Okuqukethwe
I-Hyperprolactinemia ubukhona bezinga eliphakeme ngokungavamile le-prolactin egazini. I-Prolactin iyi-hormone ekhiqizwa yi-pituitary gland. Imisebenzi eminingi ye-prolactin emzimbeni ihlotshaniswa kakhulu nokukhulelwa kanye nokukhiqizwa kobisi lwebele lwengane esanda kuzalwa. Kodwa-ke, amazinga e-prolactin angakhuphuka lapho owesifazane engakhulelwe noma engancelisi, okubangela izimo eziningana ezingase zithinte umsebenzi ovamile wokuya esikhathini nokuzala. I-Serum prolactin kufanele ilinganiswe kuphela ezigulini ezine-pituitary tumor noma izimpawu zomtholampilo kanye nezimpawu ze-hyperprolactinemia.
Yini i-hyperprolactinemia
Kunezimbangela eziningi ze-hyperprolactinemia, kuhlanganise nemithi ethile kanye nesimila se-pituitary (prolactinoma). Ukuze unqume ukwelashwa okufanele, kubalulekile ukunquma imbangela eyinhloko. I-hyperprolactinemia ingabangela i-galactorrhea (ukuphuma kobisi lwebele ngaphandle kokuncelisa) futhi iphazamise umsebenzi wokuzala. Lokhu kungasheshisa ukulahleka kwamathambo uma kungenxa yokuntuleka kwehomoni yocansi.
Iningi lama-prolactinomas yi-micro-prolactinomas. Ngokuvamile azikhuli ngokushesha ngokwanele ukuthi zibangele izinkinga ezinzima. Iziguli ezine-prolactinoma ngokuvamile ziphathwa ngempumelelo ngama-dopamine agonists afana ne-cabergoline.
Izimbangela ze-hyperprolactinemia kubantu abadala
Ukugcwala okuphezulu kwe-prolactin egazini (hyperprolactinemia) kuyisifo esivamile se-endocrine. Izimbangela zisukela ezimeni ezimbi ezingadingi ukwelashwa kuye ezinkingeni zezempilo ezibucayi ezidinga ukwelashwa ngokushesha. I-Hyperprolactinemia nayo ingaba umphumela wemithi ethile. Ukuze uqonde ingqikithi yezinqubo eziqhubekayo, kufanelekile ukuchaza kancane indima yale hormone.
I-Prolactin iyi-hormone ye-polypeptide ehlanganiswe futhi ifihliwe ngamaseli e-lactotrophic we-anterior pituitary gland. Imfihlo ye-prolactin ilawulwa ngokuyinhloko yi-dopamine, ekhiqizwa ku-hypothalamus futhi ivimbela ukukhishwa kwe-prolactin. I-hormone ye-hypothalamic thyrotropin-releasing hormone ivuselela ukukhiqizwa kwe-prolactin.
I-Prolactin yenza imiphumela yayo ngokubopha kuma-prolactin receptors. Zitholakala kulwelwesi lwamangqamuzana amaningi, ikakhulukazi esifubeni kanye nendlala yepituitary. Esifubeni, i-prolactin ikhuthaza ukukhula kwezindlala ngesikhathi sokukhulelwa kanye nokukhiqizwa kobisi lwebele ngesikhathi sokubeletha. Ku-pituitary gland, i-prolactin icindezela ukukhiqizwa kwe-gonadotropin.
Kunezimbangela zomzimba, ze-pathological kanye nezidakamizwa ezihlobene ne-hyperprolactinemia (amazinga aphezulu e-prolactin).
Izizathu ze-Physiological. Ukukhulelwa, ukuncelisa kanye nokuncelisa, ukuvivinya umzimba, ukuya ocansini nokucindezeleka kungandisa amazinga e-prolactin. Lokhu kunyuka kungokwesikhashana futhi ngokuvamile akudluli kabili umkhawulo ongaphezulu wobubanzi obuvamile.
izinkinga ze-pathological. I-Prolactinomas yizimila ezivela kumaseli e-pituitary akhiqiza i-prolactin. Iningi lama-prolactinomas (90%) ama-microadenomas (<1 cm ububanzi) avamile ngokuphindwe ka-10 kwabesifazane kunabesilisa. I-Microadenomas ibangela ukwanda okuncane kwamazinga e-prolactin, okungase kuhlotshaniswe nezimpawu ze-hyperprolactinemia, kodwa ngokuvamile azikhuli.
Ama-Macroadenoma (> 1 cm ububanzi) awavamile, futhi ama-prolactinomas amakhulu (> 4 cm ububanzi) awavamile. Uma kuqhathaniswa nabesifazane, amadoda anethuba eliphindwe kasishiyagalolunye lokuthuthukisa i-macroadenoma. Lezi zimila zibangela i-hyperprolactinemia enzima - ukuhlushwa kweprolactin okungaphezu kuka-10 mIU/L cishe njalo kubonisa i-macroprolactinoma. Zingabangela i-hypopituitarism, ukulahleka kwenkundla yokubuka, noma ukukhubazeka kwe-ocular ngokucindezela i-optic chiasm noma i-cranial nerve nuclei.
