Hyperprolactinemia

病因:
 
   -prolactinoma (50% of pituitary adenoma)
   -stalk compression due to non-prolactinoma, ( ->↓inhibitory dopamine -> ↑PRL (mild)->  泌乳, 抑制GnRH -> ↓FSH, LH)

PRL > 100 ng/L: prolactinoma (mc)
       30-100:
            -microprolactinoma
            -pituitary stalk interruption
            -drugs (抑制dopamine)
            -甲狀腺低下

臨床表現:  
  galactorrhea,
  hypogonadal Sx: amenorrhea, infertility, 陽痿, ↓性慾,
  頭痛, 視野缺損

診斷studies:

   -PRL ↑(fasting level), 
      also elevated in ffg: (需先排除)
           懷孕/使用estrogen, 
           甲狀腺低下, 
           腎衰竭 (排出↓), 肝硬化
           藥物 (dopamine agonist (psy med, 止吐劑)
           stress
           高碳水化合物飲食
   MRI, (if compression of optic chiasm -> visual field test)


治療: (JCEM 2010;95:1025)

 無症狀 & microadenoma (<1cm): 追蹤 (by MRI)

 有症狀 or macroadenoma (1cm或以上):
     內科:
         dopamine agonist: 
              cabergoline (70-100%成功率) 
              bromocriptine (耐受度差於上者)
          [副]: N/V, orthostasis, 鼻塞, 
                  TR (tricuspid regurgitation) (心超: before & q1-2y)
     外科:
         穿蝶鞍手術 (transsphenoidal surgery), (復發: 10-20%)
             適應症:
                 -內科失敗或無法耐受藥物
                 -合併 GH 分泌
                 -神經症狀沒改善
     Radiation: 內/外科失敗or intolerance