Zamkatimu
Hyperprolactinemia ndi kukhalapo kwa kuchuluka kwa prolactin m'magazi modabwitsa. Prolactin ndi mahomoni opangidwa ndi pituitary gland. Ntchito zambiri za prolactin m'thupi zimakhudzidwa makamaka ndi mimba komanso kupanga mkaka wa m'mawere kwa wakhanda. Komabe, mlingo wa prolactin ukhoza kukwera pamene mayi sali ndi pakati kapena akuyamwitsa, kuchititsa zinthu zingapo zomwe zingakhudze ntchito yabwino ya msambo ndi kubereka. Seramu prolactin iyenera kuyeza kokha mwa odwala omwe ali ndi chotupa cha pituitary kapena zizindikiro zachipatala ndi zizindikiro za hyperprolactinemia.
Kodi hyperprolactinemia ndi chiyani
Pali zifukwa zambiri za hyperprolactinemia, kuphatikizapo mankhwala ena ndi chotupa cha pituitary (prolactinoma). Kuti mupereke chithandizo choyenera, ndikofunikira kudziwa chomwe chimayambitsa. Hyperprolactinemia ingayambitse galactorrhea (kutulutsa mkaka wa m'mawere kunja kwa lactation) ndikusokoneza ntchito yobereka. Izi zitha kufulumizitsa kutayika kwa mafupa ngati chifukwa cha kusowa kwa mahomoni ogonana.
Ma prolactinomas ambiri ndi ma microprolactinomas. Nthawi zambiri samakula msanga moti angayambitse mavuto aakulu. Odwala omwe ali ndi prolactinoma nthawi zambiri amathandizidwa bwino ndi dopamine agonists monga cabergoline.
Zomwe zimayambitsa hyperprolactinemia mwa akuluakulu
Kuchuluka kwa prolactin m'magazi (hyperprolactinemia) ndi vuto la endocrine lodziwika bwino. Zomwe zimayambitsa zimayambira pazovuta zomwe sizifuna chithandizo mpaka zovuta zachipatala zomwe zimafunikira chithandizo chamsanga. Hyperprolactinemia ingakhalenso zotsatira za mankhwala ena. Kuti mumvetse tanthauzo la zomwe zikuchitika, ndi bwino kufotokoza pang'ono ntchito ya hormone iyi.
Prolactin ndi mahomoni a polypeptide opangidwa ndikutulutsidwa ndi maselo a lactotrophic a anterior pituitary gland. Kutulutsa kwa prolactin kumayendetsedwa makamaka ndi dopamine, yomwe imapangidwa mu hypothalamus ndipo imalepheretsa kutulutsa kwa prolactin. Homoni yotchedwa hypothalamic thyrotropin-release hormone imapangitsa kuti prolactin ipangidwe.
Prolactin imakhala ndi zotsatira zake pomanga ma prolactin receptors. Iwo ali pa selo nembanemba wa maselo ambiri, makamaka pachifuwa ndi pituitary gland. Mu bere, prolactin imapangitsa kukula kwa glands pa nthawi ya mimba ndi kupanga mkaka wa m'mawere mu nthawi yobereka. Mu pituitary gland, prolactin imachepetsa katulutsidwe ka gonadotropin.
Pali zoyambitsa thupi, pathological ndi mankhwala okhudzana ndi hyperprolactinemia (kuchuluka kwa prolactin).
Zifukwa za thupi. Mimba, kuyamwitsa ndi kuyamwitsa, kuchita masewera olimbitsa thupi, kugonana ndi kupsinjika maganizo kungawonjezere kuchuluka kwa prolactin. Kuwonjezeka kumeneku kumakhala kwakanthawi ndipo nthawi zambiri sikudutsa kuwirikiza kawiri malire apamwamba a milingo yoyenera.
Zifukwa za pathological. Prolactinomas ndi zotupa zomwe zimachokera ku ma cell a pituitary omwe amapanga prolactin. Ma prolactinomas (90%) ambiri ndi ma microadenomas (<1 cm m'mimba mwake) omwe amapezeka nthawi 10 mwa amayi kuposa amuna. Microadenomas imayambitsa kuwonjezeka pang'ono kwa ma prolactin, omwe angagwirizane ndi zizindikiro za hyperprolactinemia, koma nthawi zambiri samakula.
Macroadenomas (oposa 1 masentimita m'mimba mwake) sapezeka kawirikawiri, ndipo ma prolactinomas aakulu (opitirira 4 masentimita m'mimba mwake) ndi osowa. Poyerekeza ndi akazi, amuna ali ndi mwayi wokhala ndi macroadenoma kasanu ndi kamodzi. Zotupazi zimayambitsa hyperprolactinemia yoopsa - kuchuluka kwa prolactin kuposa 10 mIU/L pafupifupi nthawi zonse kumasonyeza macroprolactinoma. Zitha kuyambitsa hypopituitarism, kutayika kwa mawonekedwe, kapena kufooka kwamaso mwa kukakamiza optic chiasm kapena cranial nerve nuclei.
