《高泌乳激素血症》PPT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,VIPPRLStimulatebreastdevelopmentInitiateandmaintainlactationPRLreceptoralveolarsurfaceofmammarycellliver,kid

2、neyovary,testes,prostateEstrogensynergisticinpromotingbreastdevelopmentantagonizeineffectoflactationBreastdevelopment須要多種hormone的coordinatedaction包括majorstimuli:estrogenprogesteroneprolactinGHplacentalmammotropicHminorstmuli:insulincortisolthyroidhormoneBreastdevelopmentDuctgrowth:estrogenLobuloa

3、lveolardevelopment: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～-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poormarkerofhyperpr

4、olactinemiaPRL1928discoveredinextractofbovinepituitary1970sensitivebioassay1971RIA(Friesen,Fournier,Desjardians)secretedbytheerythrosinophilicsubtypeofchromophobiccellsintheadenohypophysisPRLAstresshormoneSecretedinapulsatilefashionhighestintheearlymorning(睡醒之前)lowerintheafternoonphysiologicPRL↑p

5、ainnipplestimulationfondling(womenonly)pregnancy(可達200-500ng/ml)pelvicexaminationexercisesleepPRLDailysecretionrate:400μg/天Metabolicclearance:40ml/m2/minClearancepathway:25%kidney75%liverPlasmaT1/2:50minPlasmalevel:<15ng/ml♂:5ng/ml(3-10)♀:8ng/ml(5-15)fetalPRL>300ng/mlumbilicalPRL>maternalPRLPitui

6、taryPRL:100μgperpituitaryPRLPRLvalue和prolactinomatumorsize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)stressorphysicalexaminat

7、ion(3)breastexamination(4)pelvicexaminationPRLBloodsampling須注意事項indwellingvenouscannulaatleast2hrresting20minutesinterval×3-6次samplingtimeusuallynotcriticalHyperprolactinemiaBasicmechanisms(Ⅰ)Hypothalamicdopaminedefici