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MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY PHAM THI THU HUYEN RESEARCH ON DIAGNOSIS AND TREATMENT OF HYPERPROLACTINEMIA SYNDROME IN WOMEN Specialism Obstetrics and[.]
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY PHAM THI THU HUYEN RESEARCH ON DIAGNOSIS AND TREATMENT OF HYPERPROLACTINEMIA SYNDROME IN WOMEN Specialism: Obstetrics and Gynecology Code : 9720105 ABSTRACT OF MEDICAL DOCTORAL THESIST HANOI - 2022 The Thesis has been completed at: HANOI MEDICAL UNIVERSITY Supervisor: A/Prof Le Thi Thanh Van MD PhD A/Prof Duong Dai Ha MD PhD Reviewer 1: A/Prof Vuong Tien Hoa MD PhD Reviewer 2: A/Prof Ha Kim Trung MD PhD Reviewer 3: A/Prof Nguyen Viet Trung MD PhD The Thesis will be presented in front of board of University Examiner and Reviewer lever at… on ….2022 This thesis can be found at: National Medical Informatics Library Library of Hanoi Medical University THE LIST OF WORKS HAS PUBLISHED AND RELATED TO THE THESIS Pham Thi Thu Huyen, Le Thi Thanh Van, Duong Dai Ha Research on pregnant rates of female infertility 2020 Journal of Practical Medicine ISSN: 1859-1806 Pham Thi Thu Huyen, Le Thi Thanh Van, Duong Dai Ha Clinical and paraclinical characteristics of PRL hypersecretion syndrome women 2020 Journal of Practical Medicine ISSN: 1859-1663 Pham Thi Thu Huyen, Le Thi Thanh Van, Duong Dai Ha Research on internal treatment results in PRL hypersecretion syndrome women 2020 Journal of Vietnam Medicine ISSN 1859-1868 INTRODUCTION Hyperprolactinemia in the blood has early clinical manifestations such as breast lactation outside of pregnancy (85%), amenorrhea (94%), infertility (32.7%), and menstrual disorders (26.5%), especially in young women Increased PRL in the blood inhibits the rhythmic secretion of GnRH, alters the release of FSH and LH, blocks sex steroids, and thus hypogonadism in both sexes That leads to no ovulation, amenorrhea, decreased libido, especially infertility in women Increased PRL caused by pituitary adenoma can cause compression syndrome causing increased intracranial pressure: headache, nausea, vomiting, blurred vision, double vision, ptosis Treatment of elevated PRL depends on the etiology and pathogenesis of PRL elevation Especially, the treatment of a rise in PRL in the blood due to the cause of PRL-secreting pituitary gland tumor still faces many difficulties Medical therapy is the first choice because of its high efficiency in reducing PRL and reducing tumor size Surgery is often indicated for patients who not respond to medical therapy or are intolerant to medications With the desire for early detection, effective treatment, and long-term follow-up to help bring about a happy life for women with PRL hypersecretion syndrome We carry out the project "Research on diagnosis and treatment of hyperprolactinemia syndrome in women" with two objectives: Describe the clinical and laboratory characteristics of prolactin hypersecretion syndrome in women Comment on treatment results of hyperprolactinemia syndrome in women.prolactin SUMMARY OF THE NEW CONTRIBUTIONS OF THE THESIS The research has analysed the clinical and subclinical characteristics in women suffered from PRL secreting tumors with indications for medical, surgical, and combined treatment in 145 PRL hypersecretion syndrome in women The research has analysed the treatment results of this group of patients, thereby making recommendations for obstetricians and surgeons on treatment orientation, improving the treatment efficiency of this group of patients, especially for women who want to get pregnant Internal treatment is the first choice to treat PRL hypersecretion syndrome in women, but considering surgery for women would like to have baby With this group, there were 0.0% with surgery group and 33.9% internal treatment group patient reported increased tumor after delivery THESIS STRUCTURE The thesis has 121 pages including chapters, 38 tables, charts, pictures Introduction: pages Chapter 1: Overview document has 36 pages Chapter 2: subjects and research methods have 15 pages Chapter 3: Research results have 29 pages Chapter 4: Discussion has 36 pages Conclusion: 02 pages Recommendation: 01 page References: 128 documents Article published of the thesis: 05 Chapter 1: OVERVIEW 1.1 Anatomy and physiology of the pituitary gland 1.1.1 Anatomy of the pituitary gland 1.1.2 Physiology of the pituitary gland 1.1.3 Hypothalamic-pituitary-ovarian axis and menstrual cycle 1.2 PRL hypersecretion syndrome 1.2.1 PRL PRL (PRL) is a hormon that plays an important role in reproduction, milk production, and metabolism PRL is produced by lactotrophs cells PRL secretion has a marked rhythmic character with the time of day, increasing during sleep When breast tissue is fully developed and hormonally prepared, PRL stimulates the production of proteins and other milk components 1.2.2 Clinical Hyperprolactinemia is the expression of abnormally high levels of PRL in the blood The normal value of PRL in the blood is 10-20 µg/l in men and 10-25 µg/l in women, PRL concentration varies with the diurnal rhythm, peaking at 4-6 am, can reach 30 µg/l (According to the World Health Organization, 1µg/L ≈ 21.2 mUI/L) Reason Physiological conditions Drugs that increase PRL: psychotropic drugs, H2 receptor blockers: cimetidine, Antiemetics: metoclopramide, Opioids: codeine, morphine, Estrogen in birth control pills Neuropathy - hypothalamus increases PRL Metabolic disorders: renal failure, hypothyroidism, cirrhosis Pathology of the pituitary gland: pituitary tumors, of which 80% are pituitary tumors with increased PRL secretion 1.3 Pituitary tumor increased secretion of PRL 1.3.1 Epidemiology Pituitary tumor increased secretion of PRL have an incidence of 6-50/100,000 people, accounting for about 40% of pituitary tumors In general, the male/female ratio is 1:3 1.3.2 Classification of pituitary tumor Based on histopathology, divided into types: + Pituitary adenoma increased secretion of PRL + Pituitary carcinoma increased secretion of PRL Based on size, divided into types: + Microadenoma: 40mm Based on invasion of the pituitary gland (according to Hardy) o Stage A: Tumor invades 10mm above the pituitary fossa in the visual interference pool o Stage B: Tumor extends 20mm above the pituitary fossa, pressing on the pituitary stalk and optic interference o Stage C: tumor 30mm above the pituitary, pressing on the third ventricle, growing to the foramen of Monro o Stage D: tumor is >30mm above the pituitary, with ventricular dilatation due to occlusion of the foramen of Monro o Stage E: Tumor invades the cavernous sinus Classification of Derome et al: there are stages o Stage 0: Small pituitary adenoma (