Cabergoline toxicity: A case report

We are presenting a case of cabergoline toxicity in a patient with primary infertility; the main cause being high levels of prolactin (PRL). The aim was to examine this hyperprolactinemic patient, the ability to normalize the PRL levels with cabergoline, to determine the effectiveness, to assess the effect on clinical symptoms, and to determine its management. We prospectively studied this single hyperprolactinemic patient who was treated with cabergoline to normalize the PRL levels, but negative impacts were identified by cabergoline, patient was hospitalized, symptoms were documented, dermatologists, endocrinologists, and intensivists were also consulted for the same. As a result, the patient finally had a positive response and showed no signs of toxicity.

Síndrome neuroléptico maligno asociado con intoxicación aguda por un organofosforado: reporte de caso / Neuroleptic malignant syndrome associated with acute organophosphate poisoning: Case report

El síndrome neuroléptico maligno es una condición clínica rara y potencialmente letal que frecuentemente se asocia con el uso de antipsicóticos. En la literatura especializada se encontró únicamente un reporte de caso relacionado con la ingestión de organofosforados. Se presenta un paciente con un cuadro clínico correspondiente al síndrome neuroléptico maligno posterior a la ingestión de clorpirifós. Como resultado de un intento de suicidio con el mencionado organofosforado, el hombre de 57 años presentó deterioro agudo del estado de consciencia, evolución neurológica tórpida e inestabilidad autonómica asociada a rigidez e hipertermia persistentes, así como incremento de la creatina-fosfocinasa (creatine phosphokinase, CPK). Se le administró tratamiento con bromocriptina, con lo cual el cuadro clínico remitió, y fue dado de alta sin secuelas. El diagnóstico del síndrome neuroléptico maligno es clínico y debe contemplarse en cualquier caso de exposición a sustancias que puedan resultar en una desregulación de la neurotransmisión dopaminérgica, con el fin de iniciar el tratamiento oportuno y contrarrestar efectivamente los efectos.

Neuroleptic malignant syndrome is a rare and potentially fatal clinical condition frequently associated with the use of antipsychotics. In the literature, there is only one case report associated with the intake of organophosphates. We present the case of a patient who presented with a clinical picture compatible with neuroleptic malignant syndrome, after the ingestion of an organophosphate (chlorpyrifos). A 57-year-old man who consulted for attempted suicide, acute deterioration of consciousness, torpid neurological evolution, and associated autonomic instability associated with rigidity, persistent hyperthermia, and elevated CPK. Bromocriptine treatment was offered, which resolved the clinical picture. The association with the ingestion of an organophosphate was established, and he was discharged without sequelae. The diagnosis of neuroleptic malignant syndrome is clinical and should be considered in any case of exposure to substances that may lead to dysregulation of dopaminergic neurotransmission in order to initiate timely therapy and impact outcomes.

Efficacy and safety of bromocriptine quick release as an add on therapy with metformin and glipizide in type 2 diabetes mellitus patients: an open label randomized controlled study

Background: Type 2 Diabetes Mellitus (DM) is a metabolic disorder, treated by insulin and oral hypoglycaemic agents (OHA). Despite treatment, to protect diabetic population from its complications is difficult. So, there is a need for an OHA with different mechanism of action and minimal side effects. Bromocriptine Mesylate QR (Quick release) formulation was approved by FDA for treatment of type 2 DM. Hence, this study was planned to highlight the usefulness of Bromocriptine QR in type 2 diabetes mellitus.Methods: Total 140 patients with type 2 DM were randomized into two groups. The control group was treated with Metformin 500 mg BD (twice daily) and Glipizide 5 mg BD for a period of 3 months. The study group received Bromocriptine quick release 1.6 mg once daily, metformin 500 mg BD and Glipizide 5 mg BD for a period of 3 months. In both control and study groups, fasting blood glucose, postprandial blood glucose was monitored at 0, 1st, 2nd and 3rd month. HbA1C was done at baseline and at the end of 3 months.Results: There was statistically significant decrease in fasting blood glucose, postprandial blood glucose and HbA1C when compared to baseline in both control group (p <0.05) and study group (p <0.05) at the end of 3 months. But the decrease in FBS, PPBS, HbA1C was higher in the study group (p=0.0001) than the control group (p=0.001).Conclusions: In type 2 DM patients, Bromocriptine QR, combined with metformin and Glipizide reduced fasting and postprandial blood glucose and HbA1C significantly compared to metformin and glipizide alone.

