Neurosarcoidosis: inicio con compromiso de múltiples sitios neurológicos / Neurosarcoidosis: Onset with involvement of multiple neurological sites

Resumen Presentamos el caso de una mujer joven sana, que consultó por parálisis facial periférica izquierda asociada a fiebre, tos seca, disnea y astenia de dos semanas de evolución. Al examen físico se evidenció hipoestesia en dermatomas D6 a D12 izquierdos y galactorrea bi lateral. En el laboratorio presentaba serologías virales negativas, eritrosedimentación, títulos de anticuerpos antinucleares, prolactina y hormona tiroestimulante elevados, con anticuerpos antiperoxidasa positivos. La tomografía computarizada mostró múltiples adenopatías cervicales, mediastinales e hiliares bilaterales, sin com promiso del parénquima pulmonar. El cultivo de líquido cefalorraquídeo fue negativo para gérmenes comunes, micobacterias (Xpert MTB/RIF), y la citología no mostró atipia. Se realizó una resonancia magnética con con traste endovenoso de cerebro sin hallazgos patológicos y de columna con alteración de la señal centromedular de D6 a D9 de casi la totalidad del espesor del cordón, con refuerzo con contraste endovenoso. Durante la in ternación recuperó la sensibilidad en tronco izquierdo y no repitió episodios febriles o tusígenos. Se realizó mediastinoscopía con biopsia ganglionar con anatomía patológica con presencia de numerosos granulomas no caseificantes compatibles con sarcoidosis. Se clasificó como neurosarcoidosis probable e inició tratamiento con corticoides con mejoría de los síntomas neurológi cos restantes, realizándose una resonancia magnética a los tres meses, donde la alteración de la señal se limitaba desde D7 a D8. Nuestro objetivo es destacar la presentación neurológica en múltiples sitios que obligó a descartar otras entidades más frecuentes, así como la evolución favorable incluso previo al inicio de un esquema de tratamiento de primera línea.

Abstract We present the case of a healthy young woman who consulted for left peripheral facial palsy associated with fever, dry cough, dyspnea, and asthenia of two weeks' evolution. Physical examination revealed hypoesthesia in left T6 to T12 dermatomes and bilateral galactorrhea. In the laboratory, she presented negative viral serology, elevated erythrocyte sedimentation rate, antinuclear an tibody titers, prolactin and thyroid-stimulating hormone, with positive antiperoxidase antibodies. Computed to mography showed multiple bilateral cervical, mediastinal, and hilar adenopathies, without involvement of lung parenchyma. Cerebrospinal fluid culture was negative for common germs, mycobacteria, and Xpert MTB/RIF, and cytology did not show atypia. Contrast-enhanced magnetic resonance was performed on the brain without pathological findings and on the spine with alteration of the centromedullary signal from T6 to T9 of almost the entire thickness of the cord, with posterior enhancement with gadolinium. During hospitalization, she recovered sensitivity in the left trunk and did not repeat febrile or cough episodes. She was referred to another center for mediastinoscopy with lymph node biopsy revealing the presence of numerous non-caseating granulomas compatible with sarcoidosis. It was classified as probable neurosarcoidosis and started treatment with corticoste roids with improvement of the remaining neurological symptoms. A magnetic resonance was performed three months later where the signal alteration was limited from T7 to T8. Our objective is to highlight the florid neu rological presentation that made it necessary to rule out other more frequent entities and the favorable evolution even before starting a first-line scheme of treatment.

Hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital

Background: Menstrual disorders are a common clinical problem due to multiple causes. Hyperprolactinemia, is disorders of hypothalamic-pituitary axis in young women, is usually associated with amenorrhea, oligomenorrhea, anovulation, and ovulatory cycles with short or inadequate luteal phase, and galactorrhoea. Menstrual disorder affects physical and mental health of every woman. Aims and Objectives: The aim of the study was to know hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital. Materials and Methods: Women with menstrual irregularities attending Gynae outpatient department and admitted initially checked clinically and their serum prolactin level were measured. Women in reproductive age group (15–45 years) with complain of abnormal uterine bleeding were included in the study. Menopausal women, women with organic diseases in uterus and cervix, and pregnant women were excluded from the study. Results: Prolactin level is statistically significant with age (P = 0.011). The patients from age group of 20 to 35 years had high proportion (14.4%) of hyperprolactinemia followed by age group <20 years. (12.9%) and >35 years (12.9%). The women presenting with menstrual disorders enlisted in the study were evaluated on the basis of their sociodemographic parameters. About (15.5%) were below 20 years. About (27%) were above 35 years and majority of the women (57.5%) enrolled in the study were from age group of 2035 years of age. Serum prolactin level was observed in 15.4% in patients with frequent menses, 9.1% in patients with metrorrhagia and 7.7% in patients with heavy menstrual bleeding. That result was statistically significant with P = 0.039. Conclusion: Serum prolactin level should be evaluated in every patient of menstrual disorders.

