乳腺生长
乳腺生长(mammoplasia)又称乳腺增生、乳腺增殖症,是乳房正常或自发的增大[1]。乳腺生长一般会出生在女性的青春期及妊娠阶段,在月经周期中特定阶段也会有乳房增大的情形[2][3][4]。若是男性乳腺生长,会视为是疾病,称为男性乳房发育症[4]。若是女性乳腺异常生长的情形,会称为巨乳症(或是乳房肥大症),也会视为是疾病[5][6][7]。
乳腺生长 Mammoplasia | |
---|---|
在妊娠阶段乳房会自然增大 | |
分类和外部资源 | |
ICD-10 | N62 |
ICD-9-CM | 611.1 |
乳腺生长可能是因为和乳房制造及储存母乳而产生的暂时性乳房膨胀有关,这多半是和哺乳及/或乳溢症(过度或是不正常的母乳制造)相关[8]。乳腺生长也常伴随着乳房疼痛[9][10]。
在月经周期中的黄体期,因为高浓度的雌激素及/或孕酮造成的乳房血流量增加及/或月经前水潴留,乳房的体积会暂时性的增大,女性会有乳房沉重、肿胀和刺痛的感觉[11][12]。
乳腺生长也可能是许多药物的效果或是副作用,例如雌激素[2][13]、像螺内酯[14]、醋酸环丙孕酮[15]、 比卡鲁胺[16][17]及非那斯特莱[18][19]等抗雄激素,生长激素[20][21]以及会提高体内催乳素的药物,例如D2受体拮抗剂,像是维思通等抗精神病药、甲氧氯普胺及多潘立酮[22][23],以及像选择性5-羟色胺再摄取抑制剂(SSRI)及三环类抗抑郁药(TCA)之类的抗抑郁药[23][24][25]。若是使用文拉法辛之类的5-羟色胺和去甲肾上腺素再摄取抑制剂(SNRI),这类的风险会比较小[26]。非典型的抗抑郁药米氮平及安非他酮不会提高体内催乳素浓度(安非他酮反而会降低催乳素浓度),因此使用这类药物就没有会使乳腺生长的风险[22]。其他和乳腺生长有关的药物包括D-青霉胺、布西拉明、neothetazone、环孢素、英地那韦、大麻及西咪替丁[6][27]。
1997的一个研究发现,在其研究的59名女性中,有23名(39%)发现有出现使用SSRI及和乳腺生长的相关性[26]。研究也发现SSRI和乳溢症之间有相关性[24][28][29][30]。这些副作用可能因为药物造成的高催乳素血症,这个效果可能因为抑制催乳素分泌的结节漏斗多巴胺致能神经元,因为血清素调节而被抑制的结果[26][28][29]。值得注意的是这些药物造成的乳腺生长也和体重增加高度相关(在1997年的研究中,体重增加中的人中有83%也有乳腺生长,而体重没有增加的人之中,只有30%有乳腺生长)[26]。这些伴随着SSRI用药出现的乳腺生长,在停药后是可以复原的[30]。 SSRI和乳癌风险的增加有关[31],这个现象符合高催乳素和高乳癌风险有关的事实[32][33]。
若是针对女性青春期诱导而进行的激素替代疗法(HRT)、跨性别女性进行的性别肯定激素治疗(GAHT),或者是荷尔蒙丰胸,都会希望出现乳腺生长的结果[34][35]。
参考资料
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The cyclic changes of the adult mammary gland can be associated with the menstrual cycle and the hormonal changes that control that cycle. Estrogens stimulate parenchymal proliferation, with formulation of epithelial sprouts. This hyperplasia continues into the secretory phase of the cycle. Anatomically, when the corpus luteum provides increased amounts of estrogen and progesterone, there is lobular edema, thickening of the epithelial basal membrane, and secretory material in the alveolar lumen. Lymphoid and plasma cells infiltrate the stroma. Clinically, mammary blood flow increases in this luteal phase. This increased flow is experienced by women as fullness, heaviness, and turgescence. The breast may become nodular because of interlobular edema and ductular-acinar growth.
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