Contents
Hyperprolactinemia waa joogitaanka heer aan caadi ahayn oo prolactin ah oo dhiiga ku jira. Prolactin waa hoormoon uu soo saaro qanjirka pituitary. Hawlaha tirada badan ee prolactin ee jirka waxay inta badan xiriir la leeyihiin uurka iyo soo saarista caanaha naaska ee dhallaanka cusub. Si kastaba ha ahaatee, heerarka prolactin ayaa kor u kici kara marka haweeneydu aysan uur lahayn ama naas nuujin, taasoo keenta xaalado dhowr ah oo saameyn kara shaqada caadiga ah ee caadada iyo bacriminta. Serum prolactin waa in lagu cabbiraa oo keliya bukaanka qaba buro pituitary ama calaamadaha bukaan-socodka iyo calaamadaha hyperprolactinemia.
Waa maxay hyperprolactinemia
Waxaa jira sababo badan oo keena hyperprolactinemia, oo ay ku jiraan daawooyinka qaarkood iyo buro pituitary (prolactinoma). Si loo qoro daaweynta ku habboon, waxaa muhiim ah in la go'aamiyo sababta asaasiga ah. Hyperprolactinemia waxay keeni kartaa galactorrhea (ka soo saarida caanaha naaska oo ka baxsan nuujinta) waxayna faragelisaa shaqada taranka. Tani waxay soo dedejin kartaa luminta lafaha haddii ay sabab u tahay yaraanta hoormoonka galmada.
Inta badan prolactinomas waa micro-prolactinomas. Caadiyan dhaqso uma koraan si ay u keenaan dhibaatooyin daran. Bukaanka qaba prolactinoma waxaa sida caadiga ah si guul leh loogu daaweeyaa agonists dopamine sida cabergoline.
Sababaha hyperprolactinemia ee dadka waaweyn
Xaddiga sare ee prolactin ee dhiiga (hyperprolactinemia) waa cillad endocrine caadi ah oo caadi ah. Sababuhu waxay u dhexeeyaan xaalado aan fiicneyn oo aan u baahnayn daaweyn iyo dhibaatooyin caafimaad oo halis ah oo u baahan daaweyn degdeg ah. Hyperprolactinemia sidoo kale waxay noqon kartaa saameyn dhinaca daawooyinka qaarkood. Si loo fahmo nuxurka hababka socda, waxaa habboon in la sharaxo wax yar doorka hoormoonka.
Prolactin waa hoormoon polypeptide ah oo la soo saaray oo ay soo saareen unugyada lactotrophic ee qanjirka pituitary ee hore. dheecaanka Prolactin waxaa ugu horayn nidaamiya dopamine, kaas oo lagu soo saaro hypothalamus oo joojisa dheecaanka prolactin. Hormoonka hypothalamic thyrotropin-sii daaya hormoonka wuxuu kiciyaa dheecaanka prolactin.
Prolactin wuxuu sameeyaa saameyntiisa isagoo ku xiraya soo-dhoweeyayaasha prolactin. Waxay ku yaalaan xuubka unugga unugyo badan, gaar ahaan naaska iyo qanjirka pituitary. Naaska, prolactin wuxuu kiciyaa korriinka qanjidhada xilliga uurka iyo soo saarista caanaha naaska xilliga dhalmada ka dib. Qanjirka 'pituitary gland', prolactin wuxuu xakameynayaa dheecaanka gonadotropin.
Waxaa jira sababo nafsiyeed, bahal iyo dawooyin la xiriira hyperprolactinemia (heerka prolactin sare).
Sababaha jireed. Uurka, naasnuujinta iyo nuujinta, jimicsiga, galmada iyo walbahaarka waxay kordhin karaan heerarka prolactin. Korodhkani waa mid ku meel gaadh ah oo inta badan kama badna laba jeer xadka sare ee kala duwanaanshaha caadiga ah.
sababaha pathological. Prolactinomas waa burooyin ka soo baxa unugyada pituitary ee qarsoodiga ah ee prolactin. Inta badan prolactinomas (90%) waa microadenomas (<1 cm dhexroor) kuwaas oo 10 jeer ku badan dumarka marka loo eego ragga. Microadenomas waxay sababaan koror yar oo ah heerarka prolactin, taas oo laga yaabo inay la xiriirto calaamadaha hyperprolactinemia, laakiin badanaa ma koraan.
Macroadenomas (> 1 cm dhexroorka ah) aad ayay u yar yihiin, iyo prolactinomas weyn (> 4 cm dhexroor) waa naadir. Marka la barbardhigo dumarka, ragga ayaa sagaal jeer uga dhow inay qaadaan makroadenoma. Burooyinkani waxay keenaan hyperprolactinemia daran - fiirsashada prolactin ee ka badan 10 mIU/L waxay had iyo jeer muujisaa macroprolactinoma. Waxay sababi karaan hypopituitarism, luminta goobta muuqaalka, ama curyaannimada indhaha iyagoo isku cadaadiya chiasm-ka indhaha ama nuclei dareemayaasha cranial.