Efficacy and safety of Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia： a Meta-analysis / 四川精神卫生

ObjectiveTo systematically evaluate the efficacy and safety of Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia， and to provide references for intervention of antipsychotic-induced hyperprolactinemia patients. MethodsEnglish databases （PubMed， Cochrane Library， PsycINFO and Embase） and Chinese databases （CNKI and Wanfang） were systematically searched， with a search time frame of the period from database creation to September 16， 2022. Randomized controlled studies （RCTs） on adjunctive Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia were included. Three investigators independently screened the literatures and extracted data according to PICOS principles and evaluated the quality of including literatures， and the Meta-analysis was performed by using RevMan 5.3. ResultsA total of 3 articles including 256 female schizophrenic patients with hyperprolactinemia were included. Meta-analysis results showed that at the treatment endpoint， the improvement of hyperprolactinemia symptoms reported a significant superiority of the intervention group than the control group （RR=1.73， 95% CI： 1.07~2.79， P˂0.05）. Similarly， the significant superiority of the intervention group than the control group were also found in reducing serum prolactin levels （WMD=-55.17， 95% CI： -68.16~-42.18， P<0.01） and Positive and Negative Syndrome Scale （PANSS） total scores were lower in the intervention group than in the control group （WMD=-7.36， 95% CI： -8.94~-5.77， P<0.01）. ConclusionTianmeng Oral Liquid may help improve clinical efficacy and reduce serum prolactin levels in female schizophrenia patients with hyperprolactinemia. It may improve psychiatric symptoms in female patients with schizophrenia.

Hipogonadismo masculino secundario a macroprolactinoma / Men with hypogonadism secondary to macroprolactinoma / Hipogonadismo masculino secundário a macroprolactinoma

Los prolactinomas son los tumores funcionantes de hipófisis más frecuentes. Se clasifican según su tamaño en microprolactinomas (menores a 1 cm) y macroprolactinomas (mayor o igual a 1 cm). Estos últimos tienen mayor frecuencia en hombres y en general se diagnostican más tardíamente, cuando aparecen síntomas compresivos. La hiperprolactinemia interfiere con la secreción pulsátil de la hormona liberadora de gonadotropinas (GnRH), lo que genera la inhibición de secreción de hormona luteinizante (LH) y de hormona foliculoestimulante (FSH), y en consecuencia produce hipogonadismo hipogonadotrófico. El presente artículo reporta un caso clínico de un paciente de 26 años, de sexo masculino, en el que se realiza el diagnóstico de hipogonadismo hipogonadotrófico secundario a un macroprolactinoma, en el contexto de una pubertad detenida.

Prolactinomas are the most common functioning pituitary tumors. According to size, they are classified into microprolactinomas (smaller than 1 cm) and macroprolactinomas (larger than or equal to 1 cm). The latter are more frequent among men and in general of late diagnosis upon compressive symptoms. Hyperprolactinemia interferes with the pulsatile secretion of the gonadotrophin releasing hormone (GnRH)) what results in inhibition of the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), what consequently produces hypogonadotrophic hypogonadism. The study reports the clinical case of a 26-year-old male who was diagnosed with hypogonadotrophic hypogonadism secondary to macroprolactinoma, within the context of detained puberty.

Os prolactinomas são os tumores hipofisários funcionantes mais comuns. São classificados de acordo com seu tamanho em microprolactinomas (menos de 1 cm) e macroprolactinomas (maior ou igual a 1 cm). Estas últimas são mais frequentes em homens e geralmente são diagnosticadas mais tarde, quando aparecem sintomas compressivos. A hiperprolactinemia interfere na secreção pulsátil do hormônio liberador de gonadotropina (GnRH), levando à inibição da secreção do hormônio luteinizante (LH) e do hormônio folículo-estimulante (FSH) e, consequentemente, hipogonadismo hipogonadotrófico. Este artigo relata o caso clínico de um paciente do sexo masculino de 26 anos, no qual é feito o diagnóstico de hipogonadismo hipogonadotrófico secundário a um macroprolactinoma, no contexto de puberdade interrompida.