Okunye ukwakheka kwe-hypothalamus kanye ne-pituitary gland nakho kungabangela i-hyperprolactinemia. Njengoba i-dopamine icindezela ukukhishwa kwe-prolactin, noma iyiphi i-neoplasm noma isilonda esingena ngaphakathi esicindezela isiqu se-pituitary singenza buthaka ukusebenza kwe-dopamine futhi kubangele i-hyperprolactinemia. Kodwa-ke, i-stalk crush hyperprolactinemia ivamise ukuba ngaphansi kuka-2000 mIU/L, okuyihlukanisa ne-macroprolactinoma.
Ezinye izifo zingabangela i-hyperprolactinemia. I-prolactin ikhishwa ngokuyinhloko yizinso, ngakho-ke ukwehluleka kwezinso kungandisa amazinga e-prolactin. Ngenxa yokuthi i-hormone ekhipha i-thyrotropin ivuselela ukukhiqizwa kwe-prolactin, i-hypothyroidism nayo ingabangela i-hyperprolactinemia. Ukuthunjwa kungabangela ukwanda kwesikhathi esifushane kumazinga eprolactin.
Izizathu ezihlobene nezidakamizwa. Izidakamizwa eziningi ziphazamisa ukukhululwa kwe-dopamine ku-hypothalamus, okuholela ekwandeni kokuphuma kwe-prolactin (i-prolactin 500-4000 mIU / l). I-Hyperprolactinemia iqala ezigulini ezithatha izidakamizwa ze-antipsychotic. Ingase futhi ithuthuke, ngokwezinga elincane, ngenxa ye-serotonin reuptake inhibitors ethile ekhethiwe (izidakamizwa zokucindezeleka). Ezinye izidakamizwa zingadala i-hyperprolactinemia kancane. Uma i-hyperprolactinemia ibangelwa izidakamizwa, ukugxila kuvame ukujwayela uma umuthi uyekwa kungakapheli amahora angama-72.
Izimpawu ze-hyperprolactinemia kubantu abadala
Kwezinye iziguli, i-hyperprolactinemia i-asymptomatic, kodwa ukweqisa kwe-hormone kungathinta indlala ye-mammary kanye nomsebenzi wokuzala. Kwabesifazane, kungabangela i-oligoamenorrhea (izikhathi ezifushane nezincane), ukungazali, kanye ne-galactorrhea. Kwabesilisa, i-hyperprolactinemia ingabangela ukungasebenzi kahle kwe-erectile, ukungazali, kanye ne-gynecomastia. I-Galactorrhea (ukukhishwa kobisi noma i-colostrum ebeleni) ivame kakhulu emadodeni kunakwabesifazane.
Ukuntuleka kwe-hormone ye-gonadal kungasheshisa ukulahleka kwamathambo. Iziguli zingase zibe nezimpawu noma izimpawu ezihlobene nembangela eyinhloko ye-hyperprolactinemia. Isibonelo, ikhanda nokulahlekelwa umbono esigulini esinesimila se-pituitary, nokukhathala nokungabekezelelani okubandayo esigulini esine-hypothyroidism.
Ukwelashwa kwe-hyperprolactinemia kubantu abadala
Kufanele kugcizelelwe ukuthi amazinga e-prolactin kufanele akalwe kuphela ezigulini ezinezimpawu zomtholampilo noma izimpawu ze-hyperprolactinemia noma ezigulini ezinethumba elaziwayo le-pituitary. Ukuxilongwa kwe-hyperprolactinemia kungase kusekelwe esilinganisweni esisodwa se-serum prolactin ngaphezu komkhawulo ophezulu wokujwayelekile. Ukuhlolwa kwegazi kufanele kwenziwe ngaphandle kokucindezeleka okungadingekile.
Diagnostics
Ukuhlolwa kwegazi okulula ukukala inani le-prolactin egazini kungaqinisekisa ukuxilongwa kwamazinga aphezulu e-prolactin. Amazinga e-prolactin angaphezu kuka-25 ng/mL abhekwa njengephakeme kwabesifazane abangakhulelwe. Njengoba wonke umuntu ehlangabezana nokushintshashintsha kwansuku zonke emazingeni e-prolactin, kungase kudingeke ukuba kuphindwe ukuhlolwa kwegazi uma izinga le-hormone liphakeme kancane. Abesifazane abaningi bathola lokhu kuxilongwa ngemva kokuhlolwa ukuthi abatholi abantwana noma bekhononda ngokungayi esikhathini, kodwa abanye abanazo izimpawu. Kwesinye isikhathi iziguli ziphuma ubisi ngokuzenzekelayo ezingonweni, kodwa iningi alinalo lolu phawu.