Qaababka kale ee hypothalamus iyo qanjirka pituitary ayaa sidoo kale keeni kara hyperprolactinemia. Maaddaama dopamine ay xakameyso dheecaanka prolactin, neoplasm kasta ama lesion infiltrative oo cadaadiya jirida pituitary-ga waxay daciifin kartaa ficilka dopamine waxayna sababi kartaa hyperprolactinemia. Si kastaba ha ahaatee, burburka jirida hyperprolactinemia ayaa caadi ahaan ka hooseeya 2000 mIU/L, taas oo ka soocaysa macroprolatinoma.
Cudurada qaarkood waxay keeni karaan hyperprolactinemia. Prolactin waxaa ugu horrayn ka soo baxa kelyaha, sidaa awgeed kelyuhu hawlgabku wuxuu kordhin karaa heerarka prolactin. Sababtoo ah hormoonka sii daaya thyrotropin wuxuu kiciyaa dheecaanka prolactin, hypothyroidism waxay sidoo kale keeni kartaa hyperprolactinemia. Suuxdintu waxay sababi kartaa koror muddo gaaban ah heerarka prolactin.
Sababaha la xiriira daroogada. Tiro ka mid ah dawooyinka ayaa carqaladeeya sii deynta dopamine ee hypothalamus, taasoo keenta kororka dheecaanka prolactin (prolactin 500-4000 mIU / l). Hyperprolactinemia waxay ku koraan bukaanada qaadanaya daawooyinka dhimirka. Waxa kale oo ay kobcin kartaa, ilaa xad ka yar, sababtoo ah qaar ka mid ah dawooyinka dib u soo celinta serotonin ee la xushay (daawooyinka niyad-jabka). Daawooyinka kale waxay keeni karaan hyperprolactinemia si aan joogto ahayn. Haddii hyperprolactinemia ay sababto daroogo, uruurinta caadi ahaan waa caadi haddii daawada la joojiyo 72 saacadood gudahood.
Calaamadaha hyperprolactinemia ee dadka waaweyn
Bukaanjiifka qaarkood, hyperprolactinemia waa asymptomatic, laakiin xad-dhaafka hormoonku wuxuu saameyn karaa qanjidhada naasaha iyo shaqada taranka. Dumarka, waxay keeni kartaa oligoamenorrhea (xilli gaaban iyo gaaban), dhalmo la'aan, iyo galactorrhea. Ragga, hyperprolactinemia waxay u horseedi kartaa cillad kacsi, dhalmo la'aan, iyo gynecomastia. Galactorrhea (caano laga soo saaro naaska ama dambarka) aad ayey ugu yar yihiin ragga marka loo eego dumarka.
Yaraanta hormoonka Gonadadal waxay soo dedejin kartaa luminta lafaha. Bukaan-socodka ayaa laga yaabaa inay yeeshaan calaamado ama calaamado la xiriira sababta hoose ee hyperprolactinemia. Tusaale ahaan, madax-xanuun iyo luminta aragga bukaanka qaba burooyinka pituitary, iyo daal iyo dulqaad qabow oo ku dhaca bukaanka qaba hypothyroidism.
Daaweynta hyperprolactinemia ee dadka waaweyn
Waa in la caddeeyo in heerarka prolactin ay tahay in lagu cabbiro oo keliya bukaannada leh calaamadaha bukaan-socodka ama calaamadaha hyperprolactinemia ama bukaannada qaba burada pituitary ee la yaqaan. Cilad-sheegidda hyperprolactinemia waxay ku salaysnaan kartaa hal cabbir oo serum prolactin ah oo ka sarreeya xadka sare ee caadiga ah. Tijaabada dhiigga waa in la sameeyaa iyada oo aan cadaadis aan loo baahnayn.
Bioscience
Tijaabooyin dhiig oo fudud oo lagu cabbiro cadadka prolactin ee dhiigga ayaa xaqiijin kara ogaanshaha heerarka prolactin ee sarreeya. Heerarka Prolactin ee ka sarreeya 25 ng/mL ayaa loo arkaa inay sare u kaceen haweenka aan uurka lahayn. Maadaama qof kasta uu la kulmo isbeddel maalinle ah ee heerarka prolactin, waxaa laga yaabaa inay lagama maarmaan noqoto in lagu celiyo baaritaanka dhiigga haddii heerka hormoonka uu yara sarreeyo. Dumar badan ayaa helaya cudurkan ka dib markii laga baaro dhalmo la'aanta ama ka cawda caadada aan caadiga ahayn, laakiin qaar kale ma laha calaamado. Mararka qaarkood bukaanku waxay leeyihiin dheecaan caano ah oo iskiis ah oo ka imaanaya ibta naaska, laakiin badidood ma laha calaamadahan.