Aframomum melegueta prevents the ejaculatory complications of propylthiouracil-induced hypothyroidism in sexually experienced male rats: Evidence from intravaginal and fictive ejaculations / 中西医结合学报

OBJECTIVE@#Hypothyroidism has been claimed to generate sexual dysfunctions such as ejaculatory disorders. Aframomum melegueta is an aphrodisiac plant with pro-ejaculatory properties. We investigated the protective effects of aqueous extract (AE) and methanolic extract (ME) of A. melegueta on the ejaculatory function of hypothyroid male rats.@*METHODS@#Forty sexually experienced male rats were partitioned into 8 groups (5 rats per group) and treated for 28 d as follows: Group 1, Control; Group 2, propylthiouracil (PTU, 10 mg/kg) + distilled water (DW, 10 mL/kg); Group 3, PTU + 5% Tween 80 (10 mL/kg); Group 4, PTU + bromocriptine (6 mg/kg); Group 5, PTU + AE (20 mg/kg); Group 6, PTU + AE (100 mg/kg); Group 7, PTU + ME (20 mg/kg), and Group 8, PTU + ME (100 mg/kg). On days 0, 7, 14 and 28 of treatment, each male rat was paired with primed receptive female for measurement of ejaculatory latency time (ELT) and post-ejaculatory interval (PEI) for 1.5 h. On day 29, each male rat was urethane-anesthetized and the spinal cord was transected. Thereafter, following urethral/penile stimulations and intravenous injection of dopamine, contractions of the bulbospongiosus muscles and the intraseminal pressure were registered. After these recordings, blood was collected through the catheterization of abdominal artery and plasma was used for thyroid-stimulating hormone (TSH), prolactin and testosterone assays.@*RESULTS@#PTU-induced hypothyroidism was characterized by a significant elevation (P < 0.001) of plasmatic TSH and prolactin levels, but a decline (P < 0.001) in plasmatic testosterone, compared to untreated group. ELT, PEI, contractions of the bulbospongiosus muscles and the intraseminal pressure were also altered by PTU treatment. On the contrary, A. melegueta extracts elevated testosterone (AE, 100 mg/kg, P < 0.01; ME, 100 mg/kg, P < 0.05) and decreased prolactin (AE, 100 mg/kg, P < 0.05; ME, 20 mg/kg, P < 0.05) levels, compared to corresponding controls. With regard to DW + PTU group, prolactin concentration was lowered (P < 0.05) in rats administered with bromocriptine. Treatment with A. melegueta extracts significantly prevented the lengthening of ELT (P < 0.05) and PEI (P < 0.001). Hypothyroid state also altered the fictive ejaculation by increasing the latency and decreasing the number and frequency of bulbospongiosus muscle contractions. There was also a decrease in the intraseminal pressure. These alterations were significantly (P < 0.05) alleviated in plant extract-treated groups.@*CONCLUSION@#This study highlighted the ejaculatory disturbance of hypothyroidism in male rats and its prevention with A. melegueta extracts.

Bromocriptine promotes secretion of exosomes and drug resistance of rat prolactinoma MMQ cells in vitro / 肿瘤

