Semen parameters in men recovered from COVID-19 / 亚洲男科学杂志(英文版)

The novel coronavirus disease (COVID-19) pandemic is emerging as a global health threat and shows a higher risk for men than women. Thus far, the studies on andrological consequences of COVID-19 are limited. To ascertain the consequences of COVID-19 on sperm parameters after recovery, we recruited 41 reproductive-aged male patients who had recovered from COVID-19, and analyzed their semen parameters and serum sex hormones at a median time of 56 days after hospital discharge. For longitudinal analysis, a second sampling was obtained from 22 of the 41 patients after a median time interval of 29 days from first sampling. Compared with controls who had not suffered from COVID-19, the total sperm count, sperm concentration, and percentages of motile and progressively motile spermatozoa in the patients were significantly lower at first sampling, while sperm vitality and morphology were not affected. The total sperm count, sperm concentration, and number of motile spermatozoa per ejaculate were significantly increased and the percentage of morphologically abnormal sperm was reduced at the second sampling compared with those at first in the 22 patients examined. Though there were higher prolactin and lower progesterone levels in patients at first sampling than those in controls, no significant alterations were detected for any sex hormones examined over time following COVID-19 recovery in the 22 patients. Although it should be interpreted carefully, these findings indicate an adverse but potentially reversible consequence of COVID-19 on sperm quality.

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.

Importancia de la anamnesis exhaustiva ante una ginecomastia unilateral inexplicada en un niño / Importance of the exhaustive anamnesis to an unexplained unilateral gynecomastia in a child

La ginecomastia es el crecimiento de la mama por un desequilibrio hormonal entre estrógenos y andrógenos. Un crecimiento importante y unilateral requiere descartar patologías subyacentes. Una causa poco frecuente es la traumática, que provoca aumento de tamaño por estimulación repetida. Se presenta el caso de un niño de 6 años con ginecomastia unilateral. Se destaca como único hallazgo en las pruebas complementarias hiperprolactinemia. Rehistoriando, se detecta una continua autoestimulación mamaria manual y oral a través de mordiscos de meses de evolución. Tras el cese del estímulo, se observa la involución de la mama y la normalización de los niveles de prolactina séricos.

Gynecomastia consists of breast enlargement due to a hormonal imbalance between estrogens and androgens. Unilateral and important breast growth requires ruling underlying pathologic disorders out. Mechanical cause is uncommon, causing enlargement by repeated stimulation. We report a 6-year-old boy with unilateral gynecomastia. Hyperprolactinemia is the only abnormal finding at laboratory tests. After repeated inquiries, a continuous breast selfstimulation is detected. Its relation with gynecomastia is verified because prolactin normalizes and breast regressed in further revisions, after stopping stimulus.

Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

Low estrogen doses normalize testosterone and estradiol levels to the female range in transgender women

OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate in transgender women. METHODS: The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject. RESULTS: Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. CONCLUSION: In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.

Gonadotrophic, prolactin, corticosterone, and gonadal hormones levels over 15 months in Giant Amazon River Turtles - Podocnemis expansa (Schweigger, 1812) (Testudines: Podocnemididae), in captive conditions / Gonadotrofinas, prolactina, corticosterona, e as hormonas sexuais durante 15 meses de Tartarugas da Amazônia - Podocnemis expansa (Schweigger, 1812) (Testudines: Podocnemididae), em condições de cativeiro

Abstract In order to achieve successful captive breeding the Podocnemis expansa, it is necessary to study their reproductive endocrinology. The purpose of this research was to evaluate and characterize plasma concentrations in gonadotrophic, gonadic, corticosterone and prolactin hormones from Giant Amazon Turtles under captive conditions. Blood samples were collected over a 15 month period. The samples were assayed by the use of radioimmunoassay, prolactin, corticosterone, LH, FSH, testosterone, 17β-estradiol and progesterone. We verified significant seasonal pattern increase in 17β-estradiol levels and decrease in progesterone levels in the course of a year, which indicates vitellogenesis. This is related to normal ovarian cycles and possibly to the functional integrity of the hypothalamus-pituitary-gonad axis of captive females. There were negative correlations between testosterone and corticosterone in the male samples, suggestive of stress (management stress) on the reproductive system. The plasma concentrations of gonadotrophic, gonadic, prolactin and corticosterone hormones may be used as a reference for further research and possible therapeutic approaches. The data collected during this research are unprecedented for this species and may serve as a reference for future research regarding the reproductive cycle of this turtle, also allowing reproductive management while in captivity. Information about these hormones must be gathered from wild populations during different periods of the year for better clarification of the reproductive physiology of this species.

