Contents
Hyperprolactinemia shine kasancewar babban matakin prolactin a cikin jini. Prolactin shine hormone wanda glandan pituitary ke samarwa. Yawancin ayyuka na prolactin a cikin jiki suna da alaƙa da juna biyu da samar da madarar nono ga jarirai. Duk da haka, matakan prolactin na iya tashi lokacin da mace ba ta da ciki ko kuma tana shayarwa, yana haifar da yanayi da dama da za su iya shafar aikin al'ada da haihuwa. Maganin prolactin ya kamata a auna shi kawai a cikin marasa lafiya da ciwon ƙwayar cuta na pituitary ko alamun asibiti da alamun hyperprolactinemia.
Menene hyperprolactinemia
Akwai dalilai da yawa na hyperprolactinemia, ciki har da wasu magunguna da kuma ƙwayar pituitary (prolactinoma). Domin rubuta maganin da ya dace, yana da mahimmanci don ƙayyade dalilin da ya sa. Hyperprolactinemia na iya haifar da galactorrhea (fitar da madarar nono a waje da shayarwa) kuma yana tsoma baki tare da aikin haihuwa. Wannan zai iya hanzarta asarar kashi idan ya kasance saboda rashi na hormone jima'i.
Yawancin prolactinomas sune micro-prolactinomas. Yawancin lokaci ba sa girma da sauri don haifar da rikitarwa mai tsanani. Marasa lafiya tare da prolactinoma yawanci ana bi da su cikin nasara tare da agonists na dopamine kamar cabergoline.
Abubuwan da ke haifar da hyperprolactinemia a cikin manya
Babban taro na prolactin a cikin jini (hyperprolactinemia) cuta ce ta endocrine ta gama gari. Dalilan sun bambanta daga yanayi mara kyau waɗanda basa buƙatar magani zuwa manyan matsalolin likita waɗanda ke buƙatar magani nan take. Hyperprolactinemia kuma na iya zama tasirin wasu magunguna. Don fahimtar ainihin abubuwan da ke gudana, yana da daraja bayyana kadan rawar wannan hormone.
Prolactin wani hormone ne na polypeptide wanda aka haɗa kuma ya ɓoye ta sel lactotrophic na glandan pituitary na gaba. Maganin prolactin da farko ana sarrafa shi ta hanyar dopamine, wanda aka samar a cikin hypothalamus kuma yana hana ƙwayar prolactin. Halin da ake kira hypothalamic hormone thyrotropin-sakin hormone yana motsa fitar da prolactin.
Prolactin yana aiwatar da tasirinsa ta hanyar ɗaure masu karɓar prolactin. Sun kasance a kan membrane na sel da yawa, musamman ma a cikin nono da glandan pituitary. A cikin nono, prolactin yana ƙarfafa haɓakar gland a lokacin daukar ciki da kuma samar da madarar nono a lokacin haihuwa. A cikin pituitary gland shine yake, prolactin yana hana fitowar gonadotropin.
Akwai abubuwan da ke haifar da hyperprolactinemia (high prolactin matakan).
Dalilan ilimin halitta. Ciki, shayarwa da nono, motsa jiki, jima'i da damuwa na iya kara yawan matakan prolactin. Waɗannan haɓakawa na wucin gadi ne kuma yawanci ba su wuce sau biyu na babba na jeri na al'ada ba.
pathological dalilai. Prolactinomas su ne ciwace-ciwacen da ke tasowa daga ƙwayoyin pituitary masu ɓoye na prolactin. Yawancin prolactinomas (90%) sune microadenomas (<1 cm a diamita) wanda sau 10 ya fi kowa a cikin mata fiye da maza. Microadenomas yana haifar da ƙananan haɓakar matakan prolactin, wanda zai iya haɗuwa da alamun hyperprolactinemia, amma yawanci ba sa girma.
Macroadenomas (> 1 cm a diamita) ba su da yawa, kuma manyan prolactinomas (> 4 cm a diamita) ba su da yawa. Idan aka kwatanta da mata, maza sun fi saurin kamuwa da macroadenoma sau tara. Wadannan ciwace-ciwacen suna haifar da hyperprolactinemia mai tsanani - ƙwayar prolactin fiye da 10 mIU/L kusan kullum yana nuna macroprolactinoma. Za su iya haifar da hypopituitarism, asarar filin gani, ko ciwon ido ta hanyar damfara chiasm na gani ko jijiyoyi na cranial.