Objective: To investigate the effect of bromocriptine on the secretion of exosomes and the role of exosomes in drug resistance of rat prolactinoma MMQ cells. Methods: The effect of different concentrations of bromocriptine on the proliferation of MMQ cells was detected by CCK-8 assay, and the half maximal inhibitory concentration (IC50) was calculated. MMQ cells were exposed to bromocriptine for 48 h, then the exosomes were isolated by differential centrifugation. The morphology of exosomes was observed by transmission electron microscopy, the particle size of exosomes was analyzed by nanoparticle tracking analysis (NTA), and the expression of exosomal marker CD63 was detected by Western blotting. MMQ cells uptaking PKH67-labeled exosomes were observed by laser confocal microscopy. Then the sensitivity of MMQ cells to bromocriptine was tested again by CCK-8 method. The expression level of PR domain zinc finger protein 2 (PRDM2) mRNA in MMQ cells treated with exosomes was detected by real-time fluorescent quantitative PCR. The expression levels of PRDM2, dopamine 2 receptor (D2R), extracellular signal-regulated kinase 1/2 (ERK1/2) and phospho-ERK1/2 (p-ERK1/2) proteins in MMQ cells treated with exosomes were determined by Western blotting. Results: The IC50 of bromocriptine on MMQ cells was (52.91±1.48) µmol/L. Compared with the exosomes collected from MMQ cells not treated with bromocriptine, the particles and proteins in exosomes collected from MMQ cells treated with 50 µmol/L bromocriptine were significantly increased (both P < 0.01). The expression of CD63 was only observed in the exosomes. The exosomes collected from MMQ cells treated with bromocriptine were uptaken by MMQ cells. After the exosomes were absorbed by MMQ cells, the IC50 of bromocriptine [(73.74±1.17) µmol/L] was increased on MMQ cells (P < 0.01). In exosome-treated MMQ cells, the expression levels of PRDM2 mRNA and protein (both P < 0.05) and D2R protein (P < 0.05) were down-regulated, while the expression level of p-ERK1/2 was higher than that in the control group (P < 0.05). Conclusion: Bromocriptine can promote the secretion of exosomes in MMQ cells, and the exosomes may be involved in the transmission of information through intercellular communication of tumors, which can make MMQ cells to obtain drug resistance.

Diagnosis and treatment of peripartum cardiomyopathy / 中国实用妇科与产科杂志

Typical symptoms of peripartum cardiomyopathy(PPCM)are heart failure and dyspnea.Echocardiography is the first choice.Bromocriptine and oral drugs for heart failure are the main treatments.For pregnant women with heart failure with hemodynamic instability,pregnancy should be terminated regardless of the size of the gestational age.The predictors of maternal mortality are NYHA class Ⅲ/Ⅳ and left ventricular ejection fraction(LVEF)<40%.

Meta-analysis of Effectiveness and Safety of Bromocriptine by Vaginal Delivery for Hyperprolactinemia in Chinese Female Patients / 中国药房

OBJECTIVE:To evaluate the effectiveness and safety of bromocriptine by vaginal delivery in the treatment of hyperprolactinemia in Chinese female patients,and to provide evidence-based reference for clinic.METHODS:Retrieved from PubMed,The Cochrane Liabmry,Excerpta Medica Database,Chinese Journal Full-text Database,Wanfang Database and China Bxdxiology Medicine disc,randomized controlled trials (RCTs) about bromocriptine oral tablets by vaginal delivery (trial group) vs.bromocriptine by oral administration (control group) in the treatment of bromocriptine in Chinese female patients were collected.After data extraction,quality evaluation of included studies with Cochrane system evaluator manual 5.1.0,Meta-analysis of serum level of Prolactin levels,the rate of menstruation improvement,the rate of pregnancy recovery,the rate of galactorrhea disappearance,the incidence of ADR in digestive tract and the incidence of ADR in nervous system was conducted by using Rev Man 5.1 statistical software.RESULTS:A total of 16 RCTs were included,involving 1 175 patients.The results of Meta-analysis showed that the incidence of ADR in digestive tract [OR=0.14,95％CI(0.09,0.23),P＜0.001] and ADR in nervous system [OR=0.32,95％CI(0.11,0.90),P=0.03] in trial group were significantly lower than control group,with statistical significance.There was no statistical significance in serum level of PRL [MD=0.24,95％ CI (-0.94,1.41),P=0.69],the rate of menstruation improvement [RD=0.04,95％CI (-0.04,0.11),P=0.32],the rate of pregnancy recovery [RD=0.01,95％CI (-0.08,0.10),P=0.84] or the rate of galactorrhea disappearance [RD=0.05,95％ CI (-0.03,0.13),P=0.20] between 2 groups.CONCLUSIONS:Compared with oral administration,bromocriptine by vaginal delivery has no significant difference in therapeutic efficacy but has obvious advantages in the incidence of ADR in digestive tract and in nervous system and better safety.It is suggested to development the special vaginal delivery preparation of bromocriptine.