Resumo Com o objetivo de obter reprodução em cativeiro de Podocnemis expansa, é necessário reunir o conhecimento a respeito de sua endocrinologia reprodutiva. O objetivo deste trabalho foi avaliar e caracterizar as concentrações plasmáticas de hormônios gonadotróficos, gonadais, corticosterona e prolactina em Tartarugas da Amazônia em condições de cativeiro. Amostras de sangue foram coletadas durante 15 meses. As amostras foram ensaiadas pelo uso de um radioimunoensáio, prolactina, corticosterona, LH, FSH, testosterona, 17β-estradiol e progesterona. Verificou-se aumento de padrão sazonal significativo nos níveis de 17β-estradiol e diminuição dos níveis de progesterona ao longo do ano, o que indica o recrutamento folicular. Isto está relacionado com ciclos ovarianos normais e possivelmente para a integridade funcional do eixo hipotálamo-hipófise-gônadas de fêmeas em cativeiro. Houve correlação negativa entre testosterona e corticosterona nas amostras do sexo masculino, sugestivos de efeito do estresse de manejo sobre o sistema reprodutivo. As concentrações plasmáticas de hormônios gonadotrofinas, gonadais, prolactina e hormônios corticosterona pode ser usado como referência para futuras pesquisas e possíveis abordagens terapêuticas. Os dados médios coletados durante a pesquisa são inéditos para a espécie e pode servir como referência para futuras pesquisas sobre o sistema reprodutivo da tartaruga, também permitindo manejo reprodutivo em cativeiro. Informações sobre esses hormônios devem ser recolhidas a partir de natureza selvagem em diferentes períodos do ano para melhor esclarecimento da fisiologia da reprodução desta espécie.

Lactation Induction in a Commissioned Mother by Surrogacy: Effects on Prolactin Levels, Milk Secretion and Mother Satisfaction / Indução da lactação em mãe por útero de substituição: efeitos na concentração de prolactina, produção láctea e satisfação materna

Abstract Case report of a 39-year-old intended mother of a surrogate pregnancy who underwent induction of lactation by sequential exposure to galactagogue drugs (metoclopramide and domperidone), nipple mechanical stimulation with an electric pump, and suction by the newborn. The study aimed to analyze the effect of each step of the protocol on serum prolactin levels, milk secretion and mother satisfaction, in the set of surrogacy. Serum prolactin levels and milk production had no significant changes. Nevertheless, themother was able to breastfeed for four weeks, and expressed great satisfaction with the experience. As a conclusion, within the context of a surrogate pregnancy, breastfeeding seems to bring emotional benefits not necessarily related to an increase in milk production.

Resumo Relato de caso de mãe por útero de substituição, de 39 anos de idade, submetida a indução da lactação por exposição sequencial a drogas galactogogas (metoclopramida e domperidona), estimulação mamilar mecânica com bomba elétrica, e sucção pelo recém-nascido. O estudo teve como objetivo analisar os efeitos de cada etapa do protocolo na concentração sérica de prolactina, no volume de secreção láctea e na satisfação materna. A concentração sérica de prolactina e a produção láctea não apresentaram mudanças significativas. Entretanto, a mãe foi capaz de amamentar a criança por quatro semanas, e manifestou grande satisfação com a experiência. Como conclusão, no contexto de maternidade por útero de substituição, o aleitamento materno parece promover benefícios emocionais, não necessariamente relacionados ao aumento do volume de leite.

