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Serum prolactin levels in normal women and in women with disorders of menstruation.

The mean (+/-SD) serum prolactin (PRL) level of 78 normal premenopausal women was 10-6+/-3-0 ng/ml, and this was significantly different from that of post-menopausal women (8-2+/-4-0 ng/ml) and women taking combined oral contraceptive preparations (12-2+/-4-0 ng/ml). No significant differences were found between follicular and luteal phase PRL levels. Serum PRL levels higher than the ranges given above were found in 31 of 87 patients with secondary amenorrhoea and two of 41 patients with oligomenorrhoea. Nine of the 33 patients with hyperprolactinaemia did not have galactorrhoea. Only two of the patients with hyperprolactinaemia had pituitary tumours evident on skull X-ray films. Serum PRL levels were of value in predicting the likely success in achieving ovulation with clomiphene citrate or CB-154; clomiphene citrate was less likely to be successful in the presence of hyperprolactinaemia, whereas the reverse applied for treatment with CB-154.

Adolescent

Suppression of prolactin secretion by lisuride throughout the menstrual cycle and in hyperprolactinaemic menstrual disorders.

Normally menstruating volunteers as well as patients with hyperprolactinaemic menstrual disorders were treated with lisuride hydrogen maleate (200 micrograms b.i.d.), an ergoline derivative with dopaminergic properties. Within 3 h after an oral dose of 200 micrograms lisuride, PRL levels decreased significantly in all subjects to a plateau which lasted up to 3 h. Thereafter a gradual increase of serum PRL was noted. In the normally menstruating volunteers lisuride treatment did not result in any significant change of gonadotrophin or of sex steroid secretion, while both, basal as well as metoclopramide (MTCL) stimulated PRL release were significantly diminished. The inhibition of PRL secretion in patients with short luteal phases resulted in an increase of luteal progesterone output. In both treated groups ovulation occurred 1 to 5 days earlier in cycles on lisuride than in control cycles. LF-RH/MTCL tests performed in the patient bearing a pituitary prolactinoma before and after lisuride treatment revealed a continuous increase of pituitary LH pools, while PRL secretion decreased under lisuride therapy. Subsequently ovulation and menstruation occurred. The data presented demonstrate that lisuride is a potent inhibitor of PRL secretion and has proven its clinical usefulness for treatment of hyperprolactinaemic menstrual disorders. Application of lisuride resulted in an increase of luteal progesterone secretion in previously demonstrated corpus luteum insufficiency as well as in restoration of normal cyclical feedback mechanisms in tumorous hyperprolactinaemic anovulation. The MTCL-PRL stimulation test is suitable to monitor PRL suppression during lisuride treatment, while LH-RH testing reveals the effectiveness of lisuride by demonstrating an increase of pituitary gonadotrophin pools.

Adenoma

The significance of galactorrhea in patients with normal menses, oligomenorrhea, and secondary amenorrhea.

Thyroid-stimulating hormone and prolactin (PRL) were measured in a group of 149 women with galactorrhea. Three of these patients were found to have primary hypothyroidism. In the remaining 146 patients, the PRL assay was correlated with the menstrual history and the results of hypocycloidal polytomography. Sixty-two per cent of these patients had hyperprolactinemia and 35 per cent had abnormal tomograms. Nine patients with abnormal x-rays had normal prolactin levels. None of the patients with normal menses and normal PRL was found to have an abnormal x-ray. Fourteen of the 15 patients with PRL levels greater than 200 ng. per milliliter had abnormal tomograms. Almost 70 per cent of patients with secondary amenorrhea and low estrogen status had abnormal x-rays. In patients with oligomenorrhea and secondary amenorrhea with normal estrogen status, it was not possible to differentiate between patients with normal or abnormal tomograms based on the level of serum PRL. Polytomography remains the single most important diagnostic test in establishing the presence of a pituitary tumor.

Adolescent

[Cytogenetic studies in women with primary amenorrhea (author's transl)].

During the past 10 years, 106 women with primary amenorrhea were studied. According to the X chromatin determination the cases were subdivided into 2 main groups. In the X chromatin negative group the Y chromatin positive and the Y chromatin negative cases were differentiated by fluorescent methods. The diagnosis was made according to the chromosome analysis. The X chromatin positive cases were classified following in detail clinical and cytogenetic studies. In our series, 50% of the cases showed chromosomal abnormalities whereas the literature reports 20-25% chromosomal abnormalities.

Adolescent