Contents 1 Pinyin 2 English reference 3 Overview 4 Disease name 5 English name 6 Alias ??of amenorrhea galactorrhea syndrome 7 Classification 8 ICD number 9 Epidemiology 10 Cause 10.1 Physiological factors 10.2 Pathological factors 11 Pathogenesis 11.1 Inhibition Hypothalamic pituitary function 11.2 Suppression of ovarian function 11.3 Effect on the breast 12 Clinical manifestations of amenorrhea galactorrhea syndrome 13 Complications of amenorrhea galactorrhea syndrome 14 Laboratory tests 14.1 Pituitary function 14.2 Ovarian function test blood 14.3 Thyroid function test 14.4 Prolactin dynamic test 15 Auxiliary examination 15.1 X-ray tomography of sella turcica 15.2 CT and MRI 15.3 Contrast examination 16 Diagnosis 16.1 Medical history 16.2 Physical examination 16.3 Ophthalmological examination 17 Differential diagnosis 18 Treatment of amenorrhea galactorrhea syndrome 18.1 Cause treatment 18.2 Drug treatment 18.3 Ovulation induction treatment 18.4 Surgical treatment and Radiotherapy 19 Prognosis 20 Prevention of amenorrhea galactorrhea syndrome 21 Related drugs 22 Related examinations are attached: 1 Drugs related to amenorrhea galactorrhea syndrome 1 Pinyin
bì jīng yì rǔ zōng hé zhēng 2 English reference
< p> amenorrhea galactorrhea syndrome 3 OverviewNon-pregnant and lactating women, or women who stop breastfeeding for 1 year and have persistent galactorrhea accompanied by amenorrhea, are called amenorrhea galactorrhea syndrome. , including different causes and pathologies. It should be noted that amenorrhea galactorrhea syndrome is often a symptom of a prolactinoma of the pituitary gland and can occur up to 10 years before the tumor is confirmed on radiographs. The rate of amenorrhea galactorrhea syndrome with hyperprolactinemia is 79% to 97%.
Prolactin is secreted by the prolactin cells of the adenohypophysis. The secretion increases at night and gradually decreases 1 hour after waking up; the hypothalamus synthesizes PIF (dopamine) and PRF (TRH) and reaches the adenohypophysis through the pituitary portal vein, regulating its Prolactin is synthesized and released, but the main role is PIF, that is, it is always in a suppressed state. Serotonin and estrogen cause the lactating cells of the pituitary gland to synthesize prolactin. The blood concentration of adult women should be kept below 20 μg/L. The effect of normal levels of prolactin on ovarian function is not very clear, but if the level is too high, it will hinder the ovarian corpus luteum from synthesizing progesterone. If it is accompanied by LH and FSH secretion disorders, it will cause anovulation and amenorrhea.
4 Disease name
Amenorrhea galactorrhea syndrome 5 English name
amenorrhea galactorrhea syndrome 6 Alias ??of amenorrhea galactorrhea syndrome
Amenorrhea galactorrhea syndrome Syndrome 7 Classification
Endocrinology> Female gonadal diseases 8 ICD number
E34.8 9 Epidemiology
Fiedeleff et al. The disease evolution of PRL tumors (40 cases, 29 female and 11 male) was carefully observed. The age of onset of female patients is 8 to 16 years old, and most of them are tiny PRL tumors. The main clinical manifestations are menstrual disorders and galactorrhea. The age of onset in males is 8 to 17 years old, and most of them are large PRL adenomas. The clinical manifestations are mainly local symptoms caused by the tumor itself. Therefore, the manifestations of PRL tumors in prepubertal women are different from those in patients during the reproductive period, and drug treatment can normalize gonadotropin secretion in most patients.
Kleinberg et al. analyzed the clinical data of 235 patients (5.5% male) with galactorrhea. They found that 34% of female patients with amenorrhea had pituitary tumors and their serum PRL was also high. About 1/3 of the patients only had galactorrhea. Without amenorrhea, 86% of these patients had normal blood PRL, and 5 cases had vacuolated sella syndrome. Some people still have galactorrhea and/or amenorrhea after medication, surgery or even radiotherapy. Bromocriptine or lergotrile mesylate can stop galactorrhea in half of the cases and resume menstruation in 70% of patients. 10 Causes
There are many causes of hyperprolactinemia, but hyperprolactinemia does not necessarily lead to galactorrhea, nor is galactorrhea necessarily accompanied by hyperprolactinemia.