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.

A Giant Prolactinoma: A Case Report

A 38-years-old woman presented to our hospital 2 years ago with 5-year history of reduced vision, chronic cephaleea and secondary amenorrhea. Her baseline prolactin level was 46504 ?IU/mL (reference range=127-637mUI/ml) with secondary hypogonadism, and pituitary magnetic resonance imaging revealed a giant prolactinoma (4 × 2.2 × 2.6 cm3) with suprasellar extension, optic chiasma and right cavernous sinus compression. She was initially treated with cabergoline in order to reduce the prolactin level and tumoral mass, but after 6 months of medical treatment she proceed to transsphenoidal tumor debulking surgery. Prolactin level dropped in the normal range only after the addition of cabergoline treatment after surgery (1 mg/day 3 times/per week). However, the extensive tumour was not completely resectable so she remained amenorrheic requiring hormone replacement therapy as well as thyroxine replacement due to the development of TSH deficiency (free T4 6.03 pmol/L)

A case of pituitary adenoma presenting with normal hormone levels

We report a case of pituitary adenoma with normal hormone levels in a 34-year-old female. She presented to OP with headache, milky discharge from nipples and secondary amenorrhea with transient loss of vision. Patient had hyperprolactinemia with normal levels of all other pituitary hormones. MRI revealed space occupying lesion in sellar and suprasellar region. Neurological consultation suggested Rathke抯 cyst/ craniopharyngioma/ macroadenoma. Excised lesion was diagnosed as pituitary adenoma during histopathological analysis.

Galactorreia pós-mastopexia com prótese: relato de caso / Post-mastopexy galactorrhoea with a prosthesis: a case report

A mastopexia é a cirurgia plástica responsável pela correção da ptose mamária, problema caracterizado pela discrepância entre o volume da mama e sua camada cutânea. As complicações mais relatadas no pós-operatório imediato são deiscência de suturas, seroma, edema e infecção, enquanto outras, como a galactorreia, são consideradas raras. O caso em questão consiste em uma paciente de 52 anos, que realizou a mastopexia bilateral com inclusão de prótese e desenvolveu após 30 dias do procedimento galactorreia com hiperprolactinemia. O diagnóstico foi suspeitado devido ao aumento de volume, associado a dor ou desconforto mamário no pós-operatório, seguido de saída secreção leitosa. A galactocele pósmastopexia com prótese pode ou não estar associada à hiperprolactinemia, porém pouco se sabe sobre a real fisiopatologia do desenvolvimento desse quadro. O tratamento foi feito com cabergolina 0,5mg em duas doses, com melhora do quadro.

Mastopexy is the plastic surgery responsible for correcting breast ptosis, a problem characterized by a discrepancy between the volume of the breast and its skin layer. The complications most commonly reported in the immediate postoperative period are suture dehiscence, seroma, edema and infection, while others such as galactorrhea are considered rare. The case in question consists of a 52-yearold patient who underwent bilateral mastopexy with prosthesis inclusion and developed galactorrhea with hyperprolactinemia 30 days after the procedure. The diagnosis was suspected of increased volume, associated with postoperative breast pain or discomfort, followed by milky discharge. Galactocele after mastopexy with a prosthesis may or may not be associated with hyperprolactinemia, but little is known about the real pathophysiology of the development of this condition. Treatment was done with cabergoline 0.5mg in two doses, improving the condition.