Korodhka yar ee prolactin, oo u dhexeeya 25-50 ng / ml, badanaa ma keeno isbeddel muuqda oo ku yimaada wareegga caadada, inkastoo ay yarayn karto dhalmada guud. Heerarka sare ee prolactin ee 50 ilaa 100 ng/mL waxay sababi karaan caadada caadada oo aan joogto ahayn waxayna si wayn u yareeyaan bacriminta dumarka. Heerarka Prolactin ee ka weyn 100 ng/mL waxay bedeli karaan shaqada caadiga ah ee habka taranka ee haweeneyda, taasoo keenaysa calaamadaha menopausal (caado la'aan, dhalaal kulul, qallayl siilka) iyo dhalmo la'aan.
Marka la ogaado cudurka hyperprolactinemia, waa in la sameeyaa baaritaan si loo ogaado sababta dhabta ah iyo dhibaatooyinka la xiriira. Dumarka iyo ragga waa inay cabbiraan estrogen iyo testosterone subaxdii, siday u kala horreeyaan, oo ay la socdaan gonadotropins. Dumarka ku jira da'da dhalmada, tayroodhka iyo shaqada kelyaha waa in la qiimeeyaa oo uurka laga saaro.
Haddii aan sabab kale oo cad la helin, MRI ee qanjirka pituitary ayaa la tilmaamayaa. Bukaanka qaba burada pituitary ee ka weyn dhexroorka 1 cm waa in la baaro si loo qiimeeyo hormoonnada kale ee pituitary oo loo eego goobta muuqaalka. Waa muhiim in la go'aamiyo cufnaanta macdanta lafaha ee bukaanka qaba hypogonadism.
Daaweynta casriga ah
Bukaanjiifka qaar uma baahna daaweyn. Bukaanka qaba hyperprolactinemia physiological, macroprolactinemia, asymptomatic microprolactinoma, ama hyperprolactinemia ay sababto daroogada caadi ahaan uma baahna daaweyn. Haddii hyperprolactinemia uu yahay heerka labaad ee hypothyroidism, daaweynta bukaanka qaba thyroxine waa inay caadi ka dhigtaa heerarka prolactin.
Tilmaamaha bukaan-socodka
Marka loo eego tilmaamaha kiliinikada, heerarka sare ee prolactin waxaa lagu daaweeyaa habab dhowr ah oo isku dhafan.
Daawooyinka u eg maskaxda dopamine kiimikaad ayaa si guul leh loogu isticmaali karaa in lagu daaweeyo badi bukaanada leh heerarka prolactin ee sarreeya. Daawooyinkani waxay xaddidaan soo saarista prolactin ee qanjirka pituitary waxayna sababaan xakamaynta unugyada prolactin-ka soo saara. Labada dawo ee ugu badan ee loo qoro waa cabergoline iyo bromocriptine. Laga bilaabo qiyaas yar, oo si tartiib tartiib ah u kordheysa, dhibaatooyinka soo raaca, oo ay ku jiraan isbeddelka cadaadiska dhiigga iyo ceeryaaminta maskaxda, waa la yarayn karaa. Bukaan-socodka ayaa sida caadiga ah si fiican uga jawaaba daawooyinkan iyo heerarka prolactin ayaa hoos u dhacaya 2 ilaa 3 toddobaad ka dib.
Marka heerarka prolactin hoos u dhacaan, daaweynta waa la hagaajin karaa si loo ilaaliyo heerarka caadiga ah ee prolactin, mararka qaarkoodna si buuxda ayaa loo joojin karaa. Dib u noqoshada buro kedis ah waxay badanaa ku dhacdaa dhowr sano gudahood iyada oo aan wax cawaaqib caafimaad ah la helin.
Tiro yar oo bukaan ah, daawooyinku ma hoos u dhigaan heerarka prolactin, iyo burooyinka waaweyn (macroadenomas) ayaa sii socda. Bukaannadani waxay u sharaxan yihiin daaweynta qalliinka (transsphenoidal adenom resection) ama daaweynta shucaaca.
Ka hortagga hyperprolactinemia ee dadka waaweyn ee guriga
Nasiib darro, ilaa maanta, ma jiraan habab waxtar leh oo la sameeyay si looga hortago cudurkan. Tallaabooyinka ka-hortagga caadiga ah ayaa lagula talinayaa, oo ay ku jiraan ilaalinta qaab nololeed caafimaad leh, ka tanaasulida caadooyinka xun, daweynta cudur kasta oo ku jira qaybta taranka iyo dheef-shiid kiimikaadka hormoonnada.
Su'aalaha iyo jawaabaha caanka ah
Marka la eego ogaanshaha iyo daaweynta dhibaatada qanjirka pituitary iyo prolactin sare, sifooyinka ka hortagga, waxaan la hadalnay. urologist, khabiir ku takhasusay ogaanshaha ultrasound, dhakhtarka qaybta ugu sareysa Yuri Bakharev.