Effects of Different Dosages of Bromocriptine on Clinical Efficacy of Prolactinoma,Serum Level of PRL and Tumor Volume / 中国药房

OBJECTIVE:To investigate clinical efficacy and safety of different dosages of bromocriptine in the treatment pro-lactinoma,and its effects on serum prolactin(PRL)and tumor volume. METHODS:A total of 60 patients with prolactinoma were selected from our hospital during Jan.-Dec. 2015 as research objects,and then divided into group A and B according to random number table,with 30 cases in each group. Both groups were given Bromocriptine mesilate tablets orally during meal. Group A was given medicine with initial dose of 2.5 mg/d,increasing to 3.75 mg/d 3 d later,increasing by 2.5 mg every week after 2-3 d,and then recovering to 3.75 mg/d till serum PRL level had been controlled. Group B was given medicine with initial dose of 1.25 mg/d, increasing to 2.5 mg/d 3 d later,increasing by 1.25-2.5 mg every week after 2-3 d,and then recovering to 2.5 mg/d till serum PRL level recovered to normal. Both groups were treated for consecutive 3 months. Clinical efficacies as well as serum level of PRL and tumor size were observed in 2 groups,and the occurrence of ADR was recorded. RESULTS:The total response rate of group A (83.33％) was higher than that of group B (66.67％),without statistical significance (P>0.05). Before treatment,there was no statistical significance in serum level of PRL and tumor size between 2 groups (P>0.05). After 1,2 months of treatment,serum levels of PRL in 2 groups were decreased significantly,and the group A was significantly lower than the group B,with statistical significance(P0.05). After treatment,tumor size of 2 groups were decreased significantly,and large adenoma and giant adenoma size in group A were significantly smaller than group B,with statisti-cal significance(P0.05). The inci-dence of ADR in group A(12 cases,40.00％)was significantly higher than group B(5 cases,16.67％),with statistical signifi-cance(P<0.05). CONCLUSIONS:Increasing dosages of bromocriptine no significant influence on therapeutic effect of prolactino-ma,but it can shorten the time of serum PRL level back to normal,and reduce the tumor size. The incidence of adverse reactions in-crease with the dosage.

Role of bromocriptine in multi-spectral manifestations of traumatic brain injury / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury.</p><p><b>METHODS</b>A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimally conscious state were enrolled in the study. After hemodynamic stability, bromocriptine was given at paediatric dose of 3.75 mg/d and adult dose of 7.5 mg/d. It was administered through a naso-gastric (NG) feeding tube in the patients with minimally conscious state, then changed to oral route after proper swallowing and good gag reflex were ensured in the patient. The drug was slowly reduced over three weeks after neurological improvement in the patients. Positive result was determined by improved GCS score of 2 and motor power by at least 1 British Medical Council (BMC) motor score. Improvement of deficits was evaluated in terms of fluency of speech for aphasia, task switching, digit span double tasking and trail-making test for cognition and attention, and functional independence measure score for motor functioning and self-independence.</p><p><b>RESULTS</b>Accelerated arousal was seen in 47.0% of cases (8/17) in 4-40 days. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Improvement in hemiparesis by at least 1 BMC score was seen in 55.6% of cases (5/9) in 40 days. Aphasia was improved in 80% of cases (4/5) in 7-30 days. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 14-20 days. Improvement in memory was observed in 50% of cases (1/2) in over 30 days. No cases were withdrawn from the study because of adverse reactions of the drug. There was no mortality in the study group.</p><p><b>CONCLUSION</b>Bromocriptine improves neurological sequelae of traumatic brain injury as well as the overall outcome in the patients. If medication is given to promote recovery and treat its associated disabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects.</p>

Inhibition of SKP2 Sensitizes Bromocriptine-Induced Apoptosis in Human Prolactinoma Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Prolactinoma (prolactin-secreting pituitary adenoma) is one of the most common estrogen-related functional pituitary tumors. As an agonist of the dopamine D2 receptor, bromocriptine is used widely to inhibit prolactinoma progression. On the other hand, it is not always effective in clinical application. Although a dopamine D2 receptor deficiency contributes to the impaired efficiency of bromocriptine therapy to some extent, it is unknown whether there some other underlying mechanisms leading to bromocriptine resistance in prolactinoma treatment. That is the main point addressed in this project. MATERIALS AND METHODS: Human prolactinoma samples were used to analyze the S-phase kinase associated protein 2 (SKP2) expression level. Nutlin-3/adriamycin/cisplatin-treated GH3 and MMQ cells were used to analyze apoptosis in SKP2 overexpression or knockdown cells. SKP2 expression and the interaction partners of SKP2 were also detected after a bromocriptine treatment in 293T. Apoptosis was analyzed in C25 and bromocriptine-treated GH3 cells. RESULTS: Compared to normal pituitary samples, most prolactinoma samples exhibit higher levels of SKP2 expression, which could inhibit apoptosis in a p53-dependent manner. In addition, the bromocriptine treatment prolonged the half-life of SKP2 and resulted in SKP2 overexpression to a greater extent, which in turn compromised its pro-apoptotic effect. As a result, the bromocriptine treatment combined with C25 (a SKP2 inhibitor) led to the maximal apoptosis of human prolactinoma cells. CONCLUSION: These findings indicated that SKP2 inhibition sensitized the prolactinoma cells to bromocriptine and helped promote apoptosis. Moreover, a combined treatment of bromocriptine and C25 may contribute to the maximal apoptosis of human prolactinoma cells.