10.1 Physiological factors
Plasma prolactin increases during sleep, and the increase in PRL secretion begins after sleep and continues throughout the sleep process. The secretion of PRL also increases during pregnancy, which is more than 10 times higher than during non-pregnancy. Sucking can temporarily increase the secretion of PRL, but after 3 months of breastfeeding, the increase gradually decreases. During long-term breastfeeding, prolactin levels within the normal range can cause milk secretion; physical activity, stress, mental stimulation, nipple stimulation, and the luteal phase of menstruation can all increase prolactin secretion. 10.2 Pathological factors
(1) Tumor hyperprolactinemia (ForbesAlbright syndrome): caused by tumors of the hypothalamic pituitary system. According to reports, this type of hyperPRLemia accounts for 71.6% of all patients with hyperprolactinemia, among which prolactinoma accounts for 33% to 76.9% of amenorrhea galactorrhea syndrome. Most are microadenomas (diameter <1cm, 66%), and a few are macroadenomas, accounting for 30%. Tumor cells are not inhibited by hypothalamic PIF and autonomously secrete large amounts of prolactin. Growth hormone (GH) tumors, GH/PRL mixed tumors, ACIH tumors, and chromophobe tumors can also cause hyperprolactinemia. When the tumor enlarges and compresses the LH and FSH-secreting cells of the pituitary stalk and adenohypophysis or the PIF and GnRH transport of the hypothalamus is blocked, prolactin will increase accompanied by abnormal secretion of LH and FSH, leading to amenorrhea galactorrhea syndrome. Gastrointestinal carcinoid tumors or gastrinomas are occasionally combined with hyperGH and hyperPRL. Patients have amenorrhea and galactorrhea. The pituitary gland can be enlarged and have imaging manifestations of pituitary tumors. After gastrointestinal carcinoids are removed, the pituitary tumors also disappear. , the reason is unknown. Pituitary gonadotropin (LH/FSH)-secreting tumors are rare. The average age of onset in male patients is over 50 years old, and blood FSH is elevated. Female patients also have elevated blood FSH/LH, but they are often difficult to treat due to menopause and other reasons. Considering the possibility of this disease, measuring the serum α subunit level can help in early diagnosis, and high-resolution MRI can confirm the diagnosis. When postmenopausal women experience galactorrhea (already menopausal) and their blood PRL rises, they should consider the possibility of pituitary gonadotropin-secreting tumors. If the patient responds poorly to dopaminergic agonist treatment, the effect is not obvious, the pituitary tumor does not shrink, and the symptoms do not improve, or if the blood PRL decreases during treatment, but cortisol and ACTH increase, pituitary prolactinoma should be considered. It is possible to develop into ACTH tumors, and a very small number of patients with PRL tumors can develop Cushing syndrome (not PRL/ACTH mixed tumors, in which the PRL immunohistochemical staining of tumor cells is negative but ACTH staining is positive). This phenomenon can occur when the pituitary stalk is compressed or due to a disorder in the secretion of regulatory factors (such as galanin) from the hypothalamus. In addition to PRL tumors that can coexist with GH tumors, LH/FSH tumors, TSH tumors, and α subunit tumors, they can also be combined with central diabetes insipidus.
In addition, vacuolar sella syndrome and tumors in and around the hypothalamus compress the pituitary gland, causing PIF to decrease and prolactin to increase. Craniocerebral trauma, pituitary accidental tumor, craniopharyngioma, pituitary cyst, meningioma, third ventricular hematoma, arachnoid cyst, Rathke's cyst, polyradiculoneuritis, multiple endocrine neoplasia syndrome (MEN), etc. can also be treated Accompanied by idiosyncrasies.
(2) Postpartum hyperprolactinemia (ChiafiFrommel syndrome): accounting for about 30% of all hyperprolactinemia, secondary to pregnancy, childbirth, abortion or induction of labor, prolactinemia Once it rises it is not easy to fall. The PRL of this disease is only slightly elevated, the symptoms are mild, and the prognosis is good.
(3) Idiopathic hyperprolactinemia (Ahumada Argonzdel Castillo syndrome): rare. The cause is unknown, mostly caused by mental trauma and stress factors, and some are caused by microadenoma or high prolactin in macromolecules.