Sauran samuwar hypothalamus da pituitary gland shine yake iya haifar da hyperprolactinemia. Tunda dopamine yana hana ɓoyewar prolactin, duk wani neoplasm ko rauni na infiltrative wanda ke damfara tururuwa na pituitary zai iya raunana aikin dopamine kuma ya haifar da hyperprolactinemia. Duk da haka, stalk crush hyperprolactinemia yawanci yana ƙasa da 2000 mIU / L, wanda ke bambanta shi da macroprolactinoma.
Wasu cututtuka na iya haifar da hyperprolactinemia. Prolactin yana fitar da kodan da farko, don haka gazawar koda na iya ƙara matakan prolactin. Saboda hormone mai sakin thyrotropin yana motsa siginar prolactin, hypothyroidism kuma na iya haifar da hyperprolactinemia. Seizures na iya haifar da karuwa na ɗan lokaci a cikin matakan prolactin.
Dalilan da suka shafi kwayoyi. Yawancin kwayoyi suna rushe sakin dopamine a cikin hypothalamus, wanda ke haifar da haɓakar haɓakar prolactin (prolactin 500-4000 mIU / l). Hyperprolactinemia yana tasowa a cikin marasa lafiya da ke shan magungunan antipsychotic. Hakanan zai iya haɓaka, zuwa ɗan ƙarami, saboda wasu zaɓaɓɓun masu hana sake dawo da serotonin (magungunan don baƙin ciki). Wasu magunguna na iya haifar da hyperprolactinemia ƙasa da yawa. Idan hyperprolactinemia yana haifar da kwayoyi, yawanci yawanci yana daidaita idan an dakatar da maganin a cikin sa'o'i 72.
Alamun hyperprolactinemia a cikin manya
A wasu marasa lafiya, hyperprolactinemia yana da asymptomatic, amma yawan adadin hormone zai iya rinjayar glandar mammary da aikin haihuwa. A cikin mata, yana iya haifar da oligoamenorrhea (gajeren lokaci da kankanin lokaci), rashin haihuwa, da galactorrhea. A cikin maza, hyperprolactinemia na iya haifar da rashin aiki na mazauni, rashin haihuwa, da gynecomastia. Galactorrhea (fitar da madara ko colostrum daga nono) ba shi da yawa a cikin maza fiye da mata.
Rashin ƙarancin hormone na Gonadal na iya hanzarta asarar kashi. Marasa lafiya na iya samun alamu ko alamun da ke da alaƙa da ainihin dalilin hyperprolactinemia. Misali, ciwon kai da hasarar gani a cikin majiyyaci da ciwon daji na pituitary, da gajiya da sanyin sanyi a cikin majiyyaci tare da hypothyroidism.
Jiyya na hyperprolactinemia a cikin manya
Ya kamata a jaddada cewa matakan prolactin ya kamata a auna kawai a cikin marasa lafiya da alamun asibiti ko alamun hyperprolactinemia ko a cikin marasa lafiya da aka sani da ciwon daji na pituitary. Ana iya gano cutar hyperprolactinemia bisa ma'auni guda ɗaya na maganin prolactin sama da babba na al'ada. Ya kamata a yi samfurin jini ba tare da damuwa mara kyau ba.
kanikancin
Gwaje-gwajen jini mai sauƙi don auna adadin prolactin a cikin jini zai iya tabbatar da ganewar ƙimar matakan prolactin. Matakan Prolactin sama da 25 ng/mL ana ɗauka suna girma a cikin mata marasa ciki. Tun da kowane mutum yana fuskantar canje-canje na yau da kullun a cikin matakan prolactin, yana iya zama dole a maimaita gwajin jini idan matakin hormone ya ɗan ɗagawa. Yawancin mata suna samun wannan ganewar asali bayan an gwada su don rashin haihuwa ko kuma gunaguni na rashin lokaci, amma wasu ba su da alamun bayyanar. Wani lokaci majiyyata suna samun fitar da madara daga kan nonon, amma yawancin ba su da wannan alamar.