Prolactinomas: evolution after menopause

ABSTRACT Objetive The aim was to assess the evolution of tumor size and prolactin (PRL) levels in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists during fertile age, and the effects of suspension of drugs after menopause. Retrospective study, 29 patients with prolactinomas, 22 microadenomas and 7 macroadenomas, diagnosed during their fertile age were studied in their menopause; treatment was stopped in this period. Age at menopause was 49 ± 3.6 years. The average time of treatment was 135 ± 79 months. The time of follow-up after treatment suspension was 4 to 192 months. Results Pre-treatment PRL levels in micro and macroadenomas were 119 ± 57 ng/mL and 258 ± 225 ng/mL, respectively. During menopause after treatment suspension, and at the latest follow-up: in microadenomas PRL levels were 23 ± 13 ng/mL and 16 ± 5.7 ng/mL, respectively; in macroadenomas, PRL levels were 20 ± 6.6 ng/mL 5t5and 25 ± 18 ng/mL, respectively. In menopause after treatment suspension, the microadenomas had disappeared in 9/22 and had decreased in 13/22. In the group of patients whose tumor had decreased, in the latest follow-up, tumors disappeared in 7/13 and remained unchanged in 6/13. In macroadenomas, after treatment suspension 3/7 had disappeared, 3/7 decreased and 1/7 remained unchanged. In the latest control in the 3 patients whose tumor decreased, disappeared in 1/3, decreased in 1/3 and there was no change in the remaining. Conclusions Normal PRL levels and sustained reduction or disappearance of adenomas were achieved in most of patients, probably due to the decrease of estrogen levels. Dopamine agonists might be stopped after menopause in patients with prolactinomas.

A Case of Pituitary Macroadenoma Concurrently Diagnosed in a Patient Undergoing Antipsychotic Treatment / 대한내과학회지

Antipsychotics are the drug of choice for patients with schizophrenia, but they can induce hyperprolactinemia and growth of pituitary adenomas by blocking dopamine 2 receptors in the pituitary gland. In contrast, the medical treatment for a prolactinoma is a dopamine agonist. Therefore, managing a patient concurrently diagnosed with a prolactinoma and psychosis is challenging. We describe a patient with schizophrenia who was diagnosed with a prolactinoma. We changed his neuroleptic to quetiapine and prescribed bromocriptine for the prolactinoma. As a result, the patient was successfully treated with a dopamine agonist and antipsychotic without psychotic exacerbation. Our case suggests that dopamine agonists can be administrated to patients with schizophrenia and a prolactinoma without adversely affecting their psychopathological status.

Safety of ropinirole in the treatment of Parkinson′s disease / 中华全科医师杂志

To explore the safety of ropinirole in the treatment of Parkinson′s disease( PD).A total of 221 PD patients participated in a multi-center,12-week randomized,bromocriptine-controlled,double-blind, double-dummy and parallel-group trial.The safety was assessed on the basis of adverse reactions , blood pressure,pulse,laboratory parameters and electrocardiography recordings.The incidence of adverse reaction was 34.9%in ropinirole group and 34.8% in bromocriptine group.And the frequency of adverse reactions had no inter-group statistical significance (χ2 =0.000,P=0.995).Ropinirole has an excellent profile of safety in the treatment of Chinese PD patients.

