男性特发性高泌乳素血症致性功能障碍的诊治

目的探讨男性特发性高泌乳素血症致性功能障碍的临床特征和治疗方法,提高男性特发性高泌乳素血症的诊治水平。方法用甲磺酸溴隐亭治疗特发性高泌乳素血症的男性患者10例：包括性欲低下10例、勃起功能障碍8例、生精障碍2例。结果所有患者经甲磺酸溴隐亭（1．25—2．50m∥d）规律治疗1～24个只,10例患者的性欲得到提高。勃起功能改善8例,生精障碍2例得到缓解。其中3例患者治疗后性满意度不高,并且其血清睾酮水平相对较低,加服十一酸睾酮（40mg／次,1～2次／d）治疗,0．5—2个月后患者的性满意度得到进一步改善。结论男性特发性高泌乳素血症所致的性功能障碍较为少见,病因不明,甲磺酸溴隐亭治疗效果良好。高泌乳素血症应引起男科医生的高度重视。     

加味逍遥散对HPRL大鼠多巴胺受体cAMP/PKA信号转导通路的研究

目的： 探讨以肝脾为核心,运用逍遥散加减方治疗实验性高催乳激素血症（HPRL）模型大鼠下丘脑多巴胺受体环磷酸腺苷（cAMP）/蛋白激酶A（PKA）信号转导通路机制的影响。 方法： 腹腔注射甲氧氯普胺,制作HPRL大鼠模型。随机分成6组：空白对照组、阴性对照组、阳性对照组（溴隐亭组）、逍遥散加减方高、中、低剂量组。给药30 d后,采用免疫组化法测定大鼠下丘脑PKA阳性表达的数量;采用酶联免疫的法测定大鼠血清cAMP的含量、采用免疫组化法及RT-PCR检测大鼠下丘脑多巴胺D1,D2受体。 结果： 与阴性对照组相比较,逍遥散加减各剂量组下丘脑PKA活性明显降低（P < 0.01）;下丘脑cAMP活性显著降低 （P < 0.01）、下丘脑多巴胺D1受体数量有增高趋势、D2受体数量显著增加（P < 0.01）。 结论： 逍遥散加减方对能通过多巴胺受体cAMP-PKA信号转导通路调节泌乳素水平。     

Hyperprolactinemia as a Rare Cause of Hypertension in Chronic Renal Failure

Chronic renal failure (CRF) is associated with a high risk for hypertension. An individualized treatment should be initiated after the diagnosis of hypertension and underlying etiology. Many metabolic and endocrinal abnormalities are encountered in CRF. We present an 11-year-old boy with CRF developing galactorrhea and hyperprolactinemia associated with α-methyldopa, defective dopaminergic control, and resistance to multi-antihypertensive therapy. Cabergoline, a dopamine receptor agonist, was effectively used in the treatment of hypertension. It is important to remember that sometimes treatment of an illness becomes the cause of this illness.     

不同垂体瘤对男性垂体-性腺轴影响的比较分析

 目的  分析比较泌乳素瘤、生长激素瘤和无功能腺瘤对男性患者垂体-性腺轴的影响。方法  选取2009年1月至2013年12月在复旦大学附属上海市第五人民医院手术治疗的男性垂体瘤患者291例,根据临床表现和术后病理结果分为3组:A组为泌乳素瘤组,60例;B组为生长激素瘤组,54例;C组为无功能腺瘤组,177例。对比分析3组患者年龄、瘤体大小、血清睾酮(testosterone,T)、泌乳素(prolactin,PRL)、黄体生成素(luteinizing hormone,LH)和卵泡刺激素(follicle stimulating hormone,FSH)等激素水平。结果  患者平均年龄为(48.0±14.2)岁,大腺瘤(瘤体最大径≥10 mm)占96%,T水平低下者占68%,高PRL血症者占62%,LH和FSH低下者各占15%和5%,且患者的LH水平为正常范围内的低值。A组血清PRL水平及重度高PRL血症的比例明显高于后两组(P均<0.05),B组和C组间比较差异无统计学意义(P=0.10,P=0.30)。FSH、LH和T水平由低至高依次为A组、B组和C组,而且A组与B、C组间比较差异有统计学意义(P均<0.05);尽管后两组间的LH水平比较差异无统计学意义(P=0.54),但B组的T水平明显低于C组(P=0.03)。 结论  泌乳素瘤对男性垂体-性腺轴的影响明显大于生长激素瘤和无功能腺瘤,而且三者对LH的影响均大于FSH。生长激素瘤可能还有其他机制导致T水平低下。     

