What Is Galactorrhea?

Celiac disease

Galactorrhea

Celiac disease

Lactation in males or non-lactating women.

Etiology

In both sexes, prolactinoma is the most common secretory tumor produced by the pituitary to produce excessive PRL. In women, most tumors are microadenomas (diameter <10mm), but a few are large adenomas (diameter> 10mm) at diagnosis. The incidence of microadenomas is very low, because they are mostly discovered late.

Hyperprolactinemia or dyspnea can also be caused by taking certain drugs, including phenothiazine, some antihypertensive drugs (especially methyldopa), and opioids. Primary hypothyroidism due to increased TRH Exciting the secretion of TSH and PRL can produce hyperprolactinemia and croup. It is unclear why hyperprolactinemia is accompanied by hypogonadotropin and hypogonadism. The common causes of hyperprolactinemia can be summarized as physiological , Pathological, pharmacological and idiopathic.

Symptoms and signs

Women are often accompanied by lactation.

There are three groups of genital amenorrhea:

(1) Postpartum persistent croupia-amenorrhea syndrome (Chiari-Frommei);

(2) Pregnancy-free amenorrhea-amenorrhea syndrome (Ahumada-delCastillo);

(3) Pituitary chromocytoma causes Forbes-Albright syndrome.

Because the first two syndromes can also have pituitary tumors, but these differences do not help the clinic. The typical complaints of male prolactinoma are headache or difficulty in seeing. About 2/3 of male patients lose their libido and impotence. As mentioned above, increase PRL What causes low LH and FSH and decreased sexual function remains unclear.

Leprosy-menopausal women often have symptoms of estrogen deficiency, including paroxysmal fever, pain during intercourse. However, estrogen production can be normal, and some hyperprolactinemia women have symptoms and signs of excessive androgen. In addition, hyperprolactinemia can have other menstrual cycle disorders, including rarely or reduced ovulation and luteal dysfunction.

diagnosis

The purpose of the first diagnosis is to prove basic hyperprolactinemia. Basic PRL levels are generally related to tumor size and can be used as a basis for long-term patient follow-up. Women with high prolactinemia have low serum gonadotropin and estrogen levels or have Normal range. In patients with normal TSH, primary hypothyroidism can be easily ruled out. Although single lateralconed-downview sphenoidal lateral film can exclude large pituitary tumors, high-resolution CT and MRI are differential Adenoma is the preferred method. Any large adenoma disease that is selected for medical treatment or follow-up should be visualized.

treatment

Treatment of pituitary tumors with hyperprolactinemia is controversial. PRL levels <100ng / ml and normal CT or MRI scans or only microadenomas can be treated with bromocriptine therapy or follow-up monitoring. Bromocriptine therapy is even used in patients without tumors Women with hyperprolactinemia often have low estrogen, which may increase the risk of osteoporosis. Bromocriptine should be recommended to those patients who are expecting pregnancy and hate lactation. Because less than 5% of patients with microadenomas have a certain tumor Increased so that patients with low estrogen can receive exogenous estrogen therapy. All patients with hyperprolactinemia should be regularly tested for basic PRL and saddle radiographs. The scope of these monitoring is controversial. Patients should be tested at least every 4 months Once evaluated, CT or MRI is performed once a year for at least 2 years. If the basic PRL is not increased, the number of saddle radiographs can be reduced.

Patients with large adenomas are usually treated with bromocriptine or surgical treatment, but must undergo a pituitary function test after consultation with endocrinologists, neurosurgeons, and radiation therapy experts. Most endocrinologists use bromocriptine as the first choice of initial treatment. If PRL levels decrease and tumor compression symptoms and signs disappear, no other treatment is necessary. Bromocriptine is also often used before surgery to reduce the tumor to some extent. There is evidence that the diameter of large adenomas is less than 2 cm and In patients with higher PRL levels, treatment with bromocriptine alone is sufficient.

Radiation therapy is only for those patients who have failed other treatments and developed sexually. The main problem of radiation therapy is that pituitary dysfunction occurs several years after treatment. Large adenomas need to be observed for endocrine function (at least once a year) after treatment and undergo butterfly treatment. Saddle evaluation.