月经过少闭经溢乳症60例临床观察

目的探讨用溴隐亭治疗月经过少、闭经、溢乳症的临床效果,以及溴隐亭的治疗用量及疗程.方法回顾分析总结1995～2000年诊治60例月经过少、闭经、溢乳症的临床资料,用溴隐亭治疗,先从小剂量1.25 mg/日治疗1周,第2周开始增加剂量至2.5 mg/日,第3周5 mg/日,症状改善后逐渐减量,至少量1.25 mg/日维持1～1.5月.结果经用溴隐亭治疗后,3例垂体微腺瘤者症状消失,月经来潮;11例月经过少,3例治疗后2～8周月经量增多,3例治疗4～12周妊娠(其中2例为高PRL);51例溢乳患者,47例治疗后溢乳停止,4例明显减少;继发不孕10例,治疗期间妊娠6例(其中4例为高PRL),治疗后妊娠1例.结论溴隐亭是药物治疗垂体泌乳素瘤的首选有效药物,对高PRL引起的月经量少、闭经及不孕治疗效果好,对某些不明原因的乳房溢乳、继发不孕可考虑使用溴隐亭治疗.     

溴隐亭治疗对克罗米芬无反应的正常催乳素血症性无排卵

本文对14例下丘脑性闭经患者进行溴隐亭治疗观察。14例中原发闭经5例,继发闭经9例。平均年龄29.5岁(18～38岁),继发闭经时间为1～16年,血清催乳索(PRL)水平均正常(<25ng/ml),无溢乳及溢乳史而排除雄激素过多症、神经性厌食     

高泌乳素血症伴不孕症49例治疗探讨

目的:探讨高泌乳素血症伴不孕症治疗方案及效果。方法:2002年1月～2007年6月本院生殖医学专科收治的高泌乳素血症伴不孕症患者49例,采用分组治疗:A组26例(其中2例为垂体巨腺瘤,已行开颅垂体瘤切除术),采用溴隐亭口服治疗;B组23例(其中1例为垂体微腺瘤),采用溴隐亭阴道给药治疗。用药半个月、1个月、1个半月后观察泌乳素(PRL)变化情况。对PRL值降至25ng/ml以下者采用CC/HMG/HCG方案促排卵,观察妊娠情况。结果:经半个月、1个月或1个半月溴隐亭口服或阴道给药治疗后,各组血PRL值较治疗前明显降低(P0.05或P0.01);A组与B组比较,PRL值治疗前后差异均无统计学意义;A组25例、B组21例PRL降至25ng/ml以下,给予CC/HMG/HCG方案促排卵后,分别有18例和14例妊娠。结论:溴隐亭口服与阴道给药两种治疗方案在降低高泌乳素血症伴不孕症患者PRL水平方面疗效无明显差异,溴隐亭阴道给药是治疗高泌乳素血症伴不孕症可选方案之一。     

控制性超促排卵中溢乳症的临床处理分析

目的探讨不同临床处理对体外授精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)中伴溢乳症的不孕症患者妊娠结局的影响。方法选择在邢台不孕不育专科医院生殖中心接受IVF-ET的不孕症患者358例,其中伴溢乳症296例,无溢乳症及基础血清催乳素(prolactin,PRL)正常的62例。按有无溢乳症、高PRL血症及其处理方法分为5组,A组为溢乳症不伴有高PRL血症,应用甲磺酸溴隐亭治疗;B组为溢乳症伴有高PRL血症,应用甲磺酸溴隐亭治疗;C组为溢乳症不伴有高PRL血症,应用中药治疗;D组为溢乳症不伴有高PRL血症,未给予药物治疗;E组为无溢乳症及基础血清PRL正常。比较5组不孕症患者外源性促性腺激素(gonadotropin,Gn)启动日PRL水平、注射绒毛膜促性腺激素(chorionic gonadotrophin,HCG)日PRL水平、获卵数、可用胚胎数、临床妊娠率。结果 5组不孕症患者比较,A组临床妊娠率最低(P0.05);在Gn启动日和注射HCG日,A组PRL水平低于其他4组(P0.05)。结论不孕症患者无高PRL血症的溢乳症状无需进行治疗,为改善症状,中药治疗可作为很好的尝试。     

