The Etiology And Clinical Features Study Of Hyperprolactinemias

Objective: To study the etiology and clinical features of hyperprolactinemias in retrospective. Method: Undertaking the retrospective analysis of clinical data (etiopathogenisis analysis,clinical features,laboratory examination, imageology check,treatment) of hyperprolactinemias patients,who were in our hospital from May 1995 to April 2004.Using radio-immunity assay to determine the serum PRL of 149 patients,simultaneously determining the follicle stimulating hormone(FSH),luteinizing hormone(LH), dihydrofolliculin(E2),progesterone(P),testosterone(T),thyrotropin(TSH), free-triiodothyronine(FT3),free-thyroxine(FT4) of 45 patients of the total. Processing X-ray sella turcica checks of all patients,at least involving pituitary gland enhanced-CT or MRI. Results: Clinical features: In the 149 cases,there are 106 female cases(71.14%)who were 15-72 years old (31.4±10.6)and 97 of them are married persons(intrauterine pregnancy 76 persons, unpregnancy 21 persons);43 persons are male with age from 14 to 68 years old(39.2±9.8)and 40 of them are married.Etiopathogenisis analysis: Prolactinoma 111 cases(74.5%),other pituitary tumours 12 cases,vacuole sella turcica 1 case,hypothalamus syndrome 1 case,craniopharyngioma 1 case,primary hypothyroidism 3 cases,drug-prolactinoma 6 cases (contraceptives 1, cimetidine 2,metoclopramide 2, chlorperphenazine 1),14 cases have not exact etiological factors.laboratory examination: 93.4% of the patients whose PRL>100μg/L were prolactinoma;98.4% of the patients whose PRL>200μg/L were prolactinoma,and the sizes of prolactinoma were correlative with PRL level,PRL average value of macroprolactinoma of this group reached 194μg/L,while PRL average value of microprolactinoma only reached 128μg/L(p<0.05);it's worth noting that even PRL< 100μg/L, macroprolactinoma could not be precluded,PRL values of 25 macroprolactinoma persons among this group were <100μg/L; galactorrhea patients(81/149,54.4%) PRL126.1±46.5μg/L;ungalactorrhea patients PRL144.8±95.1μg/L(P>0.05),male galactorrhea patients were rare(3/43,7%);menostasis patients (40/106,37.7%)PRL151.1±43.6 μg/L,40 oligomenorrhea patients PRL 106.3±35.1μg/L, PRL of 26 persons who were fundamental normal emmenia was 56.1 ±15.1μg/L(P<0.05);Except 2 cases, FSH,LH,E2,T ,P decreased.Imageology check: sella turcica checks of 119 persons were abnormal, pituitary enhanced-CT of 42 persons showed 6 microadenoma,36 macroadenoma, MRI of 138 patients showed 16 microadenoma,102 macroadenoma,1 vacuole sella turcica,1 craniopharyngioma.Therapy condition: 102 patients of pituitary adenoma took operating,4 died,16 recidivated,7 persons developed the permanent antehypophysis hypofunction.PRL of 3 primary hypothyroidism was normal,after thyroid hormone replacement therapy;6 medico-hyperprolactinemias,in 1-3 months after stopping taking correlative medicines ,PRL gradually recovered to normal level. After taking Bromocriptine,clinical symptoms of 15 patients with microadenoma and 6 patients with macroadenoma were improved in 1-6 months,and PRL decreased 50%; the patient of hypothalamus syndrome took Bromocriptine, his PRL level became normal 3 months later. The PRL level of the patient with craniopharyngioma became normal after operation.14 patients of idio-hyperprolactinemias after Bromocriptine therapy,their PRL loweredand symptoms were improved,but one of them developed pituitary microadenoma 6 months later,and another did 2 years later. Conclusion: In hyperprolactinemia, woman take more percentage. Prolactinoma is the most frequent reason.The patient of idio-hyperprolactinemia should take follow-up observation, since there is possibility of developing microadenoma.To these patient with hyperprolactinemia, the thyroid function should be routinely detected and should be drug-hyperprolactinemia excluded. The level of serum PRL shows positive correlation with sizes of node and menostasia,but no correlation with galactorrhea, male patients of hyperprolactinemia rarely have galactorrhea.The indication of operation of appendices suprasphenoidalis PRL no...