摘要
Prolactin is a pulsatile, not a static, hormone. Prolactin secretion occurs episodically in 14 secretory pulses over 24 hours. It has a circadian fluctuation, with the highest levels achieving between 4 and 6 am and the lowest occurring between 10 am and noon. The nocturnal elevation is sleep entrained, especially in non-rapid eye movement sleep (REM). It is essential for human species survival by milk production during pregnancy and lactation. Hyperprolactinemia is the most common hypothalamic-pituitary disorder encountered in clinical endocrinology, obstetrics and gynaecology. Hyperprolactinemia may be due to a prolactinoma, secondary to other causes and physiologic hypersecretion. The most common cause of hyperprolactinemia is prolactinoma. Secondary to other causes including drug effects, renal disease, liver disease, hypothyroidism and polycystic ovary syndrome should be ruled out before investigating prolactinoma. They present with clinical features of hyperprolactinemia (galactorrhea, gonadal hypofunction). Headache and visual field defects due to optic chiasm compression are common in patients who have macroprolactinomas. Indications for treatment would contain the presence of confusing symptoms, such as menstrual disturbance, bothersome galactorrhea, infertility, impotence, long-lasting hypogonadism, and prevention of bone loss. Medical therapy with dopamine agonists is well responsive in achieving normoprolactinemia in most patients, and other methods of treatment such as surgery and radiotherapy currently have many limited indications. The pregnant women with prolactinomas need careful planning and close monitoring.
並列摘要
泌乳素(prolactin)是以一種脈衝的方式所分泌的激素。正常的個體一天中大約有14個分泌波峰。除此之外，泌乳素的分泌量亦有日夜的差異，亦即與周圍環境的光暗週期有關。夜間睡眠時，特別是在非快速動眼期(non-rapid eye movement)呈現較高量的分泌。在人類懷孕和泌乳期，泌乳素的主要作用是刺激乳汁分泌。高泌乳素血症(hyperprolactinemia)是內分泌科和婦產科最常見的下視丘－腦下腺軸疾病。造成原因包括最常見的泌乳素瘤(prolactinoma)及其他次發性和生理性過度分泌。懷疑泌乳素瘤要先排除藥物、甲狀腺功能低下、肝腎疾病、多囊性卵巢症等等。臨床症狀包括溢乳、性腺功能低下，如果是巨泌乳素瘤，可能壓迫到視交叉造成頭痛、視野缺損。病患如有溢乳、月經不規則、不孕、性無能、性腺功能低下等明顯症狀和為了預防骨質疏鬆，可考慮治療。多巴胺促效劑(dopamine agonists)可讓大部分病患泌乳素恢復正常，其他治療方法包括手術和放射治療，但皆有其限制。泌乳素瘤的懷孕病患在妊娠期需要謹慎地追蹤。
延伸閱讀
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