Ukwanda okuncane kwe-prolactin, ebangeni le-25-50 ng / ml, ngokuvamile akubangeli izinguquko eziphawulekayo emjikelezweni wokuya esikhathini, nakuba kunganciphisa ukuzala okuphelele. Amazinga aphezulu e-prolactin angu-50 kuya ku-100 ng/mL angabangela ukuya esikhathini okungajwayelekile futhi anciphise kakhulu inzalo yowesifazane. Amazinga e-prolactin angaphezu kuka-100 ng/mL angashintsha ukusebenza okuvamile kwesistimu yokuzala yowesifazane, okubangela izimpawu zokunqamuka kokuya esikhathini (ukungabikho kokuya esikhathini, ukushisa okushisayo, ukomisa kwesitho sangasese sowesifazane) kanye nokungazali.
Uma ukuxilongwa kwe-hyperprolactinemia sekwenziwe, ukuhlolwa kufanele kwenziwe ukuze kutholakale imbangela eyinhloko kanye nezinkinga ezihambisanayo. Abesifazane namadoda kufanele balinganise i-estrogen ne-testosterone yasekuseni, ngokulandelana, kanye nama-gonadotropins. Kwabesifazane abaneminyaka yobudala yokuzala, umsebenzi wegilo nezinso kufanele uhlolwe futhi ukukhulelwa kungabandakanywa.
Uma kungekho esinye isizathu esicacile esisungulwe, i-MRI ye-pituitary gland iboniswa. Iziguli ezine-pituitary tumor enkulu kuno-1 cm ububanzi kufanele zihlolwe ukuze kuhlolwe amanye amahomoni e-pituitary futhi kuhlolwe indawo yokubuka. Kubalulekile ukunquma ukuminyana kwamaminerali amathambo ezigulini ezine-hypogonadism.
Ukwelashwa kwesimanje
Ezinye iziguli azikudingi ukwelashwa. Iziguli ezine-physiological hyperprolactinemia, macroprolactinemia, i-asymptomatic microprolactinoma, noma i-hyperprolactinemia ebangelwa izidakamizwa ngokuvamile ayidingi ukwelashwa. Uma i-hyperprolactinemia ingeyesibili ku-hypothyroidism, ukwelashwa kwesiguli nge-thyroxine kufanele kwehlise amazinga e-prolactin.
Iziqondiso zomtholampilo
Ngokweziqondiso zomtholampilo, amazinga e-prolactin aphakeme aphathwa ngenhlanganisela yezindlela eziningana.
Izidakamizwa ezilingisa amakhemikhali obuchopho i-dopamine zingasetshenziswa ngempumelelo ukwelapha iziguli eziningi ezinamazinga e-prolactin aphakeme. Le mithi inciphisa ukukhiqizwa kwe-prolactin yi-pituitary gland futhi ibangele ukucindezelwa kwamaseli akhiqiza i-prolactin. Imithi emibili evame ukunikezwa yi-cabergoline ne-bromocriptine. Ukuqala ngomthamo omncane, okhuphuka kancane kancane, imiphumela emibi, kuhlanganise nezinguquko zomfutho wegazi kanye nenkungu yengqondo, ingancishiswa. Iziguli zivame ukuphendula kahle kule mithi futhi amazinga eprolactin ayancipha ngemva kwamaviki amabili kuya kwangu-2.
Uma amazinga e-prolactin ehla, ukwelashwa kungashintshwa ukuze kugcinwe amazinga ajwayelekile e-prolactin, futhi ngezinye izikhathi kungamiswa ngokuphelele. Ukuhlehla kwesimila okuzenzakalelayo ngokuvamile kwenzeka phakathi neminyaka embalwa ngaphandle kwemiphumela yomtholampilo.
Ngenani elincane leziguli, izidakamizwa aziwehlisi amazinga eprolactin, futhi izimila ezinkulu (macroadenomas) ziyaqhubeka. Lezi ziguli zidinga ukwelashwa ngokuhlinzwa (transsphenoidal adenoma resection) noma ukwelashwa ngemisebe.
Ukuvimbela i-hyperprolactinemia kubantu abadala ekhaya
Ngeshwa, kuze kube manje, azikho izindlela ezisebenzayo ezenzelwe ukuvimbela lesi sifo. Kunconywa izinyathelo ezijwayelekile zokuvimbela, okuhlanganisa nokugcina indlela yokuphila enempilo, ukuyeka imikhuba emibi, ukwelapha noma yiziphi izifo zendawo yokuzala kanye ne-hormonal metabolism.
Imibuzo nezimpendulo ezidumile
Mayelana nokuxilongwa nokwelashwa kwenkinga ye-pituitary gland kanye ne-prolactin ephezulu, izici zokuvimbela, sixoxe nazo. Urologist, uchwepheshe we-ultrasound diagnostics, udokotela wesigaba esiphezulu u-Yuri Bakharev.