Biller B M
Neuroendocrine Unit, Massachusetts General Hospital, Boston 02114-2696, USA.
Int J Fertil Womens Med. 1999 Mar-Apr;44(2):74-7.
Prolactinomas are the most common pituitary tumors. Hyperprolactinemia is characterized by increased production of prolactin, often leading to reproductive dysfunction and galactorrhea. Prolactinomas may also cause male-factor infertility by producing hypogonadism. In addition, if large, they can produce neurologic symptoms by mass effect in the sellar area. The diagnostic evaluation first requires exclusion of other causes of hyperprolactinemia, such as pregnancy, primary hypothyroidism, numerous medications, and miscellaneous causes. The second step in the diagnostic evaluation is to perform a head scan, preferably an MRI. This is essential in order to exclude a "pseudoprolactinoma" which would require surgery. Following diagnostic evaluation, the next step is to determine whether a patient with hyperprolactinemia has an indication for therapy, such as a macroprolactinoma (tumor >1 cm), hypogonadism (risk of osteoporosis), infertility, significant galactorrhea, acne, hirsutism, or headache. The treatment of choice for nearly all patients with hyperprolactinemic disorders is medical. In most cases, dopamine agonists (bromocriptine, pergolide, cabergoline) are extremely effective in lowering serum prolactin, restoring gonadal function, decreasing tumor size, and improving visual fields. The main limitation is side effects, particularly nausea or orthostatic dizziness. The newest dopamine agonist, cabergoline, can be given just once or twice a week, is more effective in normalizing prolactin and restoring menses than bromocriptine, and is significantly better tolerated. However, it is not yet recommended as first-line therapy for patients seeking fertility, because adequate safety data in pregnancy are not available. For the infrequent patient unable to tolerate, or resistant to, medical therapy, neurosurgical transsphenoidal resection may be necessary, particularly if the patient has a large lesion jeopardizing the optic chiasm. Hyperprolactinemia is a rewarding disorder to manage because patients typically respond well to medication, with restoration of menses and fertility.
催乳素瘤是最常见的垂体肿瘤。高催乳素血症的特征是催乳素分泌增加，常导致生殖功能障碍和溢乳。催乳素瘤还可通过导致性腺功能减退引起男性因素不育。此外，如果肿瘤较大，可因鞍区占位效应产生神经症状。诊断评估首先需要排除高催乳素血症的其他原因，如妊娠、原发性甲状腺功能减退、多种药物及其他各种原因。诊断评估的第二步是进行头部扫描，最好是磁共振成像（MRI）。这对于排除需要手术治疗的“假性催乳素瘤”至关重要。诊断评估后，下一步是确定高催乳素血症患者是否有治疗指征，如大催乳素瘤（肿瘤>1厘米）、性腺功能减退（骨质疏松风险）、不育、明显溢乳、痤疮、多毛症或头痛。几乎所有高催乳素血症疾病患者的首选治疗方法是药物治疗。在大多数情况下，多巴胺激动剂（溴隐亭、培高利特、卡麦角林）在降低血清催乳素、恢复性腺功能、减小肿瘤大小和改善视野方面极其有效。主要局限性是副作用，尤其是恶心或体位性头晕。最新的多巴胺激动剂卡麦角林，每周只需服用一次或两次，在使催乳素正常化和恢复月经方面比溴隐亭更有效，且耐受性明显更好。然而，对于寻求生育的患者，由于尚无足够的孕期安全数据，目前不推荐将其作为一线治疗药物。对于极少数无法耐受或对药物治疗耐药的患者，可能需要进行神经外科经蝶窦切除术，特别是当患者有危及视交叉的大病变时。高催乳素血症是一种易于处理的疾病，因为患者通常对药物反应良好，月经和生育功能可恢复。
