How drug therapy is carried out by hyperprolactinemia? How is surgical treatment? How the hyperprolactinemia radiation therapy is carried out? Answers to these questions you will find in the article.
Content
restoration of disturbed gonadal functions and fertility (the ability of a mature organism to produce offspring) like women,
So in men, and if there are prolactines - a decrease in the mass of the tumor.
With all the forms of hyperprolactinemia, the main method of treatment is
Medical, which, if prevailing, competes from
Surgical and radiation methods.
Medicate therapy hyperprolactiakiyia
Preparations that can reduce the secretion of the PRL (prolactin) can
divided into 2 groups - derivatives of alkaloids of the ardines - ergoline and
Preparations that are not related to derivatives of alkaloids, -
Neergolinovye. The first includes short-acting drugs
2-bromo-aero-cryptine and 2-bromo-a and (3-ergocriptine and ergolin
Derivative with long and selective action (Cabergoline). Second -
Tricyclic benzoguanolins derived, synthesized specifically
To reduce the level of PRL (Crownagolide).
Brahrocriptine - first semi-synthetic alkaloid argot,
Forest wide application in the clinic since 1972. Bromocriptine is a preparation of the first row, with
the appointments of which begins the therapy of hyperprolactiasis
states requiring medication treatment.
Bromocriptine after oral administration is well absorbed.
Reducing the preload level (prolactin) begins 1-2 hours after receiving the drug,
reaches maximum, t.E. Reducing the concentration of OPR by more than 80%
after 5-10 hours and persists close to the maximum level during
8-12 C. Bromocriptine treatment starts, as a rule, with low doses
(0,625; 1.25 mg usually before bed with food to prevent nausea and
orthostatic hypotension), increasing them by 0.625-1.25 mg every 3-4
day until the total dose of 2.5-7.5 mg per day will be reached
(taken fractionally 2-3 times a day during meals). Dose is selected
individually under the control of the level of PRL (prolactin) and if necessary
Increases every two weeks.
It is shown that the reception of bromocriptine allows you to restore
Normal level of PRL (prolactin). At
Macroprolactinities The level of PRL (prolactin) is normalized by more than 60% of cases. Therapy
Bromocriptine causes dystrophic changes and necrosis (death) in tumor
Cells, while a decrease in the size of Macroprolactin is achieved in 70%
Cases.
From the side effects of the drug for the first few days
treatment in some patients is notable for light nausea or,
less often, dizziness, weakness or vomiting, which, however, is not so
strong to demand termination of therapy.
Surgery
hyperprolaktemia
Currently, adenomectomy (removal of a diffascular tumor) is not a choice for
Treating patients with prost-secreting tumor. In patients with S
Microenomas manages to produce selective transfenoidal
adenomectomy, but in a significant number of patients (20-50%) for 5
After the operation, recurrence (re-manifestation) of hyperprolactinemia develops.
The success of the operation is determined mainly by the size of the tumor (its
distribution) and neurosurgeon experience. Smaller adenoma
better succumb to surgical treatment than larger pituitary tumors
Sizes. An indicator of the long-term effect of the operation serves
Postoperative level of PRL (prolactin) in blood serum. If after 10-15 days
After the operation of reducing or normalizing the level of PRL (prolactin) does not occur,
You can think about incomplete disposal of adenoma. In such cases, shown
Combined treatment.
Radiation therapy
hyperprolaktemia
Since positive effects after irradiation prolactin
develop gradually and until the development of the complete effect takes up to 12-18
Mes, and also possible complications (brain tissue necrosis, damage
visual nerves, in a remote period - hypocituitarism), radiation
Prolactin therapy is applied in exceptional cases and not always
Effective. Indications for radiation therapy prolactin are
inefficiency and intolerance to drug therapy, big
residual volume of tumor tissue after surgery, as well as availability
Contraindications to surgical treatment or failure of a patient
Surgical treatment.
Thus, treatment of hyperprolactinemia requires
differentiated (selective) approach with clinical and biochemical,
X-ray data and includes both monotherapy with agonists
dopamine, operational intervention or irradiation and their combination in
Different options.
To the treatment you need to approach strictly individually. Because I
Medical therapy and adenomectomy effectively reduce the level of
(prolactin) in serum, both of these methods can be used for
Treating hyperprolactinemium tumor genesis.
Preparations that reduce the level of PRL (prolactin) begin to act
quickly and appointing exactly they prefer to use as
primary treatment.
Operation, if it is completed successfully, has an advantage
disposable procedure, but may disrupt the normal functions of the front and
rear lobes of pituitary, as a result of what in patients who have previously suffered
only hyperprolactinemia, can develop transient or
Permanent hypocituitarism and unacceptable diabetes.
Medical and surgical treatment do not necessarily exclude
each other. In difficult cases, when the patient has a larger tumor
sizes may need to use dopamiomimetics as before, so
And after adenomectomy.