Mapangidwe ena a hypothalamus ndi pituitary gland angayambitsenso hyperprolactinemia. Popeza dopamine imapondereza katulutsidwe ka prolactin, neoplasm iliyonse kapena zilonda zolowera zomwe zimakanikizira phesi la pituitary zimatha kufooketsa mphamvu ya dopamine ndikuyambitsa hyperprolactinemia. Komabe, phesi limaphwanya hyperprolactinemia nthawi zambiri pansi pa 2000 mIU/L, yomwe imasiyanitsa ndi macroprolactinoma.
Matenda ena angayambitse hyperprolactinemia. Prolactin imatulutsidwa makamaka ndi impso, kotero kuti kulephera kwa impso kungapangitse kuchuluka kwa prolactin. Chifukwa chakuti mahomoni otulutsa thyrotropin amathandizira katulutsidwe ka prolactin, hypothyroidism ingayambitsenso hyperprolactinemia. Kukomoka kungayambitse kuwonjezeka kwakanthawi kochepa kwa ma prolactin.
Zifukwa zokhudzana ndi mankhwala osokoneza bongo. Mankhwala angapo amasokoneza kutulutsidwa kwa dopamine mu hypothalamus, zomwe zimabweretsa kuwonjezeka kwa katulutsidwe ka prolactin (prolactin 500-4000 mIU / l). Hyperprolactinemia imayamba mwa odwala omwe amamwa mankhwala a antipsychotic. Zitha kukhalanso, pang'ono, chifukwa cha kusankha kwa serotonin reuptake inhibitors (mankhwala osokoneza bongo). Mankhwala ena angayambitse hyperprolactinemia mobwerezabwereza. Ngati hyperprolactinemia imayamba chifukwa cha mankhwala, ndende nthawi zambiri imakhazikika ngati mankhwalawa atayimitsidwa mkati mwa maola 72.
Zizindikiro za hyperprolactinemia mwa akuluakulu
Odwala ena, hyperprolactinemia ndi asymptomatic, koma kuchuluka kwa timadzi timeneti kumatha kukhudza chiwalo cha mammary ndi ntchito yobereka. Kwa amayi, zimatha kuyambitsa oligoamenorrhea (nthawi yochepa komanso yochepa), kusabereka, ndi galactorrhea. Kwa amuna, hyperprolactinemia imatha kuyambitsa kusagwira bwino kwa erectile, kusabereka, ndi gynecomastia. Galactorrhea (kutulutsa mkaka kapena colostrum kuchokera pachifuwa) simapezeka kwambiri mwa amuna kuposa akazi.
Kuperewera kwa timadzi ta gonadal kumatha kufulumizitsa mafupa. Odwala akhoza kukhala ndi zizindikiro kapena zizindikiro zogwirizana ndi zomwe zimayambitsa hyperprolactinemia. Mwachitsanzo, mutu ndi kutaya masomphenya wodwala ndi chotupa pituitary, ndi kutopa ndi kuzizira tsankho wodwala ndi hypothyroidism.
Chithandizo cha hyperprolactinemia akuluakulu
Tiyenera kutsindika kuti mlingo wa prolactin uyenera kuyesedwa mwa odwala omwe ali ndi zizindikiro zachipatala kapena zizindikiro za hyperprolactinemia kapena odwala omwe ali ndi chotupa chodziwika bwino cha pituitary. Kuzindikira kwa hyperprolactinemia kumatha kutengera muyeso umodzi wa seramu prolactin pamwamba pamlingo wapamwamba wanthawi zonse. Kutenga magazi kuyenera kuchitidwa popanda kupanikizika kwambiri.
Diagnostics
Mayesero osavuta a magazi kuti ayese kuchuluka kwa prolactin m'magazi amatha kutsimikizira kuti pali ma prolactin okwera. Miyezo ya prolactin pamwamba pa 25 ng / mL imaonedwa kuti ndi yokwezeka kwa amayi omwe sali oyembekezera. Popeza munthu aliyense amakumana ndi kusinthasintha kwa tsiku ndi tsiku kwa ma prolactin, zingakhale zofunikira kubwereza kuyesa magazi ngati mlingo wa hormone ukukwera pang'ono. Amayi ambiri amapeza matendawa atayezetsa ngati alibe ana kapena akudandaula kuti sangasambe nthawi zonse, koma ena alibe zizindikiro. Nthawi zina odwala amakhala ndi zotuluka zamkaka kuchokera ku nsonga zamabele, koma ambiri alibe chizindikiro ichi.