Hyperprolactinemia and galactorrhea associated with the use of duloxetine to treat chronic neuropathic pain. Case report / Hiperprolactinemia e galactorreia associada ao uso de duloxetina para tratamento de dor neuropática crônica. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The association of the use of some drugs with hyperprolactinemia and galactorrhea has been reported in the literature, but information on the role of duloxetine in these alterations is scarce. Therefore, the aim of this study was to highlight this adverse effect and discuss the pathophysiological causes of galactorrhea associated with the use of duloxetine in a patient undergoing treatment for chronic pain. CASE REPORT: Female patient, 70 years old, with herpetic neuropathy diagnosis. She developed refractory pain after drug treatment and was referred to the pain clinic. Duloxetine (60mg) taken once a day was maintained and associated with blocks with local anesthetic in regions of herpetic pain. The patient complained of galactorrhea and changes in weight and showed an increase in serum prolactin. Then, the possibility of hyperprolactinemia due to duloxetine was raised. Duloxetine was suspended, and after one month, a significant reduction in serum prolactin levels and end of galactorrhea were observed. CONCLUSION: The treatment of patients with neuropathic pain is extremely challenging and the detailed understanding, especially of the pharmacological strategy and its possible adverse effects, is fundamental for the better management of patients and their well-being. Therefore, it is concluded that duloxetine, although rarely, can cause an increase in serum prolactin and galactorrhea in users.

RESUMO JUSTIFICATIVA E OBJETIVOS: A associação do uso de alguns fármacos com hiperprolactinemia e galactorreia tem sido relatada na literatura, mas são escassas as informações sobre o papel da duloxetina nestas alterações. Portanto, o objetivo deste estudo foi destacar este efeito adverso e discutir as causas fisiopatológicas da galactorreia associada ao uso de duloxetina no tratamento da dor crônica. RELATO DO CASO: Paciente do sexo feminino, 70 anos, com diagnóstico de neuropatia herpética. Evoluiu com refratariedade álgica após tratamento farmacológico, sendo encaminhada à clínica de dor. Optou-se por manter a duloxetina (60 mg) uma vez ao dia e associar bloqueios com anestésico local em regiões de dor herpética. A paciente queixou-se de galactorreia e alteração de peso e apresentou elevação da prolactina sérica. Foi aventada, então, a possibilidade de hiperprolactinemia pela duloxetina. Foi, então, realizada a suspensão da duloxetina e, após um mês, foi observada redução expressiva dos níveis séricos da prolactina e cessação da galactorreia. CONCLUSÃO: O tratamento de pacientes com dor neuropática é extremamente desafiador e a compreensão detalhada do processo, em destaque para a estratégia farmacológica e seus possíveis efeitos adversos é fundamental para o melhor manejo dos pacientes e manutenção do bem-estar. Diante disso, concluiu-se que a duloxetina, apesar de acontecer raramente, pode causar aumento da prolactina sérica e galactorreia em usuários.

Serum levels of megaprolactin and gonadal hormones in patients with hyperprolactinemia induced by antipsychotics and their clinical significance / 中国基层医药

Objective:To investigate serum levels of macroprolactin and gonadal hormones in patients with hyperprolactinemia induced by antipsychotics and their clinical significance.Methods:A total of 105 female patients with schizophrenia who received treatment in Huzhou Third Municipal Hospital from June 2017 to October 2018 were included in this study. All these patients received the antipsychotic drug clozapine for 2 months. Then 50 patients with hyperprolactinemia were included in the observation group, and 55 patients who had no hyperprolactinemia were included in this control group. The scores of the Scale for the Assessment of Negative Symptoms and Scales for the Assessment of Positive Symptoms were compared between the two groups. Serum levels of macroprolactin, progesterone, testosterone, estradiol, prolactin, luteinizing hormone, and follicle-stimulating hormone were then compared between the two groups. The Spearman correlation analysis was used to analyze the correlation between serum macroprolactin level and serum progesterone, estradiol, prolactin, and luteinizing hormone levels.Results:Serum macroprolactin level in the observation group was significantly higher than that in the control group [(63.80 ± 12.13) ng/mL vs. (59.07 ± 9.84) ng/mL, t = 2.20, P = 0.030). Serum levels of progesterone, testosterone, estradiol, prolactin, luteinizing hormone, and follicle-stimulating hormone were (4.01 ± 0.47) ng/mL, (5.59 ± 1.15) ng/mL, (236.72 ± 15.14) pg/mL, (127.30 ± 12.40) ng/mL, (6.05 ± 1.10) mIU/mL, (8.52 ± 2.13) mIU/mL, respectively, and they were (10.25 ± 1.83) ng/mL, (6.01 ± 1.20) ng/mL, (433.10 ± 20.90) pg/mL, (50.58 ± 6.22) ng/mL, (7.69 ± 2.36) mIU/mL, (8.48 ± 2.01) mIU/mL, respectively in the control group. Serum levels of progesterone, estradiol, and luteinizing hormone in the observation group were significantly lower than those in the control group, and serum level of prolactin in the observation group was significantly higher than that in the control group ( t = 23.41, 54.66, 4.63, 40.61, all P < 0.05). There were no significant differences in serum levels of testosterone and follicle-stimulating hormone between the two groups ( t = 1.82, 0.09, P = 0.071, 0.921). Spearman correlation analysis results showed that serum macroprolactin level was negatively correlated with serum levels of progesterone and estradiol, and it was positively correlated with serum levels of prolactin and luteinizing hormone ( r = -0.42, -0.51, -0.68, 0.70, all P < 0.05). Conclusion:Serum levels of macroprolactin and prolactin were higher, and serum levels of progesterone, estradiol, and luteinizing hormone levels were lower in patients with hyperprolactinemia induced by antipsychotics than in patients without hyperprolactinemia. Serum levels of macroprolactin, prolactin, luteinizing hormone, progesterone, and estradiol were remarkably correlated with the balance of gonadal hormones. The study outcomes are of great innovation and science.