(4) Other diseases: Hypothyroidism and hyperPRLemia may be caused by TRH stimulating the release of PRL. In addition, Addison's disease and chronic renal failure can also cause PRL secretion. Certain tumors (such as bronchial carcinoma, adrenal carcinoma, embryonal carcinoma) can also secrete ectopic PRL.
Primary hypothyroidism with amenorrhea and galactorrhea syndrome is mostly a manifestation of hypothyroidism itself, but it may also be caused by combined pituitary PRL tumor and hyperPRLemia after thyroid hormone replacement therapy. Even pituitary PRL tumors can disappear. The incidence of postpartum thyroiditis (prevalence rate is about 5.5%) has a certain genetic background and is also related to environmental factors such as high iodine intake. Plasma cell/lymphocyte infiltration is seen in thyroid tissue, which is accompanied by hyperthyroidism in the early stage. Hypothyroidism appears after a few months, and may be accompanied by menstrual disorders, amenorrhea, galactorrhea, and goiter. The symptoms of amenorrhea and galactorrhea are mild, and most of them resolve spontaneously with the recovery of hypothyroidism.
(5) Iatrogenic hyperprolactinemia: Certain drugs can inhibit the synthesis of dopamine in the hypothalamus for a long time or affect its action, causing prolactin secretion. It can recover naturally after stopping the drug.
Antipsychotic drugs, especially diazepam drugs, can inhibit the release of central dopamine neurotransmitters, causing hyperPRLemia and amenorrhea galactorrhea syndrome. Long-term use may even lead to PRL tumors.
It is generally recommended to add dopamine agonists, but bromocriptine can antagonize the effects of neuroleptics, making it difficult to control the patient's mental symptoms. Melkersson et al. advocated the addition of secobarbitone (Quinalbarbitone) when using tranquilizers (such as clozapine, Clozapine), which is beneficial to the control of psychiatric symptoms and prevents the increase of PRL.
(6) Reflexive factors: Nipple stimulation, chest surgery or chest lesions can stimulate prolactin secretion through nerve reflexes. Prolactin is slightly to moderately elevated, often accompanied by galactorrhea, but not necessarily galactorrhea. amenorrhea. After the cause is removed, blood prolactin returns to normal.
In a recent case-control study, continued use of birth control pills did not result in pituitary tumor growth. Prospective studies have shown no adverse effects of hormone replacement therapy in hyperprolactinemia due to pituitary microadenoma. 11 Pathogenesis 11.1 Inhibition of hypothalamic pituitary function
Hyperprolactinemia inhibits the secretion of dopamine (DA) in the hypothalamus, inhibits the synthesis and release of GnRH, and inhibits the positive feedback response of E2 and the ovulation peak induced by LH. disappear. 11.2 Inhibit ovarian function
Reduce the number of FSH, LH, and PRL receptors in antral follicles and accelerate follicular atresia. Inhibits FSH-mediated aromatase activity in granulosa cells, reduces estrogen secretion, and causes luteal insufficiency. If PRL ≥ 100 μg/ml, progesterone synthesis stops completely. Yoshimura et al. found in isolated rabbit granulosa cell cultures that after adding PRL to the culture medium, follicle development was blocked, the synthesis of ovarian steroid hormones and progesterone stopped, and the plasminogen activity in the follicles decreased, causing the follicular epithelial cells and follicles to The wall cannot be decomposed. Even if follicles occasionally mature and ovulate, the cleavage and fertilization abilities of the eggs are significantly reduced, indicating that high levels of PRL can directly inhibit follicle development, maturation and ovulation, and reduce the quality of eggs. 11.3 Effect on the mammary gland
Prolactin affects the milk secretion of the mammary gland through its corresponding receptors on the mammary gland tissue, promoting the production of mammary gland casein and lactalbumin. High prolactin can cause mammary gland lobular hyperplasia. , big breasts and galactorrhea. Galactorrhea can be spontaneous (overt) or latent (occurs when the breast is squeezed), and can be serous, fatty or milky. In recent years, people have noticed that PRL plays an important role in the occurrence and development of breast cancer. Some people believe that hyperprolactinemia is a reliable indicator of poor prognosis of breast cancer. 12 Clinical manifestations of amenorrhea and galactorrhea syndrome
The main symptoms are amenorrhea, galactorrhea, increased blood prolactin and infertility. The vast majority are secondary amenorrhea (89%), but primary amenorrhea (4%) and delayed puberty with hyperprolactinemia have also been reported. Menorrhagia is often seen before amenorrhea. 2/3 patients have galactorrhea, which can be bilateral or unilateral. The breasts are mostly normal or accompanied by lobular hyperplasia. Amenorrhea usually occurs first, and galactorrhea is often discovered by doctors. There are also cases where galactorrhea occurs first and menstrual disorders or even amenorrhea later occur. In hyperprolactinemia, the ovarian corpus luteum function is insufficient, and ovulation is rare or absent, causing infertility. Those with mildly elevated prolactin may have ovulatory menstruation, but the luteal phase is shortened, and sometimes progesterone withdrawal bleeding may occur. Some women with hyperprolactinemia do not experience galactorrhea, which may be related to a simultaneous lack of estrogen. There are also a few women with galactorrhea who have normal prolactin levels. People with hyperprolactinemia and ovulatory menstrual cycles may secrete large molecules of prolactin (macroprolactin).
