographic assessment of the pituitary gland. The treatment of choice for hyperprolactinemia leading to abnormal lactation is bromocriptine mesylate, even when small pituitary tumors are present. Surgery is reserved for patients who fail to respond to medical treatment and have tumors larger than 1 cm.     

Prolonged over-suppression syndrome

The syndrome of postpill amenorrhea was investigated retrospectively by studying records of diagnosed cases of amenorrhea (1300) treated or confirmed at the Mayo Clinic. Data are taken from records dating to 1960 (low use of contraceptives) and terminate in 1971. 12 cases are reviewed which were diagnosed as prolonged oversuppression syndrome. No particular oral contraceptive formulation was implicated. 4 of 12 patients had had irregular menstrual cycles before oral contraceptive therapy; whereas 8 had had regular cycles. Bioassay of urinary gonadotropins were consistently in the mid-low normal limits (only 1 determination was available for each patient); some patients had been radioimmunoassayed (single assay) for other pituitary hormones: LH (luteinizing hormone) was at normal basal levels and FSH (follicle stimulating hormone) was also in the normal range. Concentrations of total circulating estrogens were in low or subnormal range in each case. 4 cases had associated galactorrhea, which was attributed to exogenous steroid suppression of the prolactin-inhibiting center of the pituitary. Clomiphene citrate was used to restore functions of the hypothalamic-pituitary axis, and of the 8 receiving clomiphene, 5 responded and 2 conceived.     

Amenorrhea-galactorrhea syndrome in the prolactin-secreting pituitary tumor: nursing implications

The amenorrhea-galactorrhea syndrome in prolactin-secreting pituitary tumors is described. The role of prolactin in the development of amenorrhea and galactorrhea is discussed along with the other endocrine abnormalities that overproduction of prolactin may cause. The diagnostic tests that are commonly performed to identify this disease entity are presented with reference to the nurse's role in preparing patients for the diagnostic work-up. Recent advances in transsphenoidal surgery, radiotherapy, and the use of Bromocriptine as therapeutic modalities for this disorder are described. Nursing guidelines that accompany planning care for patients undergoing these treatment regimes are provided.     

Galactorrhea may be clue to serious problems. Patients deserve a thorough workup

Three cases of nonphysiologic hyperprolactinemia associated with pituitary disease evidenced by galactorrhea are presented. Two patients had significant pituitary disease associated with low-level prolactin elevations. The third patient had only a history of infertility and expressible galactorrhea on examination. This patient was found to have high prolactin levels and a locally invasive pituitary tumor. Physicians need to be aware of the serious conditions associated with galactorrhea so that appropriate diagnostic studies can be done and treatment instituted.     

Primary low cerebrospinal fluid pressure syndrome with galactorrhea: findings at MR imaging

A case of primary low cerebrospinal fluid (CSF) pressure syndrome with galactorrhea is reported. Magnetic resonance imaging demonstrated diffusely enhanced meninges, edematous brain, and enlarged pituitary gland. Coincidental enlargement of pituitary gland and edematous brain due to low CSF pressure compressed the pituitary portal system. The 1ow-perfused anterior lobe of pituitary gland would be the mechanism of galactorrhea.     

Galactorrhea: a complication of spinal cord injury.

Galactorrhea, a secretion of milk or milk-like products from the breast in the absence of parturition, has been reported to occur in women with spinal cord injuries in association with amenorrhea and hyperprolactinemia. Four cases of galactorrhea in association with spinal cord injury are reported. Galactorrhea developed in four spinal cord injured women who had thoracic paraplegia. The onset of galactorrhea was from one month to five months after injury. Although the onset of galactorrhea may have been related to prescribed medications in all four cases, insufficient data exist to draw conclusions. The three women whose galactorrhea persisted declined treatment and galactorrhea continuing for more than two years in one instance. We conclude that galactorrhea with or without amenorrhea may develop after a spinal cord injury and that spinal cord injured women may have an enhanced sensitivity to medication-induced galactorrhea.     

Gynecomastia with rare granulomatous lobular mastitis: a case report and literature review

This study was performed to describe a rare case of granulomatous lobular mastitis (GLM) that was successfully treated with bromocriptine in a male patient with gynecomastia and hyperprolactinemia. A 20-year-old man presented with a 1-year history of breast enlargement and galactorrhea. Physical examination revealed bilateral breast enlargement, porous discharge, and a 3-cm left breast lump in the 10-o’clock quadrant. Magnetic resonance imaging of the brain showed a 1.2-mm pituitary tumor. Laboratory analysis revealed hyperprolactinemia with low serum testosterone and elevated prolactin and estradiol levels. The lump in the left breast was examined by ultrasonography and mammography, and a core needle biopsy revealed chronic inflammation. The patient’s galactorrhea and breast lump disappeared after 3 months of treatment with bromocriptine at 2.5 mg once a day. His serum prolactin level also normalized. Following a review of this case, the patient was diagnosed with gynecomastia with hyperprolactinemia complicated by rare GLM. To the best of our knowledge, this is the first reported case of concurrent gynecomastia and GLM.