Prolaktinoma

Description:

Prolaktinoma – hormonal active tumor of a front share of a hypophysis developing excess amount of hormone of prolactin. It is shown by the pathological secretion of milk which is not connected with childbirth (galactorrhoea), irregular periods or their absence at women, decrease in a potentiality and sexual desire at men when progressing a tumor - headaches, a vision disorder and consciousnesses. Depending on a tumor degree of activity treatment conservative or surgical, a recurrence is possible, the absolute recovery comes only in a quarter of cases.
Prolaktinoma treat group of the benign adenomas which are most often found among hypophysis tumors (to 30%), ozlokachestvlyatsya extremely seldom and observed at women of a genital age group at 6-10 times more often than at men. The sizes prolactin usually do not exceed 2-3 mm, however large adenomas more than 1 cm in the diameter, as a rule, occur at men.

Prolaktinoma are the hormonal and active adenomas of a hypophysis cosecreting prolactin – the "milk hormone" stimulating a puerperal lactation at women. Normal in smaller quantities prolactin is produced also men. Together with luteinizing and follicle-stimulating hormones prolactin has the regulating effect on reproduction and sexual function. At women these hormones provide synthesis of estrogen, regulation of a menstrual cycle and an ovulation, at men – production of testosterone and activity of spermatozoa.

Excess of the prolactin cosecreted prolaktinomy (giperprolaktinemiya) suppresses эстрогеногенез at women and leads to anovulation and infertility. Prolaktinsekretiruyushchy adenoma causes erectile dysfunction, a gynecomastia and loss of sexual desire in men.

Prolaktinoma reasons:

The reasons of development of a prolaktinoma are authentically unknown.

However, at a part of patients with hypophysis adenomas (including prolaktinomy) existence of genetic disorders – a multiple endocrine neoplasia of the I type – the hereditary disease which is characterized by supersecretion of hormones parathyroid, pancreatic glands, a hypophysis and multiple round ulcers is noted. In some cases, the tendency to hereditary development of a prolaktinoma is traced.

The modern endocrinology together with genetics continues researches on identification of the genes which are responsible for emergence of a prolaktinoma.

Prolaktinoma symptoms:

By the sizes and an arrangement within a pituitary pole of a prolaktinoma are divided into two groups:
- intrasellyarny mikroprolaktinoma – the prolaktinsekretiruyushchy adenomas with a diameter up to 1 cm which are not going beyond the Turkish saddle;
- ekstrasellyarny makroprolaktinoma - the prolaktinsekretiruyushchy adenomas with a diameter more than 1 cm extending out of limits of the Turkish saddle.

The sizes of a prolaktinoma exert impact on the symptomatology caused by local deformation and define the choice of a method of therapy.

Manifestations of a prolaktinoma can be caused as the increased prolactin level, and a prelum by a tumor of surrounding tissues of brain. Expressiveness of symptomatology directly depends on the prolaktinoma sizes.

At the makroprolaktinoma squeezing optic nerves visual disturbances are noted (narrowing of fields of vision, difficulties in recognition of side objects, doubling in eyes). The prelum makroprolaktinomy visual decussation can lead to a blindness.

Big prolaktinoma cause symptomatology from the central nervous system: headaches, depression, feeling of alarm, irritability, emotional instability.

Besides, makroprolaktinoma, putting pressure upon a hypophysis, cause disturbance of products of other hormones of this gland.

Prolaktinoma symptoms at women.

As early manifestation of a prolaktinoma at women serves change of a rhythm of a menstrual cycle from oligo-and opsomenorrheas to an amenorrhea. Disturbance of formation of follicle-stimulating and luteinizing hormones results in lack of an ovulation and impossibility of conception.

The physiological effect of prolactin is shown in development and allocation from mammary glands of milk (galactorrhoea) in the absence of pregnancy. Milk can be emitted on drops when pressing for a nipple, either independently – periodically or constantly. The galactorrhoea at a prolaktinoma is not connected with diseases of mammary glands, including breast cancer in any way, however quite often causes the subsequent development of a mastopathy.

Giperprolaktinemiya accompanying development of a prolaktinoma leads to washing away of mineral substances from a bone tissue and to development of osteoporosis. The osteoporosis caused by change of structure of a bone tissue causes increase in fragility of bones. Oestrogenic deficit causes a delay of liquid and increase in body weight.

If the current of a prolaktinoma is accompanied by a giperandrogeniya, then at the woman the hirsutism and acne rash develops.
At women mikroprolaktinoma meet more often.

Prolaktinoma symptoms at men.

Influence of a prolaktinoma on a male body is expressed in reduction of level of testosterone and disturbance of a spermatogenesis. Weakening of sexual desire, a potentiality, disturbance of an erection results, infertility develops. Chest glands increase in sizes (gynecomastia), the galactorrhoea sometimes develops. Among other manifestations of a prolaktinoma at men the atrophy of testicles, reduction of growth of hair in the person, osteoporosis and muscular weakness is noted.

