Peña K S, Rosenfeld J A
Department of Family Practice, Franklin Square Hospital, Baltimore, Maryland 21237, USA.
Am Fam Physician. 2001 May 1;63(9):1763-70.
Galactorrhea, or inappropriate lactation, is a relatively common problem that occurs in approximately 20 to 25 percent of women. Lactation requires the presence of estrogen, progesterone and, most importantly, prolactin. Stress, suckling, sleep, sexual intercourse and medications may increase prolactin levels, whereas dopamine inhibits its release. The differential diagnosis of galactorrhea includes pituitary adenomas, neurologic disorders, hypothyroidism, numerous medications, breast stimulation, chest wall irritation and physiologic causes. The evaluation includes a thorough history and physical examination, as well as selected laboratory and imaging studies to rule out secondary causes such as an intracranial mass or a tumor. Diagnostic studies include a pregnancy test, a prolactin level, renal and thyroid function tests and, if indicated, magnetic resonance imaging of the brain. Treatment options for prolactinomas include observation, dopamine agonists, surgery and radiation therapy, depending on tumor size and associated symptoms. Fortunately, the prognosis for patients with prolactinomas is good: most prolactinomas remain stable or regress. In pregnant women, prolactinomas must be observed closely because the lesions may greatly increase in size.
溢乳，即非哺乳期泌乳，是一个相对常见的问题，约20%至25%的女性会出现。泌乳需要雌激素、孕激素存在，最重要的是需要催乳素。压力、哺乳、睡眠、性交及药物可能会使催乳素水平升高，而多巴胺会抑制其释放。溢乳的鉴别诊断包括垂体腺瘤、神经系统疾病、甲状腺功能减退、多种药物、乳房刺激、胸壁刺激及生理原因。评估包括全面的病史和体格检查，以及选择的实验室和影像学检查，以排除诸如颅内肿块或肿瘤等继发原因。诊断性检查包括妊娠试验、催乳素水平测定、肾功能和甲状腺功能检查，如有必要，还包括脑部磁共振成像。催乳素瘤的治疗选择包括观察、多巴胺激动剂、手术及放射治疗，具体取决于肿瘤大小和相关症状。幸运的是，催乳素瘤患者的预后良好：大多数催乳素瘤保持稳定或缩小。对于孕妇，必须密切观察催乳素瘤，因为这些病变可能会大幅增大。
