高泌乳激素血症（hyperprolactinemia）课件

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1、高泌乳激素血症(Hyperprolactinemia)白永河內分泌暨新陳代謝科彰化基督教醫院PRLRegulatedbythehypothalamus主要是tonicinhibitionHypothalamus分泌2種hypothalamicfactorsPIF(PRL-inhibitingfactor)DopaminePRF(PRL-releasingfactor)TRH,VIPPRLStimulatebreastdevelopmentInitiateandmaintainlactationPRLrecep

2、toralveolarsurfaceofmammarycellliver,kidneyovary,testes,prostateEstrogensynergisticinpromotingbreastdevelopmentantagonizeineffectoflactationBreastdevelopment須要多種hormone的coordinatedaction包括majorstimuli:estrogenprogesteroneprolactinGHplacentalmammotropicHmino

3、rstmuli:insulincortisolthyroidhormoneBreastdevelopmentDuctgrowth:estrogenLobuloalveolardevelopment:PRL+progesteroneLactation:PRL+oxytocinGalactorrhea需要PRL+Gonadalsteroid才會出現∴notnecessarilyseeninallprolactinomas和serumPRLlevel無關Galactorrhea的incidence差異很大女性30～

4、-80%男性常nogalactorrhea即使有galactorrhea,其中50%病人的PRL可能正常反之，即使PRL>100ng/ml,也可能nogalactorrhea∴Galactorrhea為poormarkerofhyperprolactinemiaPRL1928discoveredinextractofbovinepituitary1970sensitivebioassay1971RIA(Friesen,Fournier,Desjardians)secretedbytheerythrosinop

5、hilicsubtypeofchromophobiccellsintheadenohypophysisPRLAstresshormoneSecretedinapulsatilefashionhighestintheearlymorning(睡醒之前)lowerintheafternoonphysiologicPRL↑painnipplestimulationfondling(womenonly)pregnancy(可達200-500ng/ml)pelvicexaminationexercisesleepPRL

6、Dailysecretionrate:400μg/天Metabolicclearance:40ml/m2/minClearancepathway:25%kidney75%liverPlasmaT1/2:50minPlasmalevel:<15ng/ml♂:5ng/ml(3-10)♀:8ng/ml(5-15)fetalPRL>300ng/mlumbilicalPRL>maternalPRLPituitaryPRL:100μgperpituitaryPRLPRLvalue和prolactinomatumorsiz

7、e成正比PRL>1000ng/ml→tumorextensionintocavernoussinus>150ng/ml→幾乎一定就是prolactinoma100-150ng/ml:(1)prolactinoma(2)pseudoprolactinoma(3)drug-induced20-100ng/ml:須repeat檢查(∵pulsatilesecretion)(1)stressofveinpuncture(pain)(2)stressorphysicalexamination(3)breastexami

8、nation(4)pelvicexaminationPRLBloodsampling須注意事項indwellingvenouscannulaatleast2hrresting20minutesinterval×3-6次samplingtimeusuallynotcriticalHyperprolactinemiaBasicmechanisms(Ⅰ)Hypothalamicdopaminedefici