Leung Alexander K C, Pacaud Daniele
University of Calgary Faculty of Medicine, Calgary, Alberta.
Am Fam Physician. 2004 Aug 1;70(3):543-50.
After infancy, galactorrhea usually is medication-induced. The most common pathologic cause of galactorrhea is a pituitary tumor. Other causes include hypothalamic and pituitary stalk lesions, neurogenic stimulation, thyroid disorders, and chronic renal failure. Patients with the latter conditions may have irregular menses, infertility, and osteopenia or osteoporosis if they have associated hyperprolactinemia. Tests for pregnancy, serum prolactin level and serum thyroid-stimulating hormone level, and magnetic resonance imaging are important diagnostic tools that should be employed when clinically indicated. The underlying cause of galactorrhea should be treated when possible. The decision to treat patients with galactorrhea is based on the serum prolactin level, the severity of galactorrhea, and the patient's fertility desires. Dopamine agonists are the treatment of choice in most patients with hyperprolactinemic disorders. Bromocriptine is the preferred agent for treatment of hyperprolactin-induced anovulatory infertility. Although cabergoline is more effective and better tolerated than bromocriptine, it is more expensive, and treatment must be discontinued one month before conception is attempted. Surgical resection rarely is required for prolactinomas.
婴儿期过后，溢乳通常由药物引起。溢乳最常见的病理原因是垂体肿瘤。其他原因包括下丘脑和垂体柄病变、神经源性刺激、甲状腺疾病以及慢性肾衰竭。如果患有后者这些疾病的患者伴有高催乳素血症，可能会出现月经不规律、不孕以及骨质减少或骨质疏松。妊娠试验、血清催乳素水平和血清促甲状腺激素水平检测以及磁共振成像都是重要的诊断工具，在临床有指征时应予以采用。溢乳的潜在病因应尽可能进行治疗。对溢乳患者的治疗决策基于血清催乳素水平、溢乳的严重程度以及患者的生育意愿。多巴胺激动剂是大多数高催乳素血症疾病患者的首选治疗药物。溴隐亭是治疗高催乳素引起的无排卵性不孕的首选药物。虽然卡麦角林比溴隐亭更有效且耐受性更好，但它更昂贵，并且在尝试受孕前一个月必须停药。催乳素瘤很少需要手术切除。
