EFFICACY OF ESTROGEN IN HYPERPROLACTINEMIC AMENORRHEA

雌激素替代治疗在医学和经济上的重要性 绝经后妇女的发病率降低， 骨折和冠心病。 绝经后的妇女则不然， 然而，唯一可能发展出 雌激素缺乏症 美国有超过150万年轻女性 继发性闭经患者的雌激素水平与 绝经后，有患过早骨质疏松症的风险， 心脏病 超过三分之一的闭经妇女有催乳素 分泌垂体瘤 催乳素的自主产生 垂体瘤导致卵巢功能停止，绝经 症状和脊椎骨矿物质的损失。当生育能力是一个问题 短期服用多巴胺受体激动剂是有效的， 必须长期服用，以保持月经规律和生理 雌激素水平 慢性多巴胺受体激动剂治疗是昂贵的， 耐受性和长期治疗的效果尚不清楚。 因此，大多数高催乳素血症的妇女 接受治疗并保持无泪。 不像大多数的女性 使用雌激素治疗的患者， 分泌催乳素的垂体瘤是为了避免含有雌激素 因为有刺激肿瘤生长的潜力。 的 对高催乳素血症妇女雌激素治疗的关注是基于 雌激素诱导的动物肿瘤形成和孤立的病例报告， 雌激素相关的肿瘤生长在男性和女性。 我们将使用磁性 共振成像，以确定是否长期服用雌激素， 高催乳素血症闭经的妇女会诱发肿瘤形成 或者刺激预先存在的微腺瘤的生长 骨吸收测定法，以确定是否与 高催乳素血症性闭经将改善或正常化， 雌激素给药。 可靠的前瞻性信息， 雌激素与临床上显著的肿瘤扩张无关 将改变对50多万妇女的治疗建议， 美国高泌乳素血症性闭经可预防 心血管和骨骼功能不良反应的进展 年轻女性。

The medical and economic importance of estrogen replacement therapy in postmenopausal women is demonstrated by a decreased incidence of fractures and coronary heart disease. Postmenopausal women are not, however, the only individuals who may develop the consequences of estrogen deficiency. Over 1.5 million young women in the United States with secondary amenorrhea have estrogen levels comparable to those seen after the menopause and are at risk to develop premature osteoporosis and heart disease. Over one-third of these amenorrheic women have prolactin secreting pituitary tumors. Autonomous production of prolactin by the pituitary tumor leads to cessation of ovarian function, menopausal symptoms and loss of spinal bone mineral. When fertility is an issue short-term administration of a dopamine agonist is effective but the drug must be given chronically to maintain regular menses and physiologic estrogen levels. Chronic dopamine agonist therapy is expensive, poorly tolerated and the effects of long-term therapy are not known. Consequently, the majority of women with hyperprolactinemia do not receive therapy and remain amenorrheic. Unlike most amenorrheic women who are treated with estrogen, the standard of practice for patients with prolactin secreting pituitary tumors is to avoid estrogen containing compounds because of the potential for stimulating tumor growth. The concern about estrogen therapy in hyperprolactinemic women is based on estrogen induced tumor formation in animals and isolated case reports of estrogen associated tumor growth in men and women. We will use magnetic resonance imaging to ascertain whether chronic administration of estrogen to women with hyperprolactinemic amenorrhea will induce tumor formation or stimulate growth of a pre-existing microadenoma and dual energy x-ray absorptiometry to ascertain whether the osteopenia associated with hyperprolactinemic amenorrhea will improve or normalize with chronic estrogen administration. Reliable prospective information that exogenous estrogen is not associated with clinically significant tumor expansion would alter treatment recommendations for the over 500,000 women in the United States with hyperprolactinemic amenorrhea and could prevent progression of adverse effects on cardiovascular and skeletal function in young women.