People with long-term amenorrhea may suffer from estrogen deficiency, such as flushing, palpitations, sweating, vaginal dryness, pain during sexual intercourse, loss of sexual desire, etc. Headaches, acromegaly, decreased vision, reduced visual field, and symptoms of hypothyroidism are mostly caused by PRL tumors or hypothalamic pituitary lesions. Most prolactinomas grow slowly and are rarely giant adenomas. Some patients' clinical symptoms and imaging may spontaneously improve or even resolve spontaneously.
Without treatment, patients with hyperprolactinemia often develop obesity, accompanied by insulin resistance and osteoporosis. Osteoporosis is mainly related to estrogen deficiency and elevated PRL itself.
Fiedeleff et al. carefully observed the disease evolution of a group of peri-adolescent PRL tumors (40 cases, 29 females, 1 males). The age of onset of female patients is 8 to 16 years old, and most of them are tiny PRL tumors. The main clinical manifestations are menstrual disorders and galactorrhea. The age of onset in males is 8 to 17 years old, and most of them are large PRL adenomas. The clinical manifestations are mainly local symptoms caused by the tumor itself. Therefore, the manifestations of PRL tumors in prepubertal women are different from those in patients during the reproductive period, and drug treatment can normalize gonadotropin secretion in most patients.
Kleinberg et al. analyzed the clinical data of 235 patients (5.5% male) with galactorrhea. They found that 34% of female patients with amenorrhea had pituitary tumors and their serum PRL was also high. About 1/3 of the patients only had galactorrhea. Without amenorrhea, 86% of these patients had normal blood PRL, and 5 cases had vacuolated sella syndrome. Some people still have galactorrhea and/or amenorrhea after medication, surgery or even radiotherapy. Bromocriptine or lergotrile mesylate can stop galactorrhea in half of the cases and resume menstruation in 70% of patients.
13 Complications of amenorrhea galactorrhea syndrome
If untreated, patients with hyperprolactinemia often develop obesity, accompanied by insulin resistance and osteoporosis. Osteoporosis is mainly related to estrogen deficiency and The increase in PRL itself is related. 14 Laboratory examinations 14.1 Pituitary function
(1) PRL: The blood PRL of women in normal childbearing period is <20 μg/L. Some people suggest that imaging examination should be performed if PRL is 20-30 μg/L. The incidence rate of prolactinoma is 20% for PRL50～100μg/L; the incidence rate of prolactinoma is 50% for >100μg/L: the incidence rate for PRL100～300μg is even higher; if PRL>300μg/L, if there is no pregnancy, almost all of them are pituitary tumors. Caused by. The larger the tumor, the higher the PRL. For example, if the diameter is ≤5 mm, the PRL is 171±38 μg/L; between 5 and 10 mm, the PRL is 206±29 μg/L; and ≥10 mm, the PRL is 485±158 μg/L. PRL may not increase when giant adenoma is hemorrhagic and necrotic.
For those caused by drugs, blood PRL is generally within 80 μg/L and can return to normal 36 hours after stopping the drug. For those caused by estrogen, PRL may drop significantly after several months of drug withdrawal. Imai et al. summarized the clinical characteristics of ChiariFrommel syndrome (3 cases), Argonzdel Castillo syndrome (5 cases), and drug-induced amenorrhea and galactorrhea syndrome (12 cases) and found that: ① Amenorrhoea and galactorrhea syndrome with normal blood PRL The proportion of patients is quite high, among which ChiariFrommel syndrome accounts for 66.7%, Argonzdel Castillo syndrome accounts for 40%, and drug-induced patients account for 33.3%; ② Many amenorrhea galactorrhea syndrome blood PRL is normal, and the stimulating response to TRH and other symptoms is also There is no excessive reaction, and its mechanism is unknown; ③ The main cause of menstrual disorders and amenorrhea is not caused by reduced or abnormal secretion of LH/FSH.