Establishment and comparison of two methods to produce a rat model of mammary gland hyperplasia with hyperprolactinemia

Abstract This study aimed to establish and compare models of mammary gland hyperplasia (MGH) with hyperprolactinemia (HPRL) using two different methods. The models provide information on the relationship between mammary gland hyperplasia and associated hormones. Model A was constructed using intramuscular injections of estradiol benzoate injection (EBI), followed by progesterone (P), and then metoclopramide dihydrochloride (MDI). Model B was designed by administering MDI, follow by EBI, and then P intramuscularly. Model B showed higher MGH progression compared with model A. Notably, increase in estradiol (E2) was negatively correlated with prolactin (PRL) secretion. However, PRL levels in model B were significantly higher compared with the levels in model A. Estrogen (ER), prolactin receptor (PRLR), and progesterone receptor (PR) mRNA and protein expression levels in model B rats were positively correlated with changes in the corresponding hormone levels. However, E2, P, and PRL levels in model A showed no direct relationship with levels of the mRNAs of related hormones and protein expression levels. Our results suggest that model B is an appropriate model of MGH with HPRL that can be used to perform further studies about the interactions of the E2, P, and PRL hormones in this disorder.

Effect of Modified Xiaoyaosan on Dopamine Transporter in Rats with Hyperprolactinemia / 中国实验方剂学杂志

ObjectiveTo investigate the effect of modified Xiaoyaosan on central dopamine transporter （DAT）/protein kinase C （PKC）-dependent signaling pathway in hyperprolactinemia （HPRL） rats. MethodHPRL rat model was established by chronic combined stress combined with intraperitoneal injection of metoclopramide. Ninety-six rats were randomly divided into six groups， namely， the blank group， model group， western medicine （bromocriptine， 0.001 g·kg-1·d-1） group， and high-， medium-， and low-dose （60， 30， 15 g·kg-1·d-1） modified Xiaoyaosan groups. After 14 days of administration， the serum prolactin （PRL） content was detected by enzyme-linked immunosorbent assay， the expression of tyrosine hydroxylase （TH） in rat hypothalamus by immunohistochemistry， and the protein expression of DAT and PKC in hypothalamus by Western blot. ResultCompared with the blank group， the model group exhibited significantly increased PRL and DAT （P<0.01）， but decreased TH and PKC （P<0.01）. Compared with the model group， bromocriptine and modified Xiaoyaosan at the medium dose significantly lowered the content of PRL （P<0.01）. The modified Xiaoyaosan at the medium and high doses elevated the expression of TH （P<0.05， P<0.01）. The expression levels of PKC in the medium- and low-dose modified Xiaoyaosan groups and the western medicine group were significantly increased （P<0.01）， while the DAT expression levels in the high-， medium-， and low-dose modified Xiaoyaosan groups and the western medicine group were decreased （P<0.01）. ConclusionThe modified Xiaoyaosan is able to up-regulate the expression of TH and down-regulate the level of DAT through PKC-dependent signaling pathway， thereby regulating the PRL.

