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PubMedDate not supplied

[Use of Bromocriptin tablets in physiologic and pathologic hyperprolactinemia].

The authors used Bromocriptine tablet, made by Chemical Works of Gedeon Richter Ltd. in 11 cases to alleriate a physiological milk secretion and in 15 cases as a treatment for extra-puerperal galactorrhea. Under treatment the serum prolactin level dropped exponentially while under Norcolut administration a linear regression was shown and the mammary activity abated after 14 days. The best method for treating the physiological hyperprolactinemia is to give the Bromocriptine before starting milk secretion. In cases of extra-puerperal galactorrhea. The patients become free from complaint after 8 weeks. In both cases the dose was 5-7.5 mg Bromocriptine. When galactorrhea and amenorrhoea occur together during the treatments second month menstruation begins and in two cases unwanted pregnancies happened. It has been found that the latent functional hyperprolactinemia can also be galactorrhea. The result were verified in ten cases by testing the metoclopramide-burden.

Adult↗

PubMedDate not supplied

Biological response modifiers of cancer-related neuroendocrine disorders: efficacy of the long-term dopaminergic agonist cabergoline in the treatment of breast cancer-induced hyperprolactinemia.

The evaluation of the biological status of cancer patients should not be limited only to investigation of immune reactivity, but should also include analysis of the endocrine condition, namely concerning those hormones which have appeared to be tumor growth factors, such as prolactin (PRL) for breast and prostate carcinomas. This statement is justified by the fact that the evidence of abnormally high serum concentrations of PRL has been proven to be associated with poor prognosis in breast and prostate cancer patients. Moreover, since hyperprolactinemia negatively influences the efficacy of anticancer therapies in breast cancer, it could be fundamental to achieve a normalization of PRL levels by long-acting dopaminergic agents, such as cabergoline. On this basis, a study was planned to evaluate the effect of cabergoline on PRL levels in hyperprolactinemic metastatic breast cancer subjects. The study included 20 hyperprolactinemic metastatic breast cancer subjects, who were randomized to receive no therapy or cabergoline at 0.5 mg/week orally for 4 consecutive weeks. Cabergoline therapy induced a normalization in all patients, whereas no spontaneous normalization of PRL levels occured in the control group. These results show that a weekly oral administration of the long-acting dopaminergic agent cabergoline is a well tolerated and effective treatment of metastatic breast cancer-related hyperprolactinemia. The possible prognostic impact of PRL normalization needs to be established by successive studies.

Aged↗

PubMed2005

[Verapamil-induced hyperprolactinemia--a case report].

In many cases hyperprolactinemia can be caused by taking medications. Occasionally, verapamil-treated patients experience a slight asymptomatic increase in serum prolactin level. In this article we report the case of 42-year woman with manifest verapamil-induced hyperprolactinemia whose clinical symptoms suggested the occurrence of prolactinoma. A marked increase in prolactin levels and the preserved reactivity of this hormone in dynamic tests suggested that the patient exhibited "hypersensitivity" to verapamil. In the described state of the examined female detection of the disease, verapamil withdrawal and temporary bromocriptine administration have led to a full normalization of patient's clinical status.

Adult↗

PubMed2005

Hyperprolactinemia presenting with encephalomalacia-associated seizure disorder and infertility: a novel application for bromocriptine therapy in reproductive endocrinology.

OBJECTIVES: To describe successful oral bromocriptine therapy for hyperprolactinemia accompanied by seizure disorder and encephalomalacia identified during infertility evaluation. MATERIALS & METHODS: A 32 year-old male with an unspecified seizure disorder was referred for infertility consultation. The initial seizure was at age 12, and was treated sequentially with phenytoin, phenobarbitol, and carbamazepine monotherapy which was maintained for six years and then discontinued. At age 26, a second seizure was experienced and 150mg lamotrigine b.i.d. was initiated. When the patient married it was discovered that erection was impossible; tadalafil was administered without success. At our center, total testosterone was low at 107ng/dl and semen analysis revealed oligoasthenozoospermia. Serum prolactin was 79.3ng/ml; visual field examination was normal. Brain MR showed no pituitary enlargement. However, encephalomalacia of the right occiptal lobe with porencephalic dilation of the occipital horn of the right lateral ventricle was present. RESULTS: The patient was initially placed on 2.5mg/d bromocriptine but after three months only a nominal reduction of serum prolactin was achieved. Serum prolactin normalized (25.4ng/ml) after bromocriptine was increased to 7.5mg/d. Repeat semen analysis showed overall sperm concentration of 85M/ml, 30% motility and 12% normal forms morphology (Kruger strict criteria). Total testosterone level was 191ng/dl after final bromocriptine dose was attained, which was well tolerated. DISCUSSION: Bromocriptine has an established role in the management of hyperprolactinemia, particularly in women. For males with elevated serum prolactin even when associated with focal encephalomalacia and seizure disorder, bromocriptine therapy can offer safe benefits including improved semen parameters and normal serum testosterone levels.