Kuwonjezeka pang'ono kwa prolactin, m'kati mwa 25-50 ng / ml, nthawi zambiri sikumayambitsa kusintha kwakukulu kwa msambo, ngakhale kuti kungachepetse chonde. Kuchulukira kwa prolactin 50 mpaka 100 ng/mL kungayambitse kusamba kosakhazikika komanso kuchepetsa kwambiri kubereka kwa amayi. Miyezo ya prolactin yoposa 100 ng/mL imatha kusintha magwiridwe antchito a ubereki wa amayi, zomwe zimayambitsa zizindikiro za kusamba (kusowa kwa msambo, kutentha thupi, kuuma kwa ukazi) komanso kusabereka.
Pamene matenda a hyperprolactinemia apangidwa, kufufuza kuyenera kuchitidwa kuti adziwe chomwe chimayambitsa ndi zovuta zomwe zimagwirizanitsidwa nazo. Amayi ndi abambo ayenera kuyeza estrogen ndi testosterone yam'mawa, motsatana, limodzi ndi gonadotropins. Kwa amayi a msinkhu wobereka, ntchito ya chithokomiro ndi impso iyenera kuyesedwa ndikuchotsa mimba.
Ngati palibe chifukwa china chodziwika bwino, MRI ya pituitary gland imasonyezedwa. Odwala omwe ali ndi chotupa cha pituitary chokulirapo kuposa masentimita 1 m'mimba mwake ayenera kuyesedwa kuti awonenso mahomoni ena a pituitary ndikuwunika momwe akuwonera. Ndikofunikira kudziwa kuchuluka kwa mchere wa fupa kwa odwala omwe ali ndi hypogonadism.
Mankhwala amakono
Odwala ena safuna chithandizo. Odwala ndi physiological hyperprolactinemia, macroprolactinemia, asymptomatic microprolactinoma, kapena mankhwala-induced hyperprolactinemia nthawi zambiri safuna chithandizo. Ngati hyperprolactinemia ndi yachiwiri kwa hypothyroidism, chithandizo cha wodwala ndi thyroxine chiyenera kusintha mlingo wa prolactin.
Malangizo azachipatala
Malinga ndi malangizo azachipatala, kuchuluka kwa prolactin kumathandizidwa ndi njira zingapo.
Mankhwala omwe amatsanzira ubongo wa dopamine amatha kugwiritsidwa ntchito bwino pochiza odwala ambiri omwe ali ndi ma prolactin okwera. Mankhwalawa amachepetsa kupanga prolactin ndi pituitary gland ndipo amachititsa kuponderezedwa kwa maselo otulutsa prolactin. Mankhwala awiri omwe amagwiritsidwa ntchito kwambiri ndi cabergoline ndi bromocriptine. Kuyambira ndi mlingo wochepa, womwe umawonjezeka pang'onopang'ono, zotsatira zake, kuphatikizapo kusintha kwa kuthamanga kwa magazi ndi chifunga chamaganizo, zikhoza kuchepetsedwa. Odwala nthawi zambiri amayankha bwino mankhwalawa ndipo ma prolactin amachepetsa pakatha masabata awiri mpaka atatu.
Miyezo ya prolactin ikatsika, mankhwala amatha kusinthidwa kuti akhalebe ndi ma prolactin, ndipo nthawi zina amatha kuyimitsidwa kwathunthu. Kubwerera kwa chotupa modzidzimutsa kumachitika pakatha zaka zingapo popanda zotsatira zachipatala.
Odwala ochepa, mankhwala samachepetsa mlingo wa prolactin, ndipo zotupa zazikulu (macroadenomas) zimapitirizabe. Odwalawa ndi omwe akufuna kulandira chithandizo cha opaleshoni (transsphenoidal adenoma resection) kapena chithandizo cha radiation.
Kupewa hyperprolactinemia akuluakulu kunyumba
Tsoka ilo, mpaka pano, palibe njira zothandiza zomwe zapangidwa kuti zipewe izi. Njira zodzitetezera zimalimbikitsidwa, kuphatikiza kukhala ndi moyo wathanzi, kusiya zizolowezi zoyipa, kuchiza matenda aliwonse am'mimba komanso kagayidwe kazakudya.
Mafunso ndi mayankho otchuka
Ponena za matenda ndi chithandizo cha vuto la chithokomiro cha pituitary ndi prolactin yayikulu, mawonekedwe a kupewa, tidakambirana nawo. urologist, katswiri wa ultrasound diagnostics, dokotala wapamwamba gulu Yuri Bakharev.