Miocardiopatía periparto: caso clínico / Per partum cardiomyopathy: case report

Se presenta el caso clínico de una mujer de 20 años que presenta insuficiencia cardíaca de rápida instalación, asociada a síntomas de infección respiratoria viral, 9 semanas post parto. Previamente había presentado hipertensión en el puerperio precoz. Se demostró una severa disfunción sistólica (FE 12 por ciento). Se recuperó con medidas convencionales del tratamiento de Insuficiencia cardíaca y finalmente recibió bromocriptina basado en reportes favorables de la literatura respecto del uso de este fármaco. En el control al año de su alta, se mantenía asintomática pero persistía severa disminución de la FE (18 por ciento) y dilatación de cavidades izquierdas. Se revisa la información acerca de esta patología.

A 20 year old woman developed rapidly progressive heart failure 9 weeks after delivery. For a few weeks she was hypertensive. A severe systolic dysfunction with an EF of 12 percent was shown on echocardiography. She recovered on conventional treatment of congestive heart failure. Eventually she received bromocriptine con the basis of favorable literature reports. A follow up control at one year showed an asymptomatic patient, however severe systolic dysfunction with EF 18 percent was still present.

Síndrome neuroléptico maligno: caso clínico / Neuroleptic Malignant Syndrome: Clinical case

El Síndrome Neuroléptico Maligno (SNM) descrito por primera vez hace casi cinco décadas, es una peculiar y peligrosa complicación del tratamiento con fármacos antipsicóticos, que se caracteriza por fiebre, rigidez muscular severa y cambios en el estado autonómico y mental. Es una complicación imprevisible y rara, potencialmente mortal de medicamentos antipsicóticos, presuntamente relacionada con el bloqueo dopaminérgico. Prácticamente todos los neurolépticos son capaces de inducir el síndrome, incluyendo laclozapina, risperidona y olanzapina. Estimaciones retrospectivas de incidencia varían desde 0.02 hasta 3.23% de los pacientes psiquiátricos que reciben neurolépticos, tasas de mortalidad reportados están en el rango de 10-20%; es más común en pacientes con esquizofrenia o trastornos afectivos.Se presenta el caso clínico de una paciente que desarrollo Síndrome Neuroléptico Maligno: femenina de18 años de edad, con diagnóstico de esquizofrenia hebefrenica, tratada con antipsicóticos por 39 días, inicia con sialorrea, rigidez generalizada y sudoración profusa. Al examen físico se encontró: ritmo cardiaco de 140 latidos por minuto, presión arterial de 130/90 mmHg, frecuencia respiratoria de 26 por minuto, temperatura de 38.6°C. Los estudios de laboratorio relevantes fueron: recuento de leucocitos de 11,170 células ml y nivel de creatina quinasa de 2,563 UI. Se realizó el diagnóstico de SNM y se inició tratamiento con bromocriptina 5mg vía oral cada 6 horas durante 10 días; la paciente respondió de forma favorable. A continuación se revisa la incidencia, las características clínicas, los factores de riesgo, la mortalidad y el tratamiento del SNM...

Bromocriptine-Treated Giant Lactating Adenoma: A Case Report with Imaging Findings

Lactating adenoma is a benign breast disease that occurs during pregnancy or lactational periods. Here we report on a case of rapidly enlarging lactating adenoma in a 28-year-old postpartum woman, which was mistaken for a malignant breast tumor. Treatment with bromocriptine resulted in a rapid reduction of the mass, suggesting that bromocriptine could be used for shrinking lactating adenoma and to facilitate surgical removal. We describe its imaging findings, including ultrasonographic findings with correlative histologic features, confirmed by surgical excision.

Clinical observation on the treatment of idiopathic hyperprolactinemia infertility by self-designed Bushen Shugan decoction combined with bromocriptine / 国际中医中药杂志