Because the secretion of PRL fluctuates greatly, blood should be collected multiple times for measurement. The PRL radioimmunoassay kit currently used in clinical practice only measures small molecule PRL (2500), but cannot measure large molecule and giant molecule PRL (50,000 to 100,000). Therefore, some patients with obvious clinical symptoms and normal PRL cannot rule out the so-called latent high molecule. Prolactinemia (occult hyperprolactinemia) refers to hyperprolactinemia of large molecules and giant molecules. If it is highly suspected to be a false increase, serum anti-PRL antibodies should be measured at the same time, or HPLC analysis and quantification of different components of PRL should be performed.
(2) FSH and LH often decrease, and the LH/FSH ratio increases.
(3) GH, TSH, and ACTH should be measured according to the needs of the condition. 14.2 Ovarian function test blood
E2 and progesterone are reduced. Measuring E2 can accurately determine the patient's estrogen secretion status. Progesterone measurement is only used for patients with galactorrhea who have not amenorrhea, but is not necessary for patients with amenorrhea and galactorrhea. Testosterone may be elevated in patients with hyperprolactinemia and hirsutism. 14.3 Thyroid function test
When combined with hypothyroidism, T3 and T4 decrease, and TSH increases. 14.4 Prolactin dynamic test
(1) TRH stimulation test: TRH not only stimulates the pituitary gland to release TSH, but also stimulates PRL secretion at the same time. When normal women receive a single intravenous injection of TRH 100-400 μg, PRL will increase 5-10 times and TSH will increase 2-fold in 15-30 minutes compared with before the injection. It is helpful to diagnose prolactinoma if it does not rise in pituitary tumors, or when the PRL level rises less than 1.5 times compared with the baseline value. All drugs that interfere with PRL secretion should be stopped before the test. Drinking alcohol and smoking have no significant effect on the results, but licorice or licorice preparations (most Chinese medicine prescriptions contain licorice) can inhibit the basal secretion of PRL and the maximum secretion after TRH stimulation.
(2) Chlorpromazine test: Chlorpromazine inhibits the absorption, conversion and dopamine function of norepinephrine through receptors, thereby promoting PRL secretion. Take 25 to 50 mg of chlorpromazine on an empty stomach after taking blood at the basic state. Take blood 60 minutes and 120 minutes after taking the medicine to measure PRL. After normal women are excited by chlorpromazine, the peak value of PRL increases 2 to 5 times compared with the basic value. Patients with pituitary tumors do not rise. high.
(3) Metoclopramide (Metoclopramide test): This drug is a dopamine receptor antagonist that can promote the synthesis and release of PRL. Take it on an empty stomach. Inject 10 mg of metoclopramide (metoclopramide) after blood injection, and take blood to measure PRL at 20, 30 and 60 minutes after injection. After injection of metoclopramide (metoclopramide) in normal people, PRL The peak occurs at 20 to 30 minutes, and the PRL peak value increases 7 to 16 times compared with the basic value. In patients with functional galactorrhea, the PRL rises to 2 to 3 times the basic value. In patients with prolactinoma, the increase is not obvious, and the PRL peak value must at least exceed the basic value. If the value is 3 times higher than the above standard, it is considered normal. If the value is lower than the above standard, it indicates the possibility of prolactinoma.
(4) Verapamil (Verapamil) stimulation test: Verapamil is a calcium channel blocker. After intravenous injection of verapamil (Verapamil), although it cannot stimulate secretion in normal people Serum PRL in patients with PRL but idiopathic hyperPRLemia was significantly elevated, while patients with pituitary PRL tumors had no response. Barbaro et al. believe that there is no overlap between the two groups of patients, so it is a good test to identify idiopathic hyperPRLemia and PRL tumors. However, the basic PRL is already high, and the net added value of PRL may not be obvious, and verapamil (differentiation) The paclitaxel test cannot distinguish pseudo-PRL tumors (i.e., weakened dopaminergic nerve impulses).