Guiding significance of "disease-syndrome-symptom" mode in FU Qing-zhu's Obstetrics and Gynecology (FU Qing-zhu Nyu Ke) for dealing with ovulation disorder infertility caused by hyperprolactinemia / 中国中药杂志

This paper discussed the guiding significance of "disease-syndrome-symptom" mode in FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) for dealing with ovulation disorder infertility caused by hyperprolactinemia(HPRL). FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) concentrates on the disease entities, main symptoms, pathogenesis, and syndrome differentiation, based on which the prescriptions are prescribed. This reflects the "disease-syndrome-symptom" mode, with the core lying in the "combination of disease with syndrome". The contained Discussion on Menstruation Regulation(Tiao Jing Pian) and Discussion on Getting Pregnant(Zhong Zi Pian) have important reference significance for later doctors in the diagnosis and treatment of inferti-lity, and many prescriptions are still in use due to good effects. It is believed in traditional Chinese medicine(TCM) that HPRL results from kidney deficiency and liver depression, among which kidney deficiency is the main cause. Liver depression accelerates the onset of HPRL, so the kidney-tonifying and liver-soothing herbs were mainly selected. The "disease-syndrome-symptom" mode in FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) sheds enlightenment on the diagnosis and treatment of ovulation infertility caused by HPRL, in that it is not confined to disease entity and syndrome type. The integration of "disease-syndrome-symptom" highlights the main complaint of patients and emphasizes the main pathogenesis, thus giving full play to the overall advantage of syndrome differentiation. For multiple diseases in FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) such as infertility due to liver depression, infertility due to obesity, delayed menstruation, and irregular menstruation, although the typical lactation symptom of HPRL is not mentioned, the medication can still be determined according to the chief complaint, syndrome type, and symptoms and signs, making up for the defects of excessive reliance on serum biochemical indicators in modern Chinese medicine. We should learn its diagnosis and treatment thoughts of paying attention to liver, spleen, kidney, and heart, holism, and strengthening body resistance to eliminate pathogenic factors.

The prevalence and clinical characteristics of macroprolactinemia: A single center survey / 中华内分泌代谢杂志

Objective:To describe the prevalence and clinical characteristics of macroprolactinemia in hyperprolactinemia patients.Methods:Consecutive 111 outpatients diagnosed with hyperprolactinemia were included in this study. Macroprolactin was routinely screened using the polyethylene glycol(PEG) precipitation method. Recovery of monomeric prolactin less than 40% was defined as macroprolactinemia. Clinical characteristics were analyzed in this study.Results:Among the 111 cases included, 99 were female and 12 were male, with an average age of(32.2±7.9) years. There were 32 cases(28.8%) of macroprolactinemia and 28 of them with normal monomeric prolactin levels(simple macroprolactinemia). prolactin levels before precipitation in simple macroprolactinemia were significantly lower than those with true hyperprolactinemia[(49.81±23.58 vs 83.56±65.82) ng/mL, P<0.05]. No amenorrhea and infertility were observed in patients with simple macroprolactinemia. The clinical manifestations of prolonged menstruation, oligomenorrhea and galactorrhea in female patients accounted for 25.9%, 37.0%, and 7.4%, respectively. Imaging data were obtained in 92 cases. The prevalence of pituitary adenomas in simple macroprolactinemia and true hyperprolactinemia was 42.9% and 66.0%, respectively. Fifteen(46.8%) of the macroprolactinemia cases were receiving or had received bromocriptine treatment, and 66.7% of them failed to achieve normal prolactin levels during therapy. Conclusion:Macroprolactinemia might be common in clinical practice. Macroprolactin should be screened in hyperprolactinemia patients lack of amenorrhea and infertility, and with poor response to dopamine agonist therapy.

Examples of Professor MA Kun's treatment of infertility caused by hyperprolactinemia with kidney deficiency and blood stasis / 中国中药杂志

Hyperprolactinemia(HPRL) is one of the diseases leading to anovulatory infertility, which is a refractory gynecological disease and seriously affects female reproductive function. Professor MA Kun has summarized his experience in clinical and scientific studies for many years. And believes that kidney deficiency is the pathogenesis of HPRL and blood stasis is the dominant pathological manifestation of HPRL and can promote the progress of the disease. In view of this, Professor MA Kun took the therapy of kidney-tonifying and blood-activating as the principle for treating anovulatory infertility caused by HPRL, with soothing the liver and promoting Qi as adjuvant therapies. She has also summarized and refined the prescriptions for tonifying kidney and inducing ovulation, which have a remarkable clinical efficacy.