Objective To evaluate the clinical efficacy of the treatment of idiopathic hyperprolactinemia infertility by Chinese medicine combined with bromocriptine.Methods 80 patients diagnosed of idiopathic hyperprolactinemia infertility were randomly recruited into a control group and a experimental group.The control group was treated with bromocriptine alone and the experimental group was treated additionally with self-designed Bushen Shugan decoction on the basis of the control group.The improvement of the clinical symptoms and follicular development were compared between the two groups.The data of ovulation and pregnancy rate was collected.The serum prolactin level and pregnancy outcomes afterdrug withdrawal was followed up and the recurrences was evaluated.Results The follicular development of the experimental group was improved greatly.Its ovulation rate was 72.5％(29/40),pregnancy rate was 60.0％ (24/40) and recurrence rate was 10.0％ (4/40).The follicular development of the control group was not obvious.Its ovulation rate was 27.5％(11/40),pregnancy rate was 20.0％(8/40)and recurrence rate was 35.0％ (14/40).The difference between the two groups was statistically significant (x2＝ 16.200,13.333,7.168,P＜0.05).Besides,there was no miscarriage,premature delivery and fetal malformations in the experimental group.Conclusion The treatment of idiopathic hyperprolactinemia infertility by Chinese medicine combined with bromocriptine had the characteristics of sound clinical efficacy,little side effect,high ovulation and pregnancy rate,low recurrence and good pregnancy outcomes.

Effect of bromocriptine on the expression of Pit-1 in prolactinoma rats / 中国药学杂志

OBJECTIVE: To investigate the effect of bromocriptine on the expression of Pit-1 in prolactinoma rats. METHODS: Firstly, to prepare prolactinoma model in rats. Adult Wistar rats were divided into two groups at random. The rats in control group were subscutaneously implanted with a blank implant. Rats in 17β-estradiol group were implanted with 17β-estradiol-containing implants. Secondly, rates in 17β-estradiol group were divided into two groups at random: model group and bromocriptine group. Water was administrated to rats in model group. Bromocriptine (0.225 mg · kg-1 · d-1) were orally administrated to rats in bromocriptine group, the rats in control group were orally administrated with water. After four weeks of treatment, all the animals were executed. Each pituitary gland was weighed. Serum prolactin (PRL) levels were measured by RIA method. Pit-1 mRNA levels in pituitaiy tissue were measured by RT-PCR method. RESULTS: The weights of pituitary gland and PRL levels in 17β-estradiol group were individually higher than those in control group (P<0.001). The expression levels of Pit-1 mRNA in bromocriptine group was obviously lower than that in model group (P≤0.001). CONCLUSION: Bromocriptine has potential preventive effect to estrogen-induced rat prolactinoma. The decrease of Pit-1 mRNA level may be involved in the mechanism of anti-prolactinoma effect of bromocriptine.

Bromocriptine Therapy for the Treatment of Invasive Prolactinoma: The Single Institute Experience

OBJECTIVE: The objective of this study was to describe and characterize the clinical course of treatment for invasive prolactinoma patients using bromocriptine. METHODS: The study group included 23 patients who were treated with bromocriptine for their invasive prolactinomas. Clinical histories, serum prolactin level and pituitary hormone assessments, tumor diameter and signal intensity on sella magnetic resonance imaging (MRI), visual field exams and the dosage of medications were reviewed for each patient. RESULTS: During 30 months (median, range 6-99) of follow-up period, 19 patients treated with bromocriptine alone achieved biochemical remission. Four patients changed the medication to cabergoline due to the adverse effects or observed resistance of bromocriptine treatment. All of five patients who had visual symptoms improved after the course of medication. Four surgically treated patients were not able to discontinue medication because they could not maintain biochemical remission state without medication. Multivariate analysis showed that decreased enhancement on the initial followed MRI after medication and longer follow-up periods were associated with higher radiologic response. CONCLUSION: We reassure that the dopamine agonist is safe and effective for the treatment of invasive pituitary adenomas. Meanwhile, surgery has a limited role on biochemical remission. Decreased enhancement on the initial follow-up MRI after medication may reflect the treatment response. Further study is required to validate the role of MRI or other factors on the actual prognosis.

Bromocriptine for Control of Hyperthermia in a Patient with Mixed Autonomic Hyperactivity after Neurosurgery: A Case Report

Mixed autonomic hyperactivity disorder (MAHD) among patients with acquired brain injury can be rare. A delayed diagnosis of MAHD might exacerbate the clinical outcome and increase healthcare expenses with unnecessary testing. However, MAHD is still an underrecognized and evolving disease entity. A 25-yr-old woman was admitted the clinic due to craniopharyngioma. After an extensive tumor resection, she complained of sustained fever, papillary contraction, hiccup, lacrimation, and sighing. An extensive evaluation of the sustained fever was conducted. Finally, the cause for MAHD was suspected, and the patient was successfully treated with bromocriptine for a month.