溴隐亭阴道用药法治疗高泌乳素血症的效果

口服溴隐亭治疗高泌乳素血症有较高的副作用发生率。作者为评价溴隐亭阴道给药法治疗高泌素血症妇女的效果,在连续非选择地对15例泌乳和高泌乳素血症妇女进行治疗。15例中10例有2～12年继发闭经史,5例月经稀发,年龄21～42岁,身高145～165cm,体重43.6～76.4kg,无服用促进泌乳素升高的药物史,甲状腺功能均正常。10例闭经者中6例对孕酮试验无反应。15例中9例CT检查证明有垂体瘤,余6例为特发性高泌乳素血症。10例(包括5例垂体瘤)曾用过口服溴隐亭2.5～20mg,停药12周后参加本研究,其停药目的只为参加此研     

低剂量溴隐亭联合逍遥丸治疗女性高泌乳素血症性不孕临床观察

目的溴隐亭与逍遥丸均可治疗高泌乳素血症,但两者联合使用研究较少。本研究旨在探究低剂量溴隐亭联合逍遥丸治疗女性高泌乳素血症性不孕的临床效果。方法选择2016-07-06-2018-11-12本院收治的高泌乳素血症性不孕女性患者84例,根据年龄、病程组间均衡的原则分为两组,每组各42例。对照组采用溴隐亭进行常规治疗(初始1.25mg/d,7d后1.25mg/d),观察组采用低剂量溴隐亭联合逍遥丸治疗(溴隐亭1.25mg/d,逍遥丸18g/d)。对比分析两组临床疗效、血清泌乳素(prolactin,PRL)、排卵率、妊娠率和不良反应发生率。结果观察组治疗总有效率为97.62%,高于对照组的73.81%,差异有统计学意义,χ~2=9.722,P=0.002。治疗后30d观察组血清PRL水平为(27.46±8.21)μg/L,低于对照组的(31.58±9.64)μg/L,差异有统计学意义,t=2.109,P=0.038;治疗后45d观察组血清PRL水平为(20.16±5.81)μg/L,低于对照组的(26.79±6.57)μg/L,差异有统计学意义,t=4.899,P<0.001。观察组排卵率为90.48%,高于对照组的71.43%,χ~2=4.941,P=0.026;妊娠率为80.95%,高于对照组的59.52%,χ~2=4.613,P=0.032;不良反应发生率为2.38%,低于对照组的19.05%,差异有统计学意义,χ~2=4.480,P=0.014。结论低剂量溴隐亭联合逍遥丸治疗女性高泌乳素血症性不孕,可有效降低血清PRL水平,提高排卵率和妊娠率,且安全性较高,临床疗效显著。     

闭经溢乳早诊治

小王今年26岁,未婚。闭经6个月,且发现双侧乳房溢乳。在门诊经CT检查颅脑,诊断为垂体瘤。给予溴隐亭治疗1年,CT复查颅脑,肿瘤明显缩小,且恢复月经,停止溢乳。 闭经溢乳综合征在临床上比较常见。其病因有以下几种:①垂体肿瘤:垂体肿瘤由催乳素的细胞组成,易发生溢乳闭经。②药物的影响:较长时间服用利血平、氯丙嗪、酚噻嗪、     

女性高催乳素血症48例临床分析

目的 探讨高催乳素血症患者的病因、临床特点、诊断方法及治疗.方法 回顾性分析近两年在西安交通大学医学院第一附属医院妇产科生殖内分泌门诊及研究室就诊的48例女性高催乳素血症患者的临床资料.结果 48例高催乳素血症患者中,垂体微腺瘤22例,巨腺瘤1例,空蝶鞍综合征2例,原发性甲状腺功能减低2例,多囊卵巢综合征5例,药物因素所致3例,特发性高催乳素血症13例;1例巨腺瘤应用伽玛刀后加溴隐亭治疗,2例原发性甲状腺功能减低补充甲状腺激素,5例多囊卵巢综合征患者用二甲双胍加安体舒通治疗,余40例均服用溴隐亭治疗;41例血清催乳素降至正常范围,14例溢乳明显减少,8例溢乳停止,21例月经恢复正常,16例B超监测有排卵并获妊娠,4例分娩正常婴儿.结论 高催乳素血症是育龄期妇女不孕症的主要原因之一,而垂体催乳素腺瘤是女性高催乳素血症的最常见原因,其治疗针对病因处理,除垂体大腺瘤神经压迫症状需手术治疗外,溴隐亭是治疗高催乳素血症首选的安全且有效的药物.     

高催乳素血症对男性性功能的影响研究

目的 提高高催乳素血症所致男性性功能障碍的诊治水平.方法 采用甲磺酸溴隐亭治疗高催乳素血症所致男性性功能障碍患者24例.其中垂体腺瘤5例(微腺瘤4例、巨腺瘤1例),特发性高催乳素血症19例.性功能障碍包括性欲差24例,勃起功能障碍22例,性高潮障碍4例.1例患者诉视野受限和头痛.结果 溴隐亭(1.25 ～5 mg/d)治疗0.5～14个月,24例患者性欲均得到不同程度改善,勃起功能改善18例,性高潮障碍功能改善4例.4例垂体腺瘤体积缩小(较原肿瘤缩小2～7 mm).4例患者治疗后症状缓解程度不满意,血清睾酮水平较低,加服十一酸睾酮(40mg/次,2次/d)治疗0.5 ～ 1.5个月后性功能障碍改善,但血清睾酮水平无明显增加.结论 高催乳素血症所致男性性功能障碍较为少见,常见原因为特发性和垂体腺瘤,溴隐亭治疗效果良好,治疗中应注意维持下丘脑-垂体-性腺轴功能的稳态.     

溴隐亭治疗高泌乳素血症的临床观察

高泌乳素(PRL)血症是多种病因所致的血清泌乳素浓度超过正常(正常妇女血清PRL浓度为1~23ug/L,男性1~20ug/L),临床上女性可表现为溢乳症或溢乳—闭经症;男性呈性功能低下或阳萎。采用澳隐亭治疗可以使溢乳症状消失,降低泌乳素水平,恢复月经和生育功能;男性恢复性功能。现就近四年中20例患者治疗结果分析报告如下。     

Interest in prolactin levels in galactorrhea

The action of prolactin (PRL) in supra-physiological levels on the ovaries or on the hypothalamic-pituitary axis for the release of gonadotropins leads to a reversible inhibition of the cyclic functioning of the pituitary gland and of the ovaries. The consequences are either the production of immature follicles marked by anovulatory or dysovulatory cycles, or the absence of follicle production marked by amenorrhea. Thus, prolactin plays a major role in the productive system by its lactotropic and antigonadotropic effects. Through this study we intend to try to determine the diagnostic value of the association of the cyclic dysfunctions with galactorrhea by measuring the prolactin levels in 2236 patients complaining of galactorrhea. Measurements of FSH and LH levels were also performed in 236 women among those consulting for infertility associated with galactorrhea. The results obtained showed that galactorrhea was associated with prolactenemia in only 17% of cases and of the ovaries was proportional to the prolactin in blood.     

Gonadotropin releasing hormone loading test with bromocryptin therapy: a new possibility in the differential diagnosis of normo-prolactinaemic anovulation]

An anovulation group with normal basal prolactin level (less than 600 mU/l) was found during GnRH loading tests. After GnRH administration there was a definite increase in prolactin value together with an insufficient hypophyseal response. Bromocriptine treatment was commenced on the 10th day (daily 2.5 mg) before carrying out the GnRH loading tests again. During the repeated tests prolactin levels remained normal, basal FSH and LH values increased and reactive hypophyseal responses occurred. On the basis of the examination a group ("latens hyperprolactinemia") responding with increased prolactin production during GnRH administration was found. This higher prolactin level inhibits gonadotropin release from hypophysis. In these cases ovulation induction with bromocriptine is adviseable in spite of basal prolactin level is normal.     

Retrograde Ejaculation Accompanying Hyperprolactinemia

A patient, 38 years of age with 10 years of infertility, suffered from an ejaculation disorder for 2 years. Based on a diagnosis of retrograde ejaculation, sperm retained in the bladder was collected and homologous artificial insemination was carried out, but pregnancy was not achieved. The subject was examined at the Department of Urology and hormone tests were conducted showing hyperprolactinemia, hypogonadotropinemia, and hypotestosteronemia. A CT scan showed a pituitary tumor. Administration of 7.5 mg/day of bromocriptine was initiated to treat this tumor. Antegrade ejaculation recurred 1 month after administration, and pregnancy was achieved from normal sexual intercourse 5 months after administration.     

Prolactin and gonadal function

Much information has been gathered on the role of human prolactin in both physiological and pathological lactation since it was identified in 1971. Although estrogens increase the number and activity of the prolactin-secreting cells, they block the action of prolactin on the breast. As a result, circulating prolactin levels rise 20-50 fold during pregnancy, but lactation does not start until estrogen levels have fallen after delivery. Prolonged breast feeding maintains high serum prolactin levels. After suckling there is an additional rise. These high serum prolactin levels act to impair fertility by several mechanisms: the ovaries are resistant to gonadotropin stimulation; the frequency of pulsatile pituitary gonadotropin secretion is reduced, and there is suppression of the normal pre-ovulatory gonadotrophin surge in response to rising estradiol levels. The contraceptive effect of lactation has proved unreliable in individual women. Small amounts of prolactin circulate in males and non-pregnant females but have no identified function. Sustained hyperprolactinemia causes galactorrhea and hypogonadism in both sexes: amenorrhea or infertility in females and relative or absolute impotence in males. Sustained hyperprolactinemia is most often the result of a prolactin-secreting pituitary tumor. The management of hyperprolactinemic patients calls for consideration of the endocrine abnormalities and of the pituitary tumor if 1 has been found.     

口服黄体酮在黄体支持中的作用

目的:探讨口服黄体酮在黄体支持方面的作用。方法:采用随机分组病例对照研究,对10例非子宫性闭经患者除外妊娠后给予口服黄体酮胶丸治疗1周后诊刮并送病理。另将监测排卵指导受孕和IUI的患者120例随机分为4组,按黄体支持的不同方法设研究A、B、C 3组:A组给予肌注HCG,B组给予肌注黄体酮,C组给予口服黄体酮胶丸,设空白对照D组不予任何黄体支持。所有患者均在TVS监测排卵后开始黄体支持,在排卵后1周测定血E2和P水平。结果:①10例闭经患者在口服黄体酮胶丸1周后进行子宫内膜活检,有6例提示分泌期子宫内膜;②给予黄体支持的A、B、C 3组患者血P水平与对照D组比较差异均有显著性(P<0.05),而A、B、C 3组组间血P水平比较差异无显著性(P>0.05);4组患者血E2水平比较差异无显著性(P>0.05)。结论:①口服黄体酮可以将增殖期子宫内膜转变成分泌期子宫内膜,有明显的孕激素活性;②口服黄体酮用于黄体支持的效果与肌注HCG和黄体酮相似,可以作为一种常规的黄体支持方式;③口服黄体酮200 mg/d与肌注黄体酮20 mg/d生物效应相当。     

Macroprolactinemia in the differential diagnosis of hyperprolactinemia

INTRODUCTION: Biologically active prolactin and the inactive fraction of macroprolactin can be present in hyperprolactinaemic sera. The reaction of routinely used prolactin assays with macroprolactin is variable. AIMS: The present study was undertaken to analyse the leading clinical signs of hyperprolactinemia in macroprolactinemia and true hyperprolactinemia and to assess the prevalence of macroprolactinemia in hyperprolactinemic females. METHODS: 1571 consecutive female patients were investigated for hyperprolactinemia. Prolactin was measured before and after precipitation of macroprolactin by polyethylene glycol in 285 hyperprolactinemic (> 520 mlU/l) patients. Since not a single case of macroprolactinemia (recovery < 40%) was found in the range of 520-700 mlU/l, only in women with prolactin > 700 mlU/l (N = 254) entered the study. RESULTS: In 59 patients (23%) macroprolactinemia was found. In women, the occurrence of macroprolactinemia increased with advancing age (p < 0.05). "A priori" clinical signs indicating hyperprolactinemia occurred less frequently in patients with macroprolactinemia than in those with true hyperprolactinemia. Pituitary microadenoma was found in 9.8% of macroprolactinemia vs. 31.6% in true hyperprolactinemia (p < 0.01); galactorrhea: 4% in macroprolactinemia vs. 19% in true hyperprolactinemia, (p < 0.05); infertility: 17% in macroprolactinemia vs. 44% in true hyperprolactinemia (p < 0.05). In 8 out of 59 women with macroprolactinemia, true hyperprolactinemia appeared simultaneously (15.3%). Occurrence of polycystic ovaries syndrome was more frequent in the true hyperprolactinemia (12%) that in macroprolactinemia (4.5%). CONCLUSIONS: It has been shown that macroprolactin does not occur in mild hyperprolactinemia. In women, the occurrence of macroprolactinemia increases with age. "A priori" clinical signs indicating hyperprolactinemia and pituitary abnormality are less frequent in macroprolactinemia than in true hyperprolactinemia. The diagnosis of macroprolactinemia should be used only, when the PRL levels fall to the normal range after precipitation. To avoid diagnostic and therapeutic pitfalls the screening for macroprolactin of all patients with prolactin > 700 mlU/L is recommended.     

输卵管通液术结合中西药物治疗不孕症

目的　探讨不孕症治疗方法。方法　采用输卵管通液术配合中西药物治疗不孕症。结果　186例不孕症患者中 ,治疗 18个月内妊娠者 16 7例 ,占 89 8% ;3年内妊娠者 9例 ,占 4 8% ;3年以上未孕 10例 ,占 5 4 % ;多胎妊娠 2例 ,约占 1%。结论　卵巢功能异常的无排卵或排卵不正常不孕症临床上较为多见 ,而输卵管堵塞 ,子宫内环境不良又是阻碍正常受精卵到达宫腔并成功着床的障碍因素 ,采用输卵管通液术结合中西药治疗效果良好。     

月经失调与甲状腺功能的联系——对1495例临庆系列病例的分析

目的探究月经失调形式和甲状腺功能（甲功）之间的联系。方法系列分析2006年1月4日至2011年3月2日妇科内分泌中心就诊的1495例患者的临床资料,均填写详细病史表格及检测促甲状腺激素、游离三碘甲状腺氨酸与游离甲状腺素水平。结果①临床月经失调和不育患者在系列病例中甲功异常发生率为13．4％;②甲功正常与甲功异常的月经分布情况无统计学差异（P=0．107）。但甲功异常者发生月经失调率是甲功正常者的1．49倍;③不同甲状腺功能状态下的月经分布情况均无统计学差异（P〉0．05）。但甲亢者发生月经失调率是甲功正常者的2．31倍。亚甲亢者是甲功正常的1．40倍。亚甲减者是甲功正常的1．27倍。甲减者发生月经失调率最高,是甲功正常的3．31倍;④甲亢与甲功正常者相比,月经过少发生率有统计学差异（P=0．025）。亚甲减者发生子宫异常出血率和月经稀发率分别是甲功正常者的1．36倍和1．34倍;甲减者发生闭经率最高,是甲功正常者的5．96倍;亚甲亢和甲亢发生月经过少率均最高,分别是甲功正常者的3．42倍和10．3倍;⑤各类与甲功异常类型联系最密切的月经失调患者的促甲状腺激素、游离三碘甲状腺氨酸与游离甲状腺素水平均有统计学差异（P〈0．001）。结论甲状腺功能低落或亢进均有可能发生月经失调。甲减合并的月经失调类型总体偏于月经稀发和闭经。亚甲减与合并子宫异常出血和月经稀发的发生都较密切。甲亢和亚甲亢的月经失调类型均以月经过少为主。     

Galactorrhea secondary to chest wall surgery in an adolescent

Although nonpuerperal galactorrhea in youth may be a sign of pituitary prolactinoma, the etiology may be benign and extensive neurologic or endocrinologic evaluation and treatment may be unnecessary. An 18-year-old female with an unusual but benign form of transient galactorrhea due to chest wall surgery is reported. It is hypothesized that the sectioning of the intercostal nerves may result in reflex stimulation of hypothalamic centers controlling lactation through the same neural pathways involved in puerperal lactation. The patient experienced galactorrhea for two months and transient amenorrhea. She is asymptomatic without galactorrhea at nine months follow up.