高泌乳素血症诊治若干临床问题探讨

Clinical issues in diagnosis and treatment of hyperprolactinemia

摘要:

高泌乳素血症是继发性性腺功能减退的常见原因，影响男性及女性的生殖功能，目前高泌乳素血症的诊治存在较多挑战。在激素测定方面存在低估激素真实水平的“钩状效应”，无症状或与症状不相符的高泌乳素水平为特点的巨泌乳素血症；在诊断时应注意鉴别生理性、病理性或药物性这三大常见原因从而减少误诊、漏诊；多巴胺受体激动剂是一线治疗，但对于耐药的高泌乳素血症应在全面评估病情后选择外科手术、放疗及其他药物的试验性治疗（如替莫唑胺）等；妊娠阶段是泌乳素生理性分泌增加的时期，不建议孕期应用泌乳素测定评价病情，主要通过有无肿瘤占位效应及病情危急情况决定是否需要启动药物或手术治疗。对于耐药/难治性高泌乳素血症及妊娠期高泌乳素血症的诊疗建议在有经验的多学科诊疗团队支持下进行。

Abstract:

Hyperprolactinemia is a common cause of secondary hypogonadism，which affects the reproductive function of both men and women. There are many challenges in the diagnosis and treatment of hyperprolactinemia. There is a ‘hook effect’ in the measurement of hormone levels，which underestimates the true level of hormone. Macroprolactinemia is characterized by asymptomatic or inconsistent high prolactin levels. In order to reduce misdiagnosis and missed diagnosis，attention should be paid to distinguish the three common causes of physiological，pathological or drug. Dopamine receptor agonist is the first-line treatment，but for patients with drug-resistant hyperprolactinemia，surgery，radiotherapy and other drug trials （such as temozolomide） should be selected after a comprehensive evaluation of the condition. Pregnancy is a period of increased physiological secretion of prolactin，and it is not recommended to use prolactin measurement to evaluate the disease during pregnancy. It is mainly determined by the tumor mass effect and critical condition to decide whether to start drug or surgical treatment. The diagnosis and treatment of resistant/refractory hyperprolactinemia and hyperprolactinemia during pregnancy are recommended under the support of an experienced multidisciplinary team.