Ƙananan karuwa a cikin prolactin, a cikin kewayon 25-50 ng / ml, yawanci ba ya haifar da canje-canje a cikin haila, kodayake yana iya rage yawan haihuwa. Matsakaicin matakin prolactin na 50 zuwa 100 ng/mL na iya haifar da rashin daidaituwar al'ada kuma yana rage yawan haihuwa ga mace. Matakan Prolactin fiye da 100 ng/mL na iya canza aikin al'ada na tsarin haihuwa na mace, yana haifar da alamun haila (rashin haila, zafi mai zafi, bushewar farji) da rashin haihuwa.
Da zarar an gano cutar hyperprolactinemia, ya kamata a yi bincike don gano ainihin abin da ke haifar da matsalolin da ke tattare da su. Mata da maza ya kamata su auna estrogen da testosterone na safe, bi da bi, tare da gonadotropins. A cikin mata masu shekarun haihuwa, yakamata a tantance aikin thyroid da koda kuma a cire ciki.
Idan babu wani dalili bayyananne, an nuna MRI na glandan pituitary. Marasa lafiya tare da ciwan palie1 fiye da XNUMX cm a diamita ya kamata a bincika don kimanta wasu kwayoyin pian kuma duba filin gani. Yana da mahimmanci don ƙayyade yawan ma'adinai na kashi a cikin marasa lafiya tare da hypogonadism.
Magungunan zamani
Wasu marasa lafiya basa buƙatar magani. Marasa lafiya tare da hyperprolactinemia physiological, macroprolactinemia, asymptomatic microprolactinoma, ko hyperprolactinemia da aka haifar da miyagun ƙwayoyi yawanci ba sa buƙatar magani. Idan hyperprolactinemia ya kasance na biyu zuwa hypothyroidism, maganin majiyyaci tare da thyroxine yakamata ya daidaita matakan prolactin.
Jagororin asibiti
Dangane da jagororin asibiti, ana kula da matakan prolactin da aka haɓaka tare da haɗuwa da hanyoyi da yawa.
Ana iya samun nasarar amfani da magungunan da ke kwaikwayi sinadarai na kwakwalwa na dopamine don magance yawancin marasa lafiya da matakan prolactin. Wadannan kwayoyi suna iyakance samar da prolactin ta glandan pituitary kuma suna haifar da danne sel masu samar da prolactin. Magunguna guda biyu da aka fi sani da su sune cabergoline da bromocriptine. Farawa da ƙaramin kashi, wanda a hankali ya ƙaru, ana iya rage tasirin sakamako, gami da canje-canje a cikin hawan jini da hazo na tunani. Marasa lafiya yawanci suna amsawa da kyau ga waɗannan magunguna kuma matakan prolactin suna raguwa bayan makonni 2 zuwa 3.
Da zarar matakan prolactin sun ragu, ana iya daidaita magani don kula da matakan prolactin na al'ada, kuma wani lokacin ana iya dakatar da shi gaba daya. Ciwon daji na kwatsam yana faruwa a cikin ƴan shekaru ba tare da wani sakamako na asibiti ba.
A cikin ƙananan marasa lafiya, kwayoyi ba su rage matakan prolactin ba, kuma manyan ciwace-ciwacen ƙwayoyi (macroadenomas) sun ci gaba. Wadannan marasa lafiya sune 'yan takara don maganin tiyata (transsphenoidal adenoma resection) ko radiation far.
Rigakafin hyperprolactinemia a cikin manya a gida
Abin takaici, har zuwa yau, ba a samar da ingantattun hanyoyi don hana wannan cutar ba. Ana ba da shawarar matakan kariya na yau da kullun, gami da kiyaye salon rayuwa mai kyau, barin ɗabi'a mara kyau, kula da duk wani cututtukan da ke cikin yanayin haifuwa da metabolism na hormonal.
Shahararrun tambayoyi da amsoshi
Game da ganewar asali da kuma lura da matsalar da pituitary gland shine yake da kuma high prolactin, da siffofin rigakafi, mun yi magana da. urologist, gwani a duban dan tayi bincike, likita na mafi girma category Yuri Bakharev.