[Galactorrhea syndrome. Treatment with bromocriptine (Parlode)].
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Biomedical subjects
Publications and source records attributed to P C Eskildsen.
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Creatinine clearance and daily urinary albumin and beta2-microglobulin excretion rates (radio-immunoassays) were measured several times in 14 patients with acromegaly. Eleven patients were treated with bromocriptine, 5 to 55 mg/day. The activity of the disease was assessed by measuring urinary growth hormone excretion (radio-immunoassay). In agreement with previous investigations we found the creatinine clearance elevated. However, no correlation was found between this variable and urinary growth hormone excretion. Urinary albumin and beta 2-microglobulin excretion rates were not significantly different from our previous results in 27 adults control subjects. There was no correlation between urinary growth hormone excretion and urinary albumin or beta 2-microglobulin excretion rates. Bromocriptine treatment reduced urinary growth hormone excretion from 220 to 91 ng/24 hours, p less than 0.01, but no significant alterations were induced in the above mentioned kidney function variables.
A total number of 23 patients treated with human growth hormone were retested by use of a combined pituitary stimulation test. Plasma concentrations of GH, FSH, LH, TSH, T4, T3, prolactin (PRL), ACTH and cortisol were measured before and after stimulation with hypoglycemia, TRH and LHRH. The test was performed in patients with persistent GH deficiency (group A) and patients with transitory GH deficiency (group B). In group A a normal pubertal development was found in three patients, whereas in prepubertal subjects the FSH/LH responses were smaller than those of prepubertal patients in group B. Also plasma ACTH increase was less pronounced in group A patients than in group B. In contrast, the plasma TSH and PRL responses were more sustained in group A than in group B. The secretory pattern of TSH and PRL was comparable in the two groups of patients. Thus, in patients with persistent GH deficiency additional multiple disturbances of the hypothalamic-pituitary function often appeared whereas in most patients with transitory GH deficiency the combined pituitary test was normal at the reinvestigation.
Fifteen acromegalic subjects were found to have elevated plasma levels of both 1,25(OH)2-vitamin D, 65 +/- 23 (SD) pg/ml [normal 33 + 15 pg/ml (SD)] and 24,25(OH)2-vitamin D, 6.8 +/- 1.6 (SD) ng/ml [normal 3.4 + 1.2 ng/ml (SD)]. Treatment with bromocriptine for 6 months reduced the plasma 1,25(OH)2-vitamin D3 level to 40 +/- 13 (SD) pg/ml, p less than 0.01 and the 24,25(OH)2-vitamin D level to 5.4 +/- 1.7 (SD) ng/ml, p less than 0.05.
Twelve patients with infertility and insufficent luteal function were studied during a control cycle, and during a cycle when 2.5 mg of bromocriptine was given twice daily. Serum levels of prolactin, progesterone, estradiol-17-beta, FSH and LH were determined during both cycles. Endometrial biopsies were taken from most patients during the late luteal phase. Two patients had persistent hyperprolactinemia, approximately 35-45 ng/ml, and both had repeated insufficient luteal function, which completely reverted to normal during treatment. Five of the 10 normoprolactinemic patients achieved a normal luteal function during bromocriptine therapy. No pregnancies were achieved during the study but one patient later conceived during bromocriptine therapy.
In 23 growth retarded children two consecutive insulin tolerance tests (ITT) were performed to establish a diagnosis of growth hormone (GH) deficiency. Nine children did not respond (GH peak value less than 8 mU/1), whereas 14 were classified as having partial GH deficiency (GH peak value less than 20 mU/1). All were treated for an average period of 40 months with human growth hormone (HGH). In a combined stimulation test at the end of the treatment period 9 children demonstrated a persistent GH deficiency, whereas a normal response was found in 14 of the previous partial GH deficient children. During treatment the monthly growth rate rose from 0.21 cm 0.58 cm in the GH deficient children and from 0.31 cm to 0.70 cm in the partial deficient children, in most of whom spontaneous pubertal development occurred during treatment. Somatomedin (SM) values were decreased in the GH deficient children before and after treatment but increased to normal levels during treatment. Growth velocity in these children during treatment was correlated to SM values before treatment. In the partial GH deficient children SM values were subnormal before but normal after treatment. This supports the assumption that in some children with constitutional delay in puberty a reversible functional hypopituitarism exists, which is normalized after the onset of puberty, due to androgens sensitizing growth hormone releasing mechanisms. Treatment with HGH may induce increased growth velocity in some of these patients.
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Twenty-four consecutively admitted episodes of acute diabetic dysregulation in 22 patients were treated with a low-dose insulin regimen, given as hourly i.m. injections of 5 IU insulin. The fall in blood glucose was almost linear during the first 8 hours of treatment, on an average 10 percent per hour of the initial value. The hyperglycemia and acidosis were corrected by 2-12 hours of treatment. The deficiency of water and electrolytes, especially potassium, was treated with infusion from the beginnning, and the fluid balance was corrected within 12-16 hours. A severe fall in plasma potassium was never seen, but hypokalemia (less than 3.6mEg/I) was still present in some cases after 24 hours of treatment. One patient died on account of a large myocardial infarction, but otherwise the patients were restored to habitual condition in 1-4 days. The regimen was found to be simple, safe and effective in all cases, without risk of late hypoglycemia or severe hypokalemia. The study indicates, however, that the parenteral supply of potassium advocated previously, 12.5 mEq/hour, is not sufficient when the plasma potassium on admission is below 5.0mEq/I. In such cases it is recommended that the rate of potassium infusion is increased.
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