prolaktinoma - this tumor of the anterior pituitary, which has all the features of benign and actively secrete prolactin.In the event of prolactinoma the representatives of both sexes there are significant distinctive features of clinical symptoms, in connection with what oncologists promote the principle of selection of an individual regimen for each patient.
Unfortunately, to achieve full recovery from existing prolaktinome patient can be extremely rare, however, the introduction of new surgical techniques therapy can significantly improve the prognosis of this disease.
prolactinoma pituitary prolactin
should be classified as benign tumors localized in the pituitary gland, which is not less than a third of all episodes of pituitary cancer pathology.By the risk of this form of pituitary adenoma include women in the reproductive age, size of tumors which do not exceed a few millimeters.Among the male half of humanity prolactinoma is considered an exception to the rule, ho
Feature prolactinoma as hormone-producing tumor, is its ability to produce high concentrations of prolactin in situations where it should not normally be in serum.For the normal functioning of the reproductive system of both women and men, must provide a minimum of prolactin synthesis, rendering the stimulation of sexual function.Stimulation of fertility in women is in the regulation of normal and regular menstrual cycle onset of the effective period of ovulation.Under the influence of prolactin in the blood circulation in the male body, the conditions for the normal production of testosterone and sperm preservation activity.
Despite carrying an enormous amount of research in the diagnosis of common and rare onokopatology various sites, the researchers are still not able to establish a reliable etiopathogenic cause of prolactinoma.
There is a perception that some hereditary diseases of genetic nature, and in particular - multiple endocrine neoplasia of the first type can be the background for the development of disease symptoms of prolactinoma.Based on this theory of pathogenesis, it is possible to assume the fact of a genetic predisposition to the development of prolactinomas in the category of patients suffering from endocrine neoplasia.This pathology is accompanied not only by the overproduction of prolactin, but the excessive synthesis of hormonal substances pancreas and parathyroid glands.
Although suggested the genetic nature of prolactinoma, reliable detection of the gene in 100% of cases provoking signs prolactinoma, could not be implemented.
Depending on the parameters of the tumors and the location of it in relation to the pituitary fossa distinguish two main groups of prolactin: intrasselyarnuyu mikroprolaktinomu (size surround education does not exceed 10 mm, and the tumor is within the bony border sella) and ekstrasselyarnuyumakroprolaktinomu (increased tumor parameters exceeding 10 mm contribute to the spread of her bony border sella).Defining the parameters of the tumor and its location is important in determining the tactics and treatment of the patient.
degree of intensity of certain clinical symptoms prolaktinome pituitary available depends on the level of prolactin production and increase its concentration in blood and the degree of compression of the brain structures tumor substrate.
macroprolactinoma contributing to a significant increase in the size of the pituitary gland, have a compression effect on the optic nerves, and therefore, when this type available prolaktinome the patient has expressed visual disturbances in the form of narrowing the field of view, the duality of objects when viewed up close.In a situation where the volume of the tumor substrate has a compression effect on the optic chiasm, the patient may experience a complete loss of two-way visual function.
neurological disorders can significantly worsen the condition of the patient, and for prolaktinomy these violations are common and occur in 70-80% of cases.Patients with large size prolaktinomy complained of constant headaches compressive nature, depressed mood, combined with a painful anxiety, tendency to emotional lability and irritability.In a situation where prolaktinoma reach large sizes, it can have an inhibitory effect on the production of pituitary hormones, which are released by this gland under normal conditions.
Despite some common clinical manifestations of prolactinoma, observed in almost all patients in whom the tumor has reached large sizes, there are individual features of clinical symptom in each case.
Thus, the debut of the clinical picture with the available prolaktinome the woman appears as a gradual progressive change from the regular cycle of menstruation oligomenorrhea to no menstrual flow for a long period of time.Also, what are irregular menstruation, they differ anovulatory, ie a complete lack of ovulation and the inability to conceive a child, which is a result of insufficient production of other pituitary hormones.
