泌乳素瘤
概述
泌乳素瘤是垂体的一种非癌性肿瘤。这种肿瘤会导致垂体产生过多的催乳素这种激素。泌乳素瘤的主要影响是某些性激素（即雌激素和睾酮）水平降低。
症状
泌乳素瘤可能不会引起任何体征或症状。然而，血液中泌乳素过多（高泌乳素血症）会导致症状。大型肿瘤对周围组织的压迫也会导致症状。
由于过多的泌乳素会扰乱生殖系统（性腺功能减退），因此泌乳素瘤的一些体征和症状是女性或男性特有的。
在女性中，泌乳素瘤可引起：
- 月经不调或闭经
- 非妊娠期或非哺乳期乳房溢乳
- 阴道干燥导致性交疼痛
- 痤疮和过度体毛和面部毛发生长
在男性中，泌乳素瘤可引起：
- 勃起功能障碍
- 体毛和面部毛发减少
- 肌肉萎缩
- 乳房增大
在女性和男性中，泌乳素瘤可引起：
- 不孕不育
- 骨质疏松（骨骼脆弱易断）
- 性欲减退
肿瘤生长引起的压迫可引起：
- 视力问题
- 头痛
- 垂体产生的其他激素减少
绝经前的女性往往会在肿瘤较小时早期注意到体征和症状。这可能是因为月经周期错过了或不规律。绝经后的女性更有可能在肿瘤较大且更可能引起头痛或视力问题时才注意到体征和症状。男性也更有可能在后期才注意到体征和症状。
何时去看医生
如果您出现可能由泌乳素瘤引起的体征和症状，请咨询您的医疗保健提供者以确定病因。
如果您患有泌乳素瘤，并且想要怀孕或已经怀孕，请咨询您的医疗保健提供者。您可能需要调整治疗方案和进行监测。
病因
泌乳素瘤是一种发生在垂体腺的肿瘤。泌乳素瘤的病因通常不明。
垂体腺是一个位于大脑底部的小豆状腺体。尽管它很小，但垂体腺几乎影响身体的每个部位。它的激素有助于控制重要的功能，例如生长、新陈代谢、血压和生殖。
风险因素
催乳素瘤在女性中的发病率高于男性。儿童中该疾病罕见。
罕见情况下，某些遗传性疾病，例如1型多内分泌腺瘤病（一种会导致激素产生腺体肿瘤的疾病），可能会增加患催乳素瘤的风险。
并发症
'泌乳素瘤的并发症可能包括：\n\n* **不孕症。*泌乳素瘤会干扰生育。过多的泌乳素会减少雌激素和睾酮的产生。在女性中，过多的泌乳素还会阻止月经周期中卵子的释放（无排卵）。在男性中，过多的泌乳素还会导致精子产量下降。\n **骨质流失（骨质疏松症）。*雌激素和睾酮减少也会导致骨骼强度下降。这会导致骨骼脆弱易断。\n **妊娠并发症。*在典型的妊娠期间，雌激素的产生会增加。这可能会导致肿瘤生长。这可能导致妊娠期女性出现头痛和视力变化等体征和症状，尤其是在患有大型泌乳素瘤的女性中。\n **视力丧失。*如果不治疗，泌乳素瘤可能会长大到足以压迫视神经。这条神经位于垂体附近。视神经将图像从眼睛发送到大脑，以便你能够看到。视神经受压的第一个迹象是侧方（周边）视力丧失。\n **其他垂体激素水平低。**较大的泌乳素瘤会对垂体的健康部分施加压力。这可能导致垂体控制的其他激素水平降低。这些包括甲状腺激素和皮质醇。皮质醇是一种应激反应激素。'
诊断
如果您出现提示您患有泌乳素瘤的体征和症状，您的医疗保健提供者可能会建议：
您的提供者也可能会将您转诊给治疗影响内分泌腺和激素疾病的专家（内分泌学家）进行进一步检查。
- 血液检查。 血液检查可以显示是否产生了过多的泌乳素。它们还可以显示垂体控制的其他激素水平是否在标准范围内。通常建议育龄女性进行妊娠试验。
- 脑成像。 您的提供者可以使用脑部磁共振成像 (MRI) 扫描来检测泌乳素瘤。
- 视力检查。 这些检查可以确定泌乳素瘤是否影响您的视力。
治疗
Understanding Prolactinoma Treatment Options
A prolactinoma is a type of tumor that forms in the pituitary gland, a small gland located at the base of the brain. This tumor can cause problems because it produces too much prolactin, a hormone that plays a role in milk production. The goal of treatment is to get prolactin levels back to normal and reduce the tumor's size. This helps to improve a person's overall health and address symptoms.
The main ways to treat a prolactinoma are medication and surgery.
Medication (Dopamine Agonists):
Many people with prolactinomas take medication, typically dopamine agonists. These medications mimic the effects of dopamine, a chemical messenger in the brain that helps regulate prolactin production. By doing so, the medication can reduce prolactin levels and shrink the tumor. This often helps to eliminate symptoms.
Common dopamine agonists include cabergoline and bromocriptine. These medications usually need to be taken regularly for an extended period. If your prolactin levels are normal for two years, you might be able to slowly reduce the dose of the medication with your doctor's guidance. It's crucial to work with your doctor to manage this process. Stopping the medication suddenly can sometimes raise prolactin levels again, so you should never stop it without first talking to your doctor.
Possible Side Effects: Some people experience side effects like nausea, vomiting, dizziness, a stuffy nose, and headaches. Your doctor might start you on a low dose and gradually increase it to help manage these side effects. Taking the medication with food or at bedtime could also help.
Although rare, some people taking cabergoline, especially at high doses for conditions like Parkinson's disease, have experienced heart valve damage. Some individuals also report impulse control disorders, such as compulsive gambling, while taking these medications. Your doctor can discuss these potential side effects further.
Medication and Pregnancy: Both cabergoline and bromocriptine can be used to treat prolactinomas in women who want to become pregnant. However, the medications have different advantages and disadvantages, so it's important to discuss these with your doctor. Together, you can determine the best course of action. Generally, the medication is stopped once a pregnancy is confirmed, though your doctor may advise restarting it in cases where the tumor is large or you experience symptoms like headaches or vision changes. Discussing these options with your doctor before trying to conceive is crucial.
Surgery:
If medication doesn't work or is not tolerated, surgery to remove the prolactinoma may be an option. Surgery is sometimes needed to relieve pressure on nerves that affect vision.
The type of surgery depends on the tumor's size and location.
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Transsphenoidal surgery: This is the most common type of surgery for prolactinomas. The surgeon removes the tumor through the nose and nasal passages, avoiding the need for larger incisions and minimizing any visible scarring.
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Transcranial surgery (craniotomy): This is used for larger tumors that have spread to nearby brain tissue. The surgeon removes the tumor through an incision in the skull.
Success of Surgery: The outcome of surgery depends on various factors, including the tumor's size, location, pre-surgery prolactin levels, and the surgeon's expertise. Sometimes, the entire tumor cannot be removed safely. If the tumor is extensive, partial removal may be necessary. Even if the entire tumor is removed, it's possible for the tumor to return in some cases. If the prolactinoma is large, medication may be used after surgery to bring prolactin levels back to normal.
Other Options: In rare cases, radiation therapy might be an option if medication and surgery are not effective. Radiation therapy aims to kill the tumor cells.
Important Considerations: Regular check-ups with your doctor are essential to monitor your prolactin levels and the size of the tumor. Your doctor will work with you to develop a treatment plan that best meets your individual needs. If you have a prolactinoma and are considering starting a family, discuss this with your doctor before pregnancy.