(5) Prolactin inhibition test: Levodopa is a precursor of dopamine, which generates DA through the action of decarboxylase to inhibit PRL secretion. Normal people take 500mg orally and their PRL decreases significantly 2 to 3 hours later. Those with pituitary tumors will not be reduced. Bromocriptine is a dopamine receptor agonist that can strongly inhibit the synthesis and release of PRL. Normal women take 2.5 to 5.0 mg orally and their PRL decreases by ≥50% in 2 to 4 hours and lasts for 20 to 30 hours. The decrease was obvious in functional hyperprolactinemia and PRL adenoma, while the decrease of GH and ACTH was lower than that of the former. 15 Auxiliary examination 15.1 Sella X-ray section
It is of great value in the diagnosis of pituitary tumors, but it cannot detect microadenomas. In normal women, the anteroposterior diameter of the sella turcica is <17mm, the deep diameter is <13mm, the area is <130mm2, and the volume is <1100mm3. CT examination should be performed if the following images appear: ① ballooning; ② double sella floor or double floor; ③ high/low density areas or heterogeneous density in the sella; ④ plate-like deformation; ⑤ Suprasellar ossification (hyperostosis); ⑥ anterior and posterior clinoid process osteoporosis or intrasellar vacuolation; ⑦ bone destruction (erosion). 15.2 CT and MRI
Precise localization and radiological determination of intracranial lesions are possible. 15.3 Angiographic examinations
Including cavernous sinus angiography, pneumoencephalography, cerebral angiography and inferior petrosal sinus sampling angiography. 16 Diagnosis 16.1 Medical history
Focus on understanding the causes of amenorrhea, galactorrhea, systemic diseases and the history of drugs causing hypercretinemia. For example, whether the patient's bra fits well, whether there is nipple itching, frequent friction and other irritations, whether there is a history of hypothyroidism such as cold intolerance, lethargy, and edema, as well as symptoms related to hypothalamic pituitary lesions such as headaches and changes in vision, which may cause hyperprolactinemia. Drugs used to treat symptoms such as contraceptives, antihistamines, and dopamine antagonists should be understood in detail about their usage, dosage, and relationship with the underlying symptoms. 16.2 Physical examination
All amenorrhea patients, regardless of whether they have symptoms of galactorrhea or not, need to check whether there is galactorrhea in both breasts (gently squeeze the breasts with both hands). Those with lactation can be diagnosed as amenorrhea galactorrhea syndrome. , pay attention to the size and shape of the breast, whether there are lumps, whether there are wrinkles and cracks in the nipple, the nature and amount of the overflow, etc. At the same time, pay attention to the systemic examination to see if there are any signs related to the thyroid, hypothalamus, and pituitary gland, such as acromegaly and myxedema. Pay attention to checking the vision and visual field. Gynecological examination requires understanding of physical signs related to sexual organs and secondary sexual characteristics. 16.3 Eye examination
Including visual acuity, visual field, intraocular pressure, and fundus examination to determine whether there are signs of intracranial tumor compression.
Based on the medical history, physical examination and laboratory examination findings, amenorrhea and galactorrhea syndrome can generally be diagnosed, and the various causes of amenorrhea and galactorrhea syndrome can be identified and distinguished to guide treatment (Figure 1 ). 17 Differential diagnosis
1. First ask about the medication history, because chlorpromazine, methyldopa, piperazines, perphenazine, haloperidol (haloperidol), and reserpine are equally common Can cause an increase in prolactin. Most symptoms gradually disappear after stopping the medication. Excludes breast and chest wall diseases (such as surgery, trauma, herpes zoster, etc.), as well as nipple stimulation, long-term sucking, etc.
2. If the disease occurs after delivery, it may be "chiariFrommel syndrome".
3. X-ray examination of the sella turcica indicates that there is a pituitary tumor, which belongs to ForbesAlbright syndrome.
4. Primary hypothyroidism, accompanied by systemic symptoms, hypothyroidism is determined, and treatment with thyroid hormone is effective.
5. Empty Sella Syndrome. Through pneumoencephalography, it can be found that gas freely enters and exits the sella, and sometimes the fluid level is visible.