In some cases, women may be a so-called galactorrhea, ie the allocation of a small amount of breast milk, which has nothing to do with normal lactation in the postpartum period.This symptom is not a terrible provocation against breast disease, but its appearance is one of the symptoms of prolactinoma.
Due to the fact that prolactin has a regulating effect on the process of the exchange of mineral substances, particularly calcium involved in the organization structure of the bone tissue, the increased concentration of this hormone in blood osteporoticheskih provokes changes in the bones of different localization.Severe osteoporosis contributes to pathological bone fractures of different anatomical regions.In addition, the lack of estrogen that occurs as a consequence of hyperprolactinemia, promotes fluid retention in the female body, thereby provoking a progressive weight gain.
In severe cases, prolactinoma, combined with hyperandrogenism, a woman may experience increased body hair skin and acne.
In a situation where a woman is diagnosed prolactinoma during pregnancy, you need a lot of attention paid to the diagnosis of disease progression, as in this period, the majority of patients showed a significant increase in the parameters of the tumor and the appearance of severe complications caused by compression of the brain structures.Signs of disease progression is an absolute indication for abortion at any stage.
prolactinoma in men is accompanied by symptoms caused by a progressive decrease in testosterone production and subsequent violations of the physiological process of spermatogenesis.This pathology manifests itself in decreased libido, no erectile function and even the development of secondary infertility.Galactorrhea the male category of patients is extremely rare, but some patients with elevated levels of prolactin in the blood can provoke the development of gynecomastia or double-sided nature, and wasting of the testicles.Patients suffering from overproduction of prolactin prolactinoma, suffer from various bone pathologies associated with reduced bone mineralization.
timely treatment is the key to success, as the consequences of prolactinomas with malignant recurrent course, very heavy.In a situation where prolaktinoma presented small size of the tumor substrate is not accompanied by significant changes in the health status of the patient, specific treatment is required and we can restrict dynamic medical observation for a patient with a mandatory assessment of laboratory and instrumental dynamics of cancer.
When the tumor is small, but is accompanied by disorders of sexual sphere and the inability to conceive a child, the physician should evaluate the need to restore reproductive function individually in each case.Macroprolactinoma necessarily subject to medical and surgical correction, since their presence provokes serious complications.
drugs of choice in the treatment of prolactin, accompanied by overproduction of prolactin, are drugs group dopamine antagonists.The use of drugs of this pharmacological group in 90% of cases contribute to the full restoration of fertility in women who are premenopausal.
only drug with proven efficacy against leveling manifestations prolactinoma is Bromkriptin in average daily dose of 2.5 mg orally.Due to the fact that this drug can induce a number of side reactions of the digestive organs, to minimize reception of these manifestations of the drug to be combined with the proton pump antagonists (Omez 1 tablet 2 times a day).Despite pronounced efficacy for normalizing prolactin synthesis, characterized Bromkriptin not prolonged effect, so to remove the drug may be a relapse of hyperprolactinemia.
method of surgical treatment of pituitary tumors, and in particular - suprassellyarnoy macroprolactinoma is transsphenoidal resection, after which the product in 90% of cases there is a pronounced positive effect during the first day of the normalization of prolactin in the blood.The scope of this type of treatment is the presence of prolactinoma in women of reproductive age, which is marked idiosyncrasy drugs of dopamine antagonists.
In a situation where resection is not accompanied by a persistent effect of the normalization of hyperprolactinemia, and the patient has clinical manifestations of the disease, treatment should be supplemented prolaktinomy long course receiving bromocriptine in the maintenance dose of 1.25 mg or radiation therapies.Of course, radiation therapy is not accompanied by rapid normalization of prolactin levels, but progressive decline in its concentration has a more stable result.Radiation treatment as monotherapy is not recommended, since this method of treatment increases the risk of hypopituitarism.
the appointment of a treatment prolactinomas, the initial duty of the physician is to explain the appropriateness of patient long-term treatment, which gives a distinct proof positive in 30% of cases leads to a complete recovery of the patient.Removing only the clinical manifestations is not a reason for discontinuing treatment, since this disease may experience recurrent course.