垂体移植术制作大鼠高催乳素血症模型

目的：制作垂体的异体移植引起的高催乳素血症模型。方法：将SD雌性大鼠（220±20）g随机分为空白对照组、垂体移植造模14 d组、造模18 d组、造模21 d组,用酶联免疫法检测各组大鼠血清催乳素（ PRL）水平,采用HE染色法观察各组大鼠卵巢卵泡的发育情况。结果：垂体移植组大鼠血清PRL水平明显高于对照组,且以18 d组升高最为明显（ P﹤0.05）;与正常对照组比较,各垂体移植组大鼠发育不良卵泡明显增多（ P﹤0.01）,成熟卵泡明显减少（ P﹤0.01）,垂体移植18 d组大鼠发育不良卵泡增加和成熟卵泡减少的变化比其他两个时间段明显（ P﹤0.01）。结论：垂体移植术可成功制作高催乳素血症大鼠模型,以移植18 d效果最好。     

Rapid Re-expansion of a Macroprolactinoma After Early Discontinuation of Bromocriptine

Prolactin (PRL)-secreting pituitary adenomas are the most common functioning pituitary tumors. Medical treatment with dopamine agonists is the therapy of choice for macroprolactinomas (10 mm). Withdrawal of bromocriptine after weeks or months of uninterrupted therapy has been associated with rapid tumor re-expansion as evidenced by x-ray and CT scanning of the pituitary region. We report a patient with a giant macroprolactinoma who had a dramatic response to bromocriptine (tumor volume shrinkage of 53% within a month) but rapid re-expansion to its original dimensions one week after discontinuation of bromocriptine. To our knowledge, this is the first time that the rapid shrinkage/re-expansion of a macroprolactinoma has been documented with serial MRI scans.     

复方玄驹胶囊联合溴隐亭治疗高泌乳素血症导致的勃起功能障碍的疗效观察

目的:观察复方玄驹胶囊联合溴隐亭治疗高泌乳素血症导致的勃起功能障碍的疗效。方法:46例高泌乳素血症导致勃起功能障碍患者,随机平均分为治疗组和对照组,治疗组同时口服复方玄驹胶囊(3粒,3次/d)和溴隐亭进行治疗,对照组单用溴隐亭进行治疗,治疗至病情稳定后观察勃起功能、血清泌乳素水平、血清睾酮水平变化并对疗效进行评估。结果:治疗组、对照组经治疗12周后国际勃起功能指数(IIEF-5)分别为(13.7±3.5)、(16.4±3.7),两组病例经治疗12周后勃起功能较治疗前均明显改善(P<0.05),治疗组病例勃起功能较对照组改善更显著(P<0.05),治疗组、对照组病例治疗后血清泌乳素水平分别为(156.07±26.31)mIU/L、(164.73±28.58)mIU/L,较治疗前均有显著下降(P<0.05),两组间治疗后血清泌乳素水平无显著差异(P>0.05),治疗组、对照组病例治疗后血清睾酮水平分别为(15.34±5.27)nmol/L、(12.02±2.36)nmol/L,较治疗前均有升高(P<0.05),治疗组血清睾酮水平较对照组显著升高(P<0.05),治疗组、对照组治疗后勃起功能改善有效率分别为86.96%(20/23)、65.22%(15/23),治疗组明显高于对照组(P<0.05)。结论:复方玄驹胶囊联合溴隐亭能有效治疗男性高泌乳素血症导致的勃起功能障碍,联合用药较单用溴隐亭疗效更为显著。     

The Effects of Atypical Antipsychotics on Serum Prolactin Levels

Hyperprolactinemia may be a concern in the treatment of patients with schizophrenia. The side effects associated with high prolactin levels can have a negative impact on patient compliance with treatment. Atypical antipsychotics as a group cause less hyperprolactinemia than conventional antipsychotics, yet there is considerable variation among specific drugs. Risperidone at higher doses has been shown to produce increases in prolactin similar to conventional antipsychotics. At the other end of the spectrum, clozapine and quetiapine produce minimal sustained increases in prolactin that are no different from placebo. However, correlations between prolactin elevations and clinical symptoms have not been well-established. This paper reviews the published literature regarding prolactin levels in treated and untreated patients with schizophrenia and the relationship of prolactin and dopamine. It concludes with an overview of the effects of specific atypical antipsychotics on prolactin levels in patients with schizophrenia.