Evaluación de los valores séricos de prolactina en lupus eritematoso sistémico / Assessment of serum prolactin levels in patients with systemic lupus erythematosus

El propósito del presente estudio fue determinar la relación entre los valores de prolactina sérica y las características clínicas de pacientes con lupus eritematoso sistémico (LES) asistentes a la consulta de Reumatología del Servicio Autónomo Hospital Universitario de Maracaibo, en Maracaibo, Venezuela. Se realizó un estudio descriptivo, correlacional y transversal en pacientes femeninas, mayores de 18 años, con diagnóstico de LES, quienes asistieron al Hospital Universitario de Maracaibo, durante los meses de noviembre 2012 a junio del 2013; se les realizó una historia clínica integral, basada en anamnesis y examen físico, con énfasis en la búsqueda de manifestaciones clínicas de actividad lúpica y se tomaron muestras sanguíneas para la determinación de las concentraciones séricas de prolactina, en el momento de la evaluación de la paciente. Se utilizaron como rangos normales, valores entre 2,1 y 25 ng/mL. La población consistió en un total de 50 pacientes y se clasificó en dos grupos: el primer grupo conformado por 28 mujeres con crisis lúpica y el segundo por 22 sin crisis al momento del estudio. La concentración promedio de prolactina sérica fue de 39,0 ± 59,5 ng/dL para el primer grupo y de 14,2 ± 7,2 ng/dL para el segundo grupo, con diferencias estadísticamente significativas (p=0,044). Las pacientes con crisis lúpica presentaron valores de prolactina más elevados que las pacientes en remisión, no obstante que solo la séptima parte de ellas tenían cifras de prolactina fuera del rango normal. Todas las pacientes asintomáticas presentaron niveles normales de prolactina, por el contrario, todas las pacientes con hiperprolactinemia estaban en crisis lúpica.

To determine the relationship between hyperprolactinemia levels and clinical features of patients with systemic lupus erythematosus (SLE), a descriptive, correlational and cross-sectional study, was performed in female patients over 18 years old, who attended the Rheumatology Clinic at the Hospital Universitario, in Maracaibo, Venezuela, from November 2012 to June 2013. They underwent a comprehensive medical history evaluation, based on interviews and physical examination, with emphasis on the search for clinical manifestations of lupus activity. Blood samples were taken in order to determine prolactin levels at the moment of the patient evaluation. Values from 2.1 to 47.6 ng/mL were considered as normal. The population was classified into two groups: a group formed by 28 women with lupus crisis and another group formed by 22 patients without crisis. The average prolactin serum level was 39.0 ± 59.5 ng/dL for the first group and 14.2 ± 7.2 ng/dL for the second group, indicating statistical significance (p = 0.044). Patients with lupus crisis had prolactin values higher than those of asymptomatic patients, although only oneseventh of them had absolute hyperprolactinemia. All asymptomatic patients had normal levels of prolactin. All patients with hyperprolactinemia were in lupus crisis.

Prolactinomas may have unusual presentations resulting from massive extrasellar tumor extension / Prolactinomas podem ter apresentações incomuns resultantes de maciça extensão tumoral extrasselar

ABSTRACT The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18–54 years); median serum prolactin level was 4,562 ng/ml (1,543–18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41–60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7–84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.

RESUMO O objetivo desta série de casos é relatar oito pacientes com prolactinomas gigantes enfatizando as formas de apresentação e uma complicação do tratamento. O estudo incluiu seis homens e duas mulheres. A mediana de idade foi 29 anos (18–54); e dos níveis de prolactina foi 4.562 ng/ml (1.543–18.690); três pacientes (37,5%) apresentaram pan-hipopituitarismo; a mediana do máximo diâmetro tumoral foi 50 mm (41–60 mm). Cinco pacientes (62,5%) apresentaram alterações no campo visual e três tiveram melhora durante o tratamento; seis pacientes (75%) alcançaram normalização da prolactina em 10,5 meses (7–84) com dose mediana de cabergolina de 2,0 mg / semana (1,0 a 3,0). Um paciente se apresentou como um verdadeiro incidentaloma. Um paciente apresentou uma fistula liquórica durante o tratamento medicamentoso e recusou correção cirúrgica. No entanto a fistula foi resolvida com medidas conservadoras. Esta série de casos ilustra um subtipo raro de macroprolactinomas, a importância de considerar apresentações incomuns no diagnóstico, a eficácia do tratamento farmacológico e suas possíveis complicações.

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.