Patients with primary hypothyroidism may only suffer from galactorrhea amenorrhea syndrome, but the concentration of PRL in the blood does not increase. 18 Treatment of amenorrhea galactorrhea syndrome
Treatment based on the cause. At the same time, drugs are used to inhibit the secretion of PRL, increase the activity of PRL inhibitory factors, and reduce blood PRL levels to prevent galactorrhea, induce ovulation, resume menstruation, and prevent sexual organ atrophy. 18.1 Treatment of the cause
Mainly includes the following aspects of treatment: ① Those caused by drugs (including oral contraceptives) can generally recover naturally after stopping the drug. If menstruation does not return after half a year of drug withdrawal, drug treatment can be used .
② Patients with primary hypothyroidism should use thyroxine preparations for replacement treatment. It is not advisable to blindly use bromocriptine for galactorrhea or amenorrhea. For example, bromocriptine alone can inhibit TSH secretion through the hypothalamus, aggravating the condition. ③ Patients with intracranial tumors are treated with surgical resection or radiotherapy according to their condition. Recent clinical observations show that for patients with pituitary prolactinoma combined with infertility, drug treatment alone is better than surgery and radiotherapy. Since there is no damage, it is conducive to the recovery of gonadal axis function. However, when macroadenoma has symptoms of compression, as well as when bromocriptine treatment is ineffective or when there is no hormone-secreting pituitary tumor with reduced D2 receptors, surgical treatment is recommended, and bromocriptine should be used before and after surgery. Pavilion treatment may improve efficacy. 18.2 Drug treatment
(1) Bromocriptine: It is a semi-synthetic ergot derivative and a dopamine receptor agonist. It promotes the synthesis and secretion of PIF, inhibits the synthesis and release of PRL, and directly acts on pituitary tumors. and PRL cells, suppressing tumor growth and inhibiting the secretion of PRL, GH, TSH and ACTH. It is suitable for various types of hyperprolactinemia. It is also the first choice therapy for pituitary adenomas (microadenomas or macroadenomas), especially for young people. Treatment for infertile patients who wish to have children. Generally, start with a small dose, 1.25 to 2.5 mg per day. The efficacy is judged and the dosage is adjusted based on changes in blood PRL, symptoms and basal body temperature. When it is increased to more than 5 mg, it needs to be taken in divided doses. 70% to 90% of patients are treated for about 8 weeks. Ovulation can be restored and galactorrhea stopped. Side effects include nausea, dizziness, orthostatic hypotension, etc., which are related to the dosage and disappear after stopping the drug. Pregnant women who are pregnant during the medication will not increase the miscarriage rate or teratogenesis rate. However, because the drug can pass through the placenta and inhibit fetal PRL synthesis, bromocriptine should be stopped as much as possible in early pregnancy; because the natural history of prolactin microadenomas is benign. , after several years of treatment, some patients can resume ovulatory menstruation.
(2) Levodopa: Metabolized into dopamine in the body, it acts on the hypothalamus to release PIF, 0.2 to 0.5g each time, 3 times/d, which can decrease PRL and increase gonadotropin. Most menstruation resumes after 1 month of medication, and galactorrhea stops after 2 months, but nausea and vomiting reactions are severe.
(3) Octahydrobenzoline (CV205502): It is a non-ergot dopaminergic agonist. It is a new generation of specific, efficient and long-acting anti-PRL drug. The indications are the same as bromocriptine. Ting is especially suitable for those who cannot tolerate bromocriptine, have failed treatment and have relapsed. The starting dose is 0.025mg/d, taken before going to bed. The dose is adjusted according to the treatment response and PRL level, reaching 0.1mg/d within 3 months, and the dose range is 0.04~0.1mg/d.
(4) Vitamin B6: Increases the conversion rate of dopamine in the hypothalamus, thereby increasing the effect of PIF.
