高泌乳激素血症（Hyperprolactinemia）课件.pptVIP

高泌乳激素血症(Hyperprolactinemia) 白永河 內分泌暨新陳代謝科 彰化基督教醫院 PRL Regulated by the hypothalamus 主要是 tonic inhibition Hypothalamus 分泌 2 種 hypothalamic factors PIF (PRL-inhibiting factor) Dopamine PRF (PRL-releasing factor) TRH, VIP PRL Stimulate breast development Initiate and maintain lactation PRL receptor alveolar surface of mammary cell liver, kidney ovary, testes, prostate Estrogen synergistic in promoting breast development antagonize in effect of lactation Breast development 須要多種 hormone 的 coordinated action 包括 major stimuli: estrogen progesterone prolactin GH placental mammotropic H minor stmuli: insulin cortisol thyroid hormone Breast development Duct growth: estrogen Lobuloalveolar development: PRL+progesterone Lactation: PRL + oxytocin Galactorrhea 需要 PRL + Gonadal steroid 才會出現 ∴ not necessarily seen in all prolactinomas 和 serum PRL level 無關 Galactorrhea 的 incidence 差異很大 女性 30～-80% 男性常 no galactorrhea 即使有 galactorrhea, 其中50%病人的 PRL 可能正常 反之，即使 PRL 100ng/ml, 也可能 no galactorrhea ∴ Galactorrhea 為 poor marker of hyperprolactinemia PRL 1928 discovered in extract of bovine pituitary 1970 sensitive bioassay 1971 RIA (Friesen, Fournier, Desjardians) secreted by the erythrosinophilic subtype of chromophobic cells in the adenohypophysis PRL A stress hormone Secreted in a pulsatile fashion highest in the early morning (睡醒之前) lower in the afternoon physiologic PRL↑ pain nipple stimulation fondling (women only) pregnancy (可達 200-500 ng/ml) pelvic examination exercise sleep PRL Daily secretion rate: 400μg/天 Metabolic clearance: 40 ml/m2/min Clearance pathway: 25% kidney 75% liver Plasma T1/2: 50 min Plasma level: 15 ng/ml ♂:5 ng/ml (3-10) ♀:8 ng/ml (5-15) fetal PRL 300 ng/ml umbilical PRL maternal PRL Pituitary PRL: 100 μg per pituitary PRL PRL value 和 prolactinoma tumor size 成正比 PRL 1000 ng/ml →tumor extension into cavernous sinus 150 ng