Influence of hyperprolactinemia on collagen fibers in the lacrimal gland of female mice

OBJECTIVE:To quantify the collagen fibers in the lacrimal gland of female mice with hyperprolactinemia.METHODS:Forty adult female mice were randomly divided into two groups with 20 animals each: nonpregnant control (CTR1, control group, 0.2 mL of saline solution) and nonpregnant experimental (HPRL1, experimental group, 200 µg/day metoclopramide). Treatments lasted for 50 consecutive days. On day 50, 10 females from each group (control and experimental) were euthanized in the proestrus phase; then, the blood was collected and the lacrimal glands were removed. Thereafter, the remaining females were placed with the mates and continued to receive treatment with saline solution or metoclopramide. On the 6th post-coital day, 10 pregnant females from the control group (CTR2) and 10 pregnant females from the experimental group (HPRL2) were euthanized, after which blood was collected and the lacrimal glands removed. The lacrimal glands were processed for morphological analyses and collagen quantification, and prolactin and sex steroid levels were measured in the blood samples. Data were statistically analyzed using an unpaired Student t test (p<0.05).RESULTS:Morphological analysis revealed greater structural tissue disorganization of the lacrimal glands in the metoclopramide-treated groups. The total collagen content was significantly higher in the HPRL1 group than in the CTR1 group (p<0.05), whereas the difference between the CTR2 and HPRL2 groups was not significant.CONCLUSION:Our data suggest an impairment in the functioning of the lacrimal gland as a consequence of increased prolactin levels and decreased serum levels of estrogen and progesterone.

Hypothalamic-pituitary-gonadal function in men with liver cirrhosis before and after liver transplantation / Função do eixo hipotálamo-hipófise-gonadal em homens cirróticos antes e após o transplante hepático

Objective: To evaluate the influence of end-stage liver disease and orthotopic liver transplantation in the pituitary function and hormone metabolism before and after liver transplantation. Methods: In a prospective study, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) of 30 male patients with cirrhosis were determined two to four hours before and six months after liver transplantation. The results were compared according to the Model for End-stage Liver Disease (MELD). Results: male patients with liver cirrhosis have hypogonadism. FSH was normal, but inappropriately low due to androgen failure; E2 and PRL, on their turn, were high. After liver transplantation, FSH and LH levels increased (p < 0.05), whereas E2 and PRL normalized (p < 0.05). The MELD score did not influence changes in FSH, PRL and LH, however, the more severe the cirrhosis was, the more significant was the normalization of E2 (p = 0.01). Conclusion: Patients with cirrhosis and male hypogonadism have inappropriately normal levels of FSH and LH, associated with an increase in E2 and LRP. After liver transplantation, FSH and LH increased, while E2 and PRL returned to normal. Changes in E2 levels were most pronounced in patients with MELD > 18. The severity of cirrhosis had no influence on FSH, PRL and LH. .

Objetivo: avaliar a influência da doença hepática terminal e do transplante hepático ortotópico na função hipofisária e no metabolismo hormonal através da aferição dos níveis séricos dos hormônios folículo estimulante (FSH), hormônio luteinizante (HL), estradiol (E2) e prolactina (PRL) antes e após o transplante hepático. Métodos: em um estudo prospectivo, níveis séricos dos hormônios folículo estimulante (FSH), hormônio luteinizante (HL), estradiol (E2) e prolactina (PRL) de 30 paciente masculinos com cirrose foram determinados duas a quatro horas antes e seis meses após o transplante hepático. Os resultados foram comparados de acordo com o Model for End-stage Liver Disease (MELD). Resultados: acientes masculinos com cirrose hepática apresentam hipogonadismo. O FSH encontravam-se normais, porém inapropriadamente baixos devido à falência androgênica; já o E2 e o PRL estavam elevados. Após o transplante hepático, os níveis de FHS e HL aumentaram (p < 0,05), enquanto o E2 e o PRL normalizaram (p < 0,05). O MELD não influenciou as alterações no FSH, HL ou PRL, todavia, quanto mais grave a cirrose, mais significante foi a normalização do E2 (p=0,01). Conclusão: pacientes masculinos com cirrose e hipogonadismo apresentam níveis inapropriadamente normais de FSH e HL, associados com elevação do E2 e PRL. Após o transplante hepático, FSH e HL aumentaram, enquanto E2 e PRL retornaram aos valores normais. As alterações nos níveis de E2 foram mais pronunciadas em pacientes com MELD > 18. A gravidade da cirrose não teve influência no FSH, HL e PRL. .