Dopaminergic agonists are the main effective therapeutic drugs for PRL tumors, but their efficacy depends on the dopamine D2 on the membrane of tumor cells (including proliferating PRL cells and other non-PRL-secreting pituitary tumor cells). The intensity of receptor expression. D2 receptor density can be estimated using 123I methoxybenzamide (123IIBZM) scintigraphy. If the tumor shows high uptake of 123IIBZM (high expression of D2 receptors), bromocriptine, Quinagolide and cabergoline are generally used. (Cabergoline) responds well to treatment. 123IIBZM scanning also has important diagnostic value in so-called "non-functioning" pituitary tumors, especially in screening patients suitable for treatment with dopamine agonists. Human body surface area calculator BMI index calculation and evaluation Female safe period calculator Pregnancy date calculator Normal weight gain during pregnancy Safety classification of medication during pregnancy (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes diet recommendations Common clinical biochemistry units Conversion to basal metabolic rate Calculate sodium supplementation calculator Iron supplementation calculator Commonly used Latin abbreviations for prescription Quick check Common symbols for pharmacokinetics Quick check Effective plasma osmolarity calculator Ethanol intake calculator
Medical encyclopedia, calculate now! 18.3 Ovulation induction treatment
For those who cannot successfully ovulate and become pregnant after treatment with bromocriptine alone, a comprehensive therapy based on bromocriptine and combined with other ovulation induction drugs will be used to shorten the treatment cycle and increase the ovulation rate and pregnancy. Rate. Although high PRLemia has adverse effects on the ovulation process, it is not a reliable contraceptive method. In fact, patients with mild to moderate (70-100ng/ml) PRLemia can still get pregnant naturally. In addition, for patients who require contraception, contraceptive pills can treat the symptoms of hypoestrogenism in women with hyperprolactinemia. Studies have shown that hormone replacement therapy has no adverse effects on hyperprolactinemia caused by pituitary adenomas. Zennaro et al. reported that a 45-year-old woman suffered from amenorrhea galactorrhea syndrome and hepatitis C. After receiving interferon α treatment, the amenorrhea galactorrhea syndrome resolved spontaneously and her blood PRL dropped to normal. Does interferon α have any effect on PRL? There is a therapeutic effect on tumors, which remains to be further observed.
Patients with amenorrhea and galactorrhea syndrome can resume menstruation, ovulation and pregnancy after drug treatment.
For those who had microadenomas before pregnancy, the chance of becoming larger adenomas after pregnancy is 1%, and the chance of macroadenomas further increasing during pregnancy is 23%. Therefore, pregnant women with PRL tumors can stop drug treatment (at least during pregnancy). Drug treatment should be stopped within 4 to 6 weeks after pregnancy), and changes in the condition should be closely observed. If the increase in blood PRL is found to be out of proportion to the pregnancy, or the tumor is enlarged, dopamine agonists should be taken. Bromocriptine has no significant effect on fetal development. , but it is best to use the new generation of Cabergoline. 18.4 Surgery and radiotherapy
When drug treatment is ineffective, or when the tumor causes obvious compression symptoms, or is combined with other hormone-secreting tumors, surgery or radiotherapy (γ knife treatment) should be considered. 19 Prognosis
Patients with amenorrhea and galactorrhea syndrome can resume menstruation, ovulation and pregnancy after drug treatment. 20 Prevention of amenorrhea galactorrhea syndrome
For pituitary PRL tumors, surgery or radiotherapy should not be the first choice. Because these two treatments have great interference with the normal function of the hypothalamus and pituitary gland, the recovery rate of gonadal function after surgery is low, and they may promote the transformation of benign tumors into malignant tumors. 21 Related drugs
Dopamine, bromocriptine, clozapine, secobarbital, barbiturate, plasmin, testosterone, chlorpromazine, norepinephrine, epinephrine, oxygen, Metoclopramide, verapamil, levodopa, histamine, quinagolide, cabergoline, interferon 22 related tests
Estrogen, growth hormone, gastrin, plasma cells , progesterone, plasmin, plasminogen, insulin, testosterone, vitamin B6, interferon, amenorrhea galactorrhea syndrome related drugs fluphenazine hydrochloride tablets
Difficulty urinating, constipation, galactorrhea, men and women Treat breasts, menstrual disorders, amenorrhea, etc. Drowsiness, restlessness, dizziness, and urinary retention are rare. Occasionally allergic rash... Droperidol Injection
Symptoms that may be related are: galactorrhea, gynecomastia, menstrual disorders, and amenorrhea. (4) A small number of patients may suffer from depressive reactions. (5) Symptoms that can cause attention... Fluphenazine Injection
The symptoms that may be related to it are: galactorrhea, male feminized breasts, menstrual disorders, and amenorrhea. Dry mouth, blurred vision, fatigue, dizziness, tachycardia, constipation may occur... Fluphenazine Hydrochloride Injection
Difficulty urinating, constipation, galactorrhea, gynecomastia, menstrual disorders, Amenorrhea etc. Drowsiness, restlessness, dizziness, and urinary retention are rare.
Occasionally allergic rash... Chlorprothixene Hydrochloride Injection