At men of a prolaktinoma often reach the big sizes (makroprolaktinoma).

Diagnosis:

High-informative method at suspicion on prolaktiny is brain MRT with an aim research of a hypophysis the contrasting substance gadoliniumy. Magnetic and resonant scanning allows to reveal outlines of small adenomas, their intrasellyarny or ekstrasellyarny arrangement, and also the tumors located in myagkotkanny educations (a cavernous sine, in the field of carotid arteries and t of),

At makroprolaktinoma brain KT since well visualizes bone structures (the basis of the Turkish saddle – anatomic area of an arrangement of a hypophysis) is more applicable.

Laboratory definition in blood serum of level of prolactin is recommended to be carried out three times, in different days for an exception of the accidental or arisen in connection with a stress fluctuations of its values. The prolactin level indicator> 200 ng/ml (or> 9,1 nmol/l) testifies in favor of a prolaktinoma (norm of prolactin for women - < 20 нг/мл, для мужчин - <15 нг/мл).

At increase in concentration of prolactin to 40 - 100 ng/ml (<1,8 - 4 5 нмоль л и отсутствии убедительных данных за пролактиному необходимо исключить другие возможные причины a target="_blank" href="index-3171.htm" tppabs="medicalmeds.eu/endokrinologiya/giperplolaktinemiya/">giperprolaktinemiya: pregnancy, a hypothyroidism, thorax injuries, insufficiency of functions of kidneys and a liver, reception of the medicines stimulating production of prolactin, functional disturbances of gipotalamo-pituitary system.

From stimulation tests the test with tiroliberiny is most indicative. Normal after intravenous administration of drug in 15-30 minutes there is strengthening of production of prolactin, and its concentration not less than exceeds initial level twice. Patients with prolaktinomy have later stimulations synthesis of prolactin or remains the same, or amplifies less than twice. At a giperprolaktinemiya of not tumoral genesis reaction on тиролиберин, close to normal is observed.

In the presence of complaints from organs of sight to the patient the research of fields of vision and consultation of the ophthalmologist is conducted. For an exception of osteoporosis determination of density of a bone tissue - densitometry is carried out.

Treatment of a prolaktinoma:

Usually treatment of a prolaktinoma medicamentous, directed to decrease in level of prolactin. Selection of the scheme of treatment and optimum doses of drugs is carried out by the endocrinologist according to data of additional methods of a research.

Drugs are used: Bromocriptinum (Parlodelum, sweating rooms), a levodopa, lergotrit, лизурид, цирогептадин, Peritolum, достинекс (каберголин). Reception of Bromocriptinum causes decrease in concentration of prolactin to norm within several weeks in 85% of patients. As advantages of a dostineks serve the prolonged action (there is enough 1-2 inclusion in week), the smallest, than at Bromocriptinum, amount of side effects.
In process of administration of drugs the sizes of a prolaktinoma and secretion of prolactin decrease, sight improves; small microadenomas can disappear absolutely. At women the menstrual cycle is normalized, fertility (ability to conceive the child) is recovered. At men testosterone level increases, sexual function is normalized, there is an improvement of a spermogram.

At makroprolaktinoma medicinal therapy is performed under control of a tomography of a tumor in dynamics.

If the sizes of a makroprolaktinoma do not decrease against the background of administration of drugs, and deterioration in sight progresses, the issue of operational removal of adenoma is resolved. Removal of a prolaktinoma (adenomectomy) is carried out through transsphenoidal access – microincision in nasal bosoms.

In some cases for treatment of a prolaktinoma resort to the radiation therapy allowing to stop reception of medicines. The effect of radiation therapy gradual, is completely shown several years therefore radiation is not applied at the young women planning pregnancy later. The by-product of radiation therapy should be considered development of pituitary insufficiency. In this case replacement therapy is necessary for the patient: glucocorticoids at development of insufficiency of adrenal glands, L-thyroxine – at insufficiency of function of a thyroid gland (development of a hypothyroidism), sex hormones (testosterone to men and estrogen to women).

Forecast and prevention:

Predictive data at a prolaktinoma are caused by the size, hormonal activity and the clinical course of a disease. The recurrence of a prolaktinoma and resuming of a giperprolaktinemiya in the 5-year postoperative period comes at 20-50% of patients. Postoperative improvement at makroprolaktinoma is noted in only 10-30% of cases.

Medicinal therapy of a prolaktinoma is expected long term. At mikroprolaktinoma having rummaged in treatment 1 time in 2 years for several weeks is arranged. At a part of patients the tumor disappears for this period. At makroprolaktinoma long-term drug treatment since progressing of growth of adenoma at breaks in treatment is possible is carried out.

Predictively ozlokachestvlenny prolaktinoma are adverse.

As the etiology of development by prolactin is not defined, prevention provides, first of all, the prevention of recurrent tumors. For patients dispensary control is established: the computer tomography and survey of the ophthalmologist is annually carried out, prolactin level in blood twice a year is defined.