Hyperprolactinemia associated with psychiatric disorders / Hiperprolactinemia asociada con trastornos psiquiátricos

Abstract Hyperprolactinemia may be associated with psychiatric disorders in the context of two scenarios: antipsychotic-induced hyperprolactinemia and psychiatric disorders arising from the medical treatment of hyperprolactinemia. Both situations are particularly common in psychiatric and endocrine clinical practice, albeit generally underestimated or unrecognized. The aim of this article is to provide tools for the diagnosis and treatment of hyperprolactinemia associated with psychiatric disorders to raise awareness, especially among psychiatrists and endocrinologists, so that these professionals can jointly focus on the appropriate management of this clinical entity.

Resumen La hiperprolactinemia puede asociarse con trastornos psiquiátricos en el contexto de dos escenarios: la hiperprolactinemia inducida por antipsicóticos y trastornos psiquiátricos surgidos por el tratamiento médico de la hiperprolactinemia. Ambas situaciones son particularmente comunes en la práctica clínica psiquiátrica y endocrinológica, aunque generalmente subestimadas o inadvertidas. El objetivo de este artículo es proporcionar herramientas de diagnóstico y tratamiento de la hiperprolactinemia asociada a trastornos psiquiátricos, para concientizar particularmente a psiquiatras y endocrinólogos a enfocar en conjunto el manejo apropiado de esta entidad.

Analytical study of thyroid and prolactin hormone levels in infertile women with menstrual irregularities

Background: Infertility is the inability of a couple to achieve pregnancy over an average period of one year (in a woman under 35 years of age) or 6 months (in a woman above 35 years of age) despite adequate, regular (3-4 times per week), unprotected sexual intercourse. It is of two types, primary infertility and secondary infertility. It can be due to the woman, the man, or both men and woman. Though there are several factors plays role in the causing infertility, endocrine hormones play a crucial role in it. Among all the hormones, thyroid and prolactin hormone have profound effects on reproduction and pregnancy.Methods: A prospective analytical study was conducted among 200 female patients, of age group 20-40 years, attending the outpatient department of obstetrics and gynecology. Sent for analysis of thyroid profile and prolactin levels. The data of the patients who have been completely followed up after six months was entered in excel sheet and analyzed using SPSS (version 16).Results: In this study the mean age of the study participants were 31.33±4.12 years and 4 of them were below 25 years of age. There is high prevalence of hypothyroidism (23.5%) and hyperprolactinemia (31%) was noted among the infertile females.Conclusions: The assessment of thyroid function and prolactin levels is mandatory in the work up of all infertile women, especially those presenting with menstrual irregularities. Also, early initiation of treatment may help in restoring the fertility among the infertile woman.

Caracterización clínico-etiológica y bioquímica de pacientes con ginecomastia / Clinical- etiological and biochemical characterization of patients with gunecomastia

RESUMEN Introducción: La ginecomastia define el aumento benigno del tamaño de la glándula mamaria en el hombre. Objetivo: Determinar las características clínicas, etiológicas y bioquímicas de los pacientes con diagnóstico de ginecomastia atendidos en el servicio de Cirugía General. Método: Se realizó un estudio descriptivo de corte transversal en una muestra de 108 pacientes, mayores de 18 años, atendidos en el servicio de Cirugía General con diagnóstico de ginecomastia. El estudio se llevó a cabo en los Hospitales Mariano Pérez Balí y Celia Sánchez Manduley, entre septiembre 2015 y marzo 2017. Se determinó edad, características clínicas, etiología y perfil bioquímico de estos pacientes. Resultados: La edad media fue de 27,63 años siendo la afectación estética el principal motivo de consulta. Predominó la ginecomastia bilateral, el sobrepeso/obesidad, el grado IIa de la enfermedad, la etiología idiopática y el antecedente de ginecomastia puberal. La presencia de galactorrea, hiperprolactinemia, hipoandrogenismo e hiperestrogenemia fue mínima. Conclusiones: La ginecomastia bilateral de causa idiopática, en pacientes con sobrepeso/obesidad y niveles normales de hormonas hipofisarias y gonadales es la forma de presentación más frecuente de esta afección(AU)

ABSTRACT Introduction: Gynecomastia defines the benign increase of the mammary gland size in men. Objective: To determine the clinical, etiological and biochemical characteristics of patients diagnosed with gynecomastia attended at the General Surgery service. Methods: A descriptive cross-sectional study was conducted in a sample of 108 patients over the age of 18 years, attended at the service of General Surgery with a diagnosis of gynecomastia. The study was carried out in ´´Mariano Perez Bali´´ and ´´Celia Sánchez Manduley´´ Hospitals from September 2015 to March 2017. The age, clinical characteristics, etiology, and biochemical profile of these patients were determined. Results: The mean age was 27.63 years and the aesthetic affectations were the main reason for consultation. There was a predominance of bilateral gynecomastia, overweight/obesity, grade IIa of the disease, idiopathic etiology and the history of pubertal gynecomastia. The presence of hyperprolactinemia, galactorrhea, hypoandrogenism and hyperstrogenism was minimal. Conclusions: Bilateral gynecomastia of idiopathic cause, in patients with overweight/obesity and normal levels of gonadal and pituitary hormones is the most common presentation of this condition(AU)

Body self-image disturbances in women with prolactinoma

Objective: To evaluate body dissatisfaction and distorted body self-image in women with prolactinoma. Methods: Body dissatisfaction and distorted body self-image were evaluated in 80 women with prolactinoma. All patients were in menacme, 34% had normal body mass index (BMI), and 66% were overweight. Most patients (56.2%) had normal prolactin (PRL) levels and no hyperprolactinemia symptoms (52.5%). The Body Shape Questionnaire (BSQ) was used to assess the patients' dissatisfaction with and concern about their physical form, and the Stunkard Figure Rating Scale (FRS) was used to assess body dissatisfaction and distorted body self-image. The patients were divided according to PRL level (normal vs. elevated) and the presence or absence of prolactinoma symptoms. Results: The normal and elevated PRL groups had similar incidences of body dissatisfaction and distorted body self-image. However, symptomatic patients reported a higher incidence of dissatisfaction than asymptomatic patients. Distorted body self-image was less common among symptomatic patients. Conclusion: Symptomatic patients showed higher body dissatisfaction, but lower body self-image distortion. The presence of symptoms may have been responsible for increased body awareness. The perception of body shape could have triggered feelings of dissatisfaction compared to an ideal lean body. Therefore, a distorted body self-image might not necessarily result in body dissatisfaction in women with prolactinomas.

Resolution of headache after reduction of prolactin levels in hyperprolactinemic patients / Resolução de cefaleia após redução dos níveis de prolactina em pacientes com hiperprolactinemia

Abstract Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.

Resumo Os adenomas secretores de prolactina (PRL) estão associados à alta incidência de cefaleia. O papel da hiperprolactinemia no contexto da dor de cabeça não está claro, nem o efeito da redução dos níveis da PRL na cefaleia. Métodos: O presente estudo longitudinal avaliou pacientes hiperprolactinêmicos (69), quanto à presença e às características da cefaleia antes e após o tratamento da hiperprolactinemia. Resultados: Cefaleia foi relatada por 45 (65,2%) pacientes, independente da etiologia da hiperprolactinemia. O fenótipo de enxaqueca foi mais prevalente (66,6%). Os medicamentos usados ​​no tratamento da cefaleia não foram alterados durante o estudo. A primeira linha de tratamento da hiperprolactinemia foram os agonistas dopaminérgicos. Na última reavaliação, o nível de PRL sob tratamento estava dentro da faixa de referência em 54,7% dos casos, observando-se resolução completa ou parcial da cefaleia em 75% dos casos. A mediana de PRL neste momento em pacientes com resolução completa da cefaleia foi de 17 ng/mL, nos que relataram recuperação parcial foi de 21 ng/mL, e naqueles em que a cefaleia não se alterou foi de 66 ng/mL, com uma diferença significativa entre o grupo com resolução completa da cefaleia versus o grupo com cefaleia inalterada (p=0,022). Nos casos com resolução completa da cefaleia, a queda mediana nos níveis de PRL foi de 89% e nos casos com resolução parcial de cefaleia de 86%, ambos significativamente diferentes (p<0,001) da queda nos casos com cefaleia inalterada. Conclusão: Os dados permitem concluir que, nesta série, na maioria dos casos, a redução do nível de PRL foi seguida pela cessação ou alívio da dor.