Adult↗

PubMed2005

[Suppression of hyperprolactinemia in pituitary microadenoma with cabergoline (Dostinex)].

First choice therapy of microprolactinoma is drug treatment with dopamine agonists. Cabergoline is widely accepted in clinical practice as a first line therapy for tumor-induced pituitary hyperprolactinemia. This study assessed serum prolactin levels, tumor size and adverse events in 22 women treated with cabergoline for one year (mean age 43.5 +/- 6.6 years). Serum prolactin levels changed from a baseline mean of 1417 +/- 347 UI/L to 489 +/- 102 UI/L at study end (in the normal range). Tumor size reduction to tumor disappearance was found in 18 women (from a mean of 7.2 mm to 5.5 mm), and was absent in 4 participants. Adverse events were reported in 2 women. In conclusion, the excellent therapeutic efficacy and the lack of adverse events with Cabergoline promotes its use as a first line therapy of hyperprolactinemia due to pituitary microadenoma.

Adenoma↗

PubMedDate not supplied

Macroprolactinemia in childhood and adolescence: a cause of hyperprolactinemia.

Human prolactin consists of multiple forms of different sizes including three major prolactin (PRL) species, termed as little, big, and big-big PRL. If serum contains big-big PRL, it is termed macroprolactinemia; no symptoms of hyperprolactinemia develop due to low biological activity of big-big PRL. There are still few data regarding macroprolactinemia in children and adolescents. In this paper we describe six patients with macroprolactinemia, one of whom was asymptomatic and the other five either had headache, menstrual disturbance, short stature, increased hair growth or early puberty, compatible with high PRL levels. Two of the cases had microadenoma. Initial mean +/- SD PRL levels of the patients were 75.2 +/- 22.8 ng/ml (range: 42.3-105.2 ng/ml). Macroprolactin analysis revealed big-big PRL levels of the patients ranging between 21.6-98.6 ng/ml. It was noteworthy that bromocriptine (BRC) therapy started in three patients caused an abrupt decrease in PRL levels. It may be concluded that macroprolactinemia should be taken into account in the differential diagnosis of hyperprolactinemia in childhood and adolescence, whether or not they have relevant clinical symptoms.

Adenoma↗

PubMed1991

[State of the breasts in patients with hyperprolactinemia-induced amenorrhea and the effect of the treatment with parlodel].

The mammary glands were examined in 36 patients with +Hyperprolactinemia-induced amenorrhea. ++Fibro-adipose transformation (33.3%), involutional changes unassociated with age (30.6%), the hyperplastic processes fibrocystic mastopathy, adenosis (36.1%) were found to be equally encountered in the pattern of breast alterations. Parlodel therapy given to patients with ++Hyperprolactinemia-induced amenorrhea not only recovers menstrual and reproductive functions, but exerts a favourable action on the mammary glands, promoting the restoration of glandular tissue and the decrease in deformity of a stromal component.

Adult↗

PubMed1991

Experience with bromocriptine for the treatment of female infertility due to hyperprolactinemia.

From July 1981 to September 1988, 106 infertile patients with hyperprolactinemia treated with bromocriptine were reviewed retrospectively with special attention to the dosage of bromocriptine and the evaluation of infertility before treatment. 84 patients (79.2%) became pregnant. The 106 patients were divided into 3 groups according to the following doses: 7.5, 5.0, and less than 5.0 mg/day. The pregnancy rate was 90.7%, 84.6%, and 66.7% respectively with the highest at 7.5 mg/day, which was significantly higher than that at less than 5.0 mg/day (P less than 0.02). The average duration from treatment to pregnancy was 3.6, 3.4 and 7.4 months respectively. The longest duration in the less than 5 mg/day group was twice that in the other two groups. 85% of the pregnancies occurred within 6 months of treatment. Pretreatment of organic lesions and additional therapy for induction of ovulation were given to 29.8% of the pregnancies. The causes of infertility other than hyperprolactinemia were evaluated systemically before the use of bromocriptine. The optimal dose was 5-7.5 mg/day. Macroprolactinomas can be treated with bromocriptine, but should be followed up closely for the development of symptoms of intracranial pressure during pregnancy.