Aspectos técnicos e funcionais da cateterização dos seios petrosos inferiores na síndrome de Cushing ACTH dependente / Technical and functional aspects of catheterization of inferior petrosal sinuses in ACTH dependent Cushing’s syndrome

Objetivo Descrever e analisar a técnica empregada para a cateterização bilateral dos seios petrosos inferiores (SPI) em nosso serviço, discutindo as dificuldades e as taxas de sucesso encontradas. Sujeitos e métodos Entre 2009 e 2012, foram submetidos ao cateterismo bilateral dos SPI 14 pacientes com suspeita de síndrome de Cushing, sendo descrita a técnica empregada para o cateterismo e para a análise hormonal. Resultados O procedimento foi bem tolerado por todos os pacientes, sendo alcançada a cateterização adequada dos SPI em 92,85% dos casos. O diagnóstico de doença de Cushing foi firmado em 10 casos, sendo o resultado do cateterismo dos SPI após estímulo com CRH coerente em todos, não havendo falso-negativos. Conclusão O cateterismo dos SPI, apesar de ser uma técnica invasiva, é um procedimento seguro. A sua realização pode ser feita de forma adequada na maioria dos casos e, quando bem indicada, permanece como padrão-ouro na distinção da forma hipofisária da ectópica na síndrome de Cushing. .

Objective To describe and analyze technique for bilateral catheterization of inferior petrosal sinus in our service, discussing the difficulties and success rates found. Subjects and methods Fourteen patients with suspected Cushing’s syndrome underwent bilateral inferior petrosal sinuses (IPS) catheterization between 2009 and 2012. The technique for catheterization and for hormone analysis were described. Results The procedure was well tolerated by all patients, and adequate catheterization was achieved in 92.85% of cases. The diagnosis of Cushing’s disease was confirmed in 10 cases. The result of IPS catheterization after CRH infusion was coherent in all cases, without false negatives. Conclusion The catheterization of IPS, despite being an invasive technique, is a safe procedure. The objectives can be done properly in most cases. When well indicated, this procedure remains the gold standard in distinguishing the ectopic form to pituitary source in Cushing’s syndrome. .

Comparación entre los niveles de prolactina de madres en relactancia y madres con lactancia materna exclusiva / Comparison between levels of prolactin of mother in relactation and exclusive breast feeding mothers

Estudio no experimental, prospectivo, comparativo y longitudinal, realizado con el objetivo de comparar los niveles de prolactina en 15 madres (Grupo estudio) con más de dos semanas de haber suspendido la lactancia materna y entrenadas para relactar según método recomendado por Organización Mundial de la Salud: Estimulación del pezón y del pecho, Técnica de chorrear y gotear y Extracción mecánica y manual y en 25 madres (grupo control) que lactaban en forma exclusiva, cuyos hijos menores de seis meses, fueron hospitalizados por diversas patologías, en la División Pediátrica del Servicio Autónomo Hospital Universitario de Maracaibo, desde noviembre 2010 a octubre 2011. Las madres tuvieron entre 15 y 25 años de edad en ambos grupos (p=0,58); la causa principal del abandono de la lactancia fue escasa producción láctea (46,67%).El tiempo de aparición de la secreción láctea fue de 6+1,60 días.Los niveles de prolactina de madres del grupo estudio en las primeras 24 horas del ingreso del lactante fue 35,58+18,04 ng/ml y en el grupo control 129,83+35,01 ng/ml, estadísticamente significativo (p=0,01). Iniciada la secreción láctea fue de 121,20+16,90 ng/ml, estadísticamente significativo (p=0,01) comparado con el valor inicial del grupo estudio, pero al comparar con el grupo control fue estadísticamente no significativo (p=0,13).Se concluye que en este grupo de madres que abandonaron la lactancia, una vez iniciada la relactación presentaron un aumento significativo de los niveles de prolactina, similares a los niveles en madres lactando en forma exclusiva.

Not experimental, prospective, comparative, and longitