米氮平致高泌乳素血症

Hyperprolactinemia induced by mirtazapine

1例49岁女性患者,因"发作性头痛、头晕10年伴左肾上腺占位2个月"入院,诊断为左肾上腺无功能瘤可能性大。既往焦虑症病史4年,2019年4月20日给予米氮平片(15 mg·d^-1),劳拉西泮片(0.25 mg·d^-1),并间断口服坦度螺酮胶囊治疗。7月9日入院后体格检查发现双乳触发性溢乳,查血清泌乳素>200μg·L^-1,颅脑磁共振(MRI)未见异常,甲状腺功能无减退,其余检查未见异常。排除原发疾病及其他药物因素后,考虑高泌乳素血症与米氮平相关性大。后续对患者进行随访,米氮平减量为10 mg·d^-1,溢乳症状消失,未复查血清泌乳素情况。

One 49-year-old female patient was admitted to the hospital due to paroxysmal headache and dizziness for ten years accompanied with an occupation in left adrenal gland for two months.The high possibility of nonfunctional tumor in left adrenal gland was considered.She had a 4 years history of anxiety disorder and had been treated with mirtazapine tablets(15 mg·d^-1),lorazepam tablets(0.25 mg·d^-1)and intermittent tandospirone capsules since April 20th,2019.After admission on July 9th,triggered galactorrhea in bilateral nipples was found after physical examination.The level of serum prolactin was more than 200μg·L^-1.There were no abnormal findings in craniocerebral magnetic resonance imaging(MRI),thyroid function and other examinations.Hyperprolactinemia caused by mirtazapine was considered after excluding hyperprolactinemia associated with primary diseases and other drugs.Follow-up showed that galactorrhea was disappeared after the dose of mirtazapine was reduced to 10 mg·d-1 and the serum prolactin was not detected again.