Adult↗

PubMedDate not supplied

[Hyperprolactinemia].

Hyperlactinemia is the most commonplace expression of hypophyseal pathology, above all in females, and is one of the most frequent causes of sexual disorders. The present study examined the etiopathogenesis of hyperprolactinemic syndromes and discusses their pathophysiology, paying special attention to neuroendocrine alterations in the presence of either prolactin-secreting adenoma or other forms of hyperprolactinemia. Their clinical manifestations are then described together with a detailed review of therapies, especially for prolactinoma. Both general opinion and the authors' personal point of view are reported regarding the indications for medical and surgical treatment for micro and macro-prolactinomas. Lastly, particular aspects are taken into consideration, such as the relationship between hyperprolactinemia and pregnancy, in the light of the most recent findings on the natural evolution of prolactinemia and the possibility of treatment using dopaminergic drugs.

Female↗

PubMedDate not supplied

[Role of enzymes of dopamine metabolism in the regulation of prolactin and thyrotropin secretion in hyperprolactinemia].

Altogether 24 women with the syndrome of hyperprolactinemia (SH), including 5 patients with significant PRL hypersecretion against a background of macro- and microprolactinemia, and 19 women with normoprolactinemic galactorrhea were investigated. The activity of dopamine-B-hydroxylase (DBH) and monoamino oxidase (MAO) (the key enzymes of dopamine metabolism) was determined by spectrophotometry. A different time course of secretion of PRL and TSH in metoclopramide testing was revealed in the patients with regard to the level of basal prolactinemia. The determination of MAO and DBH activity made it possible to estimate in more detail the state of dopaminergic control of PRL and TSH secretion in the syndrome of hyperprolactinemia.

Dopamine↗

PubMedDate not supplied

[The effect of acute ACTH1-24 loading on the steroid hormone and prolactin content of the blood serum in women with hyperprolactinemia and hyperandrogenism].

Adrenocortical and ovarian function in women with hyperprolactinemia and hyperandrogenism was evaluated using the functional ACTH1-24-test (with syncorpin--25 U/ml), a radioimmunoassay was used to estimate the levels of II-OCS, androgens, progestins, estrogens and prolactin in the blood serum of 29 women with primary prolactinemic hypogonadism (HG), in 15--with hyperandrogenic ovarian dysfunction, in 27--with the hypothalamic syndrome of neuro-endocrine type, and in 13 healthy women. Marked interference of a clinical picture was found in patients with disturbed menstrual and reproductive function with relation to the presence of galactorrhea and hirsutism. All the examinees retained glucocorticoid function. Patients with hyperprolactinemia demonstrated an increase in the basal concentration of the ovarian androgen androstenedione in the absence of its response to ACTH. The level of 17-oxyprogesterone in them was decreased. A paradoxical response of prolactin to syncorpin was observed in patients with microprolactinemia, the syndrome of the "empty" Turkish saddle and functional type of HG.

Adult↗

PubMedDate not supplied

[The reaction of the hypophysis to thyroliberin and metoclopramide in women with hyperprolactinemia].

Functional tests with i.v. injection of metoclopramide (10 mg) and thyroliberin (200 micrograms) with a record of PRL and TSH levels for 120 min. were performed in 87 women of reproductive age (19 healthy nonpregnant women, 9 women in the early postnatal period, 10 patients with primary hypothyroidism, and 30 patients with PRL secreting chromophobe adenomas). Hyperprolactinemic anovulation was noted in 35 examinees. Comparison of the results of thyroliberin and metoclopramide tests in different groups of examinees was suggestive of a decrease in dopaminergic inhibition of the hypophysis in postnatal and adenomatous hyperprolactinemia. The presence and a degree of hyperprolactinemia in patients with primary hypothyroidism depends, probably, on the ratio of a stimulating effect of endogenous thyroliberin and inhibitory action of dopamine on hypophyseal lactotrophs.

Adult↗

PubMed1990

Effect of experimentally-induced chronic hyperprolactinemia on insulin binding and antilipolytic response in adipocytes from male rats.

Male Wistar rats with chronic hyperprolactinemia induced by grafting an anterior pituitary gland under the right kidney capsule were studied as experimental model. In these animals basal plasma glucose and insulin levels were unaltered. Epididymal adipocytes from hyperprolactinemic rats showed a significant increase in insulin binding at low unlabeled insulin concentrations. This increase in insulin binding can be principally attributed to an increase in the high affinity-low capacity binding sites, as demonstrated when Scatchard analysis was interpreted in terms of two types of insulin receptors. The dissociation constants (KD1 and KD2) were not different between the groups. The apparent insulin receptor affinity was also unchanged. Moreover, a decreased sensitivity to the antilipolytic effect of insulin was also obtained in adipocytes from hyperprolactinemic rats. These findings indicate that chronic hyperprolactinemia is able to increase high affinity insulin receptors in epididymal adipocytes, but tends to diminish the antilipolytic response, suggesting a lack of coupling between insulin binding and its biological activity in male adipose tissue. Several possible mechanisms involved in the process are suggested.

Adipose Tissue↗

PubMed1990

[Hyperprolactinemia as a marker of the progression of cervical cancer].

Elevated blood prolactin level was identified in 80% of untreated patients with advanced (stage II-IV) cervical cancer whereas it was normal at the earlier (preinvasive) stage. Patients with stage I-A, II tumors revealed either increased or normal blood prolactin level. Patients with advanced cancer who had undergone irradiation and surgery, either alone or in combination, showed hyperprolactinemia as often as 94% of the time. Studies on pathogenesis of hyperprolactinemia and its role in tumor progression are currently conducted by the authors.

Adult↗

PubMed1989

[The value of hyperprolactinemia determination within the scope of galactorrhea].

Of 210 women with galactorrhea 66.2% had normal prolactin serum levels. Only in 33.4% elevated prolactin levels could be found, 0.4% were hypoprolactinemic. The TRH-stimulation test detected latent hyperprolactinemia in 13.5% of the cases, showed a normal thyroid function in 81.5%, hypothyroidism in 13.9% and hyperthyroidism in 4.6% and this is considered to be a more valuable diagnostic tool than the MCP-test. Galactorrhea was associated with the following conditions: hyperprolactinemia (34.8%), menstrual disturbances (67.4%), post-pill amenorrhea (30.2%), mastalgia (30.2%), prolactinoma (18.6%), fibrocystic disease (11.6%), hirsutism (4.6%), diabetes mellitus (2.3%).

Adult↗

PubMed1989

[Hypothyroidism and hyperprolactinemia as a possible cause of androgenetic alopecia in the female].

31 female patients suffering from androgentic alopecia were examined by means of the TRH test with regard to hypothyroidism and hyperprolactinemia. Before, as well as 20 and 40 minutes after, application of thyroxine releasing hormone (TRH), the serum concentrations of the hypohyseal thyroxine stimulating hormone (TSH) and prolactin (PRL) were measured by radioimmunoassay (RIA). In 7 of the patients (23%), we found increased TSH levels after stimulation with TRH--indicative of hypothyroidism. In 9 of the patients (29%), we observed increased PRL levels after TRH stimulation, indicating prolactinemia. TSH and PRL can interact with androgen metabolism at various levels. Thyroxine may influence the unbound, metabolically active testosterone via the sex hormone binding globulin (SHBG). Prolactine, which is stimulated by TRH, promotes the suprarenal cortisol and androgen production. In 48% of the patients, we found either hypothyroidism or hyperprolactinemia. This suggests that both conditions may contribute to the clinical picture of female androgenetic alopecia, as they interfere with the androgen metabolism.

Adult↗

PubMed1989

[Hypothyroidism and hyperprolactinemia].

Blood thyrotropic hormone, thyroxin, tri-iodothyronine, FSH, LH, estradiol and progesterone levels were examined in 14 patients with primary hypothyroidism and 11 normal women of reproductive age. All the women under study were subjected to functional tests with intravenous thyroliberin (TRH) and metoclopramide. All hypothyroid patients had anovulatory infertility. Hyperprolactinemia was detected in 8 of 14 patients. It is demonstrated that hyperprolactinemia, developing in cases of primary hypothyroidism, is associated with impaired dopaminergic inhibition of pituitary lactotropics. Substitution thyroidin therapy resulted in the recovery of the normal ovulatory cycle in all but one patient with secondary pituitary microprolactinoma, and 8 patients became pregnant. It is believed that damaged dopaminergic regulation of hypothalamic luliberin (RH) secretion is a direct cause of ovarian dysfunction associated with primary hypothyroidism.

Adult↗

PubMed1989

Hyperprolactinemia and female infertility.

Hyperprolactinemia is a common endocrine cause of infertility in women. The pathophysiology of hyperprolactinemia in infertility is understood incompletely; however, the adverse effects of high circulating levels of prolactin on the hypothalamic-pituitary-ovarian axis cause chronic anovulation and other defects of ovarian function. Mechanisms for prolactin-induced anovulation have been postulated, and there are several contemporary approaches to the diagnosis and treatment of prolactin-secreting pituitary adenomas.

Amenorrhea↗