HIPERPROLAKTINEMIJA - Despotovic, Mile Lj (PONS - medicinski časopis, 2017)
Aleksandar Aleksić1, 2, Vojkan Stanojević2, Saška Manić2, Mile Despotović,1 Nataša Savić,1 Čedomirka Stanojević1 Visoka medicinska škola strukovnih studija Ćuprija1 Zdravstveni centra Zaječar2 Aleksandar Aleksić lukaal@ptt.rs ZC Zaječar Interno odeljnje Rasadniča b.b. 19000 Zaječar Sažetak Hipersekrecija prolaktina je najčešći sindrom povišenog lučenja hormona hipofize kod oba pola. Tumori hipofize koji luče prolaktin su najčešći tip funkcionalnih tumora hipofize. To su jedini tumori koji mogu biti lečeni isključivo medikamentnom terapijom. Klinička slika hiperprolaktinemije različita je u muškaraca i žena. Kod žena relativno rano dolazi do poremećaja menstrualnog ciklusa i pojave galaktoreje. Kod muškaraca su simptomi duže diskretni, obično u smislu slabije potencije pa će ti tumori prilikom postavljanja dijagnoze već biti makroadenomi (80%). Dijagnostika hiperprolaktinemije i prolaktinoma obuhvata endokrinološko testiranje uz radiološku i oftalmološku obradu. Radiološki „zlatni standard“ za dijagnostiku svih tumora hipofize, pa tako i prolaktinoma, jeste magnetna rezonanca. Oftalmološka obrada važna je posebno kod makroadenoma, jer oni svojim pritiskom na hijazmu optičkog živca mogu dovesti do ispada u vidnom polju. Terapija prolaktinoma može biti medikamentna, operativna i/ili terapija zračenjem. U medikamentnoj terapiji, koriste se agonisti dopamina koji, vezivanjem za dopaminske receptore, dovode do normalizacije nivoa prolaktina, a imaju i tumoricidno delovanje te dovode do smanjivanja, a ponekad i nestanka tumora. Neurohirurška terapija, najčešće transsfenoidalnim pristupom, koristi se kod rezistentnih tumora i kod onih koji svojom propagacijom ugrožavaju okolne strukture. Terapija zračenjem gotovo nikada nije prvi vid terapije prolaktinoma. Danas se redje koristi konvencionalno zračenje, a češće stereotaktička „gamma-knife“ iradijacija kojom se postižu visoke doze zračenja ciljano na tumorsko tkivo, uz očuvanje okolnog tkiva. Ključne reči: hiperprolaktinemija, dijagnoza, lečenje. Summery Prolactin hypersecretion is the most common syndrome of increased secretion of the pituitary hormone in both sexes. Hypophyseal tumors that secretes prolactin are the most common type of functional pituitary tumor. These are the only tumors that can be treated exclusively by medication therapy. The clinical picture of hyperprolactinaemia is different in men and women. In women, there is a relatively early onset of menstrual cycle disorders and the occurrence of galactorrhoea. In men, the symptoms are discrete for a long time, usually in the sense of less potency, and these tumors will be makroadenomains when diagnosing (80%). The diagnosis of hyperprolactinaemia and prolactinoma includes endocrinological testing with radiological and ophthalmic tests. A radiological "gold standard" for the diagnosis of all pituitary tumors, and thus prolactinoma, is a magnetic resonance. Ophthalmological tests are important especially for macroderenomas because they can lead to a fall in the visual field by pressing the optic nerve hijazm. Prolactinoma therapy can be by medication, surgical and/or radiation therapy. In drug therapy, dopamine agonists are used which, by binding to dopamine receptors, lead to normalization of the level of prolactin, and they also have tumoricidal activity and lead to a reduction of and sometimes, tumor failure. Neurosurgical therapy, most often with transsphenoidal approach, is used in resistant tumors and in those who endanger the surrounding structures with their propagation. Radiation therapy is almost never the first line of prolactin therapy. Today, conventional radiation is used more often, and more often stereotactic "gamma-knife", irradiation that achieves high radiation doses targeted to the tumor tissue, while preserving the surrounding tissue. Key words: hyperprolactinaemia, diagnosis, treatment.