Barry Lucinda, Pather Selvan, Gargya Ash, Marren Anthony
Royal Prince Alfred Hospital, Sydney, Australia.
Chris O'Brien Lifehouse, Sydney, Australia.
Case Rep Endocrinol. 2021 Sep 9;2021:5553187. doi: 10.1155/2021/5553187. eCollection 2021.
Prolactin-secreting leiomyomas are rare, with only eight cases reported in the literature. This case describes a 37-year-old female with hyperprolactinaemia (1846 mIU/L; 85-500 mIU/L) refractory to cabergoline causing infertility and galactorrhea. MRI pituitary was normal. The patient had a known enlarging uterine leiomyoma on serial pelvic ultrasounds (15.2 cm × 9.1 cm × 12.1 cm). The serum prolactin returned to subnormal levels two days postmyomectomy and showed recovery to normal levels in the months following surgery. Immunostaining of the leiomyoma for prolactin was negative. Despite not staining for prolactin, quick resolution of the patient's hyperprolactinaemia after myomectomy supports the diagnosis of a prolactin-secreting fibroid. A prolactin-secreting leiomyoma should be considered in patients with hyperprolactinaemia and normal pituitary MRI which is refractory to dopamine receptor agonist therapy who also have evidence of a uterine fibroid. In patients wishing to seek fertility, myomectomy should be considered to allow for normal ovulation and possibility of future fertility.
分泌催乳素的平滑肌瘤很罕见，文献中仅报道过8例。本病例描述了一名37岁女性，患有高催乳素血症（1846 mIU/L；正常范围85 - 500 mIU/L），对卡麦角林耐药，导致不孕和溢乳。垂体MRI检查正常。患者经系列盆腔超声检查发现子宫平滑肌瘤增大（15.2 cm×9.1 cm×12.1 cm）。子宫肌瘤切除术后两天血清催乳素恢复至正常水平以下，并在术后数月恢复到正常水平。平滑肌瘤催乳素免疫染色为阴性。尽管未检测到催乳素染色，但子宫肌瘤切除术后患者高催乳素血症迅速缓解支持分泌催乳素肌瘤的诊断。对于高催乳素血症、垂体MRI正常、对多巴胺受体激动剂治疗耐药且有子宫肌瘤证据的患者，应考虑分泌催乳素的平滑肌瘤。对于希望生育的患者，应考虑子宫肌瘤切除术以实现正常排卵和未来生育的可能性。
