Methods of treatment of hyperprolactinemia


  • Drug treatment of hyperprolactinemia
  • Surgical treatment of hyperprolactinemia
  • Radiation therapy hyperprolactinemia

  • On hyperprolactinemia Treatment is aimed primarily
    restoration of disturbed gonadal function and fertility (the ability of an organism to produce mature seed) in women,
    and men, and in the presence of prolactinoma - reduction of tumor mass.

    In all forms of hyperprolactinemia the main treatment is
    medical that the presence competes with prolactinomas
    surgical and radiation techniques.

    Drug treatment of hyperprolactinemia

    Drugs that can reduce the secretion of PRL (prolactin), you can
    divided into 2 groups - derivatives of ergot alkaloids - and ergolinovye
    preparations non-derivative ergot alkaloids -
    neergolinovye. The first includes a short-acting drugs
    2-bromo-aergo kriptina and 2-bromo-a-and (3-ergocryptine and ergolinovoe
    derivative sustained and selective action (cabergoline). Second -
    tricyclic derivative benzoguanolinov synthesized specifically
    to reduce the level of PRL (hvinagolid).

    Methods of treatment of hyperprolactinemia
    Bramokriptin - first semisynthetic ergot alkaloid,
    found wide application in the clinic since 1972 bromocriptine is a drug of the first row, with
    destination which therapy begins hyperprolactinemic
    conditions requiring medical treatment.

    Bromocriptine after oral administration is well absorbed.
    Reducing the level of PRL (prolactin) begins 1-2 hours after taking the drug,
    reaches a maximum, i.e. PRL concentration reduction by more than 80%
    5-10 h, and remained at close to the maximum level for
    8-12 hours. Bromocriptine treatment begins, usually with low doses
    (0.625, 1.25 mg is usually at bedtime with food to prevent nausea and
    orthostatic hypotension), on increasing their 0,625-1,25 mg every 3-4
    days, until reaching a total dose of 2.5-7.5 mg per day
    (Host fractional 2-3 times a day with meals). dose selected
    individually controlled level PRL (prolactin) and optionally
    increased every two weeks.

    It has been shown that taking bromocriptine can recover
    normal levels of PRL (prolactin). at
    macroprolactinoma level of PRL (prolactin) is normalized in more than 60% of cases. Therapy
    bromocriptine causes degenerative changes and necrosis (necrosis) in the tumor
    cells, with the size reduction achieved makroprolaktinom 70%

    Side effects from the drug during the first few days
    treatment some patients noted the presence of mild nausea or
    more rarely, dizziness, weakness or vomiting, which, however, are not so
    strong enough to require discontinuation of therapy.



    Currently prostatectomy (dobrakachestvennoy tumor removal) is not the method of choice for
    treatment of patients with PRL-secreting tumors. Patients with
    microadenomas manage to produce selective transsphenoidal
    prostatectomy, but a significant number of patients (20-50%) for 5
    years after surgery develop a recurrence (recurrence of) hyperprolactinemia.

    The operation's success is mainly determined by the size of the tumor (it
    proliferation) and experience of the neurosurgeon. Smaller adenoma
    more amenable to surgery, pituitary tumors larger than
    sizes. An indicator of the long-term effect of the operation is
    postoperative levels of PRL (prolactin) in the blood serum. If after 10-15 days
    after surgery or normalizing levels reduce PRL (prolactin) occurs,
    You can think of the incomplete removal of adenomas. In such cases shown
    combination treatment.

    Radiation therapy


    Since the positive effects after exposure prolaktinomy
    develop gradually and take full effect before the development takes place until 12-18
    months, as well as possible complications (necrosis of the brain tissue damage
    optic nerves, in the long term - hypopituitarism), radiation
    prolactin therapy is used in exceptional cases and not always
    effective. Indications for radiotherapy are prolactin
    inefficiency and intolerance to medication, a large
    residual volume of tumor tissue after surgery and the presence of
    contraindications to surgery or patient refusal to
    surgical treatment.

    Thus, the treatment requires hyperprolactinemia
    differential (selective) approach based on clinical and biochemical,
    X-ray data and includes both agonist monotherapy
    dopamine, surgery or radiation, and a combination thereof
    various embodiments.

    To treatment should be approached strictly individually. since both
    drug therapy and prostatectomy effectively reduce the level of PRL
    (PRL), serum, both of these methods can be used to
    the treatment of hyperprolactinemia tumor genesis.

    Drugs that decrease the level of PRL (prolactin), begin to act
    fast, and assign a name to them prefer to use as a
    primary means of treatment.

    Operation, if successful, has the advantage of
    a one-time procedure, but may interfere with the normal functions of the front and
    posterior lobe of the pituitary, resulting in patients who have previously suffered
    Only hyperprolactinemia, may develop transient or
    permanent hypopituitarism and diabetes insipidus.

    Medication and surgery are not necessarily excluded
    each other. In severe cases, when the patient has a tumor larger
    sizes may be required dopaminomimetikov both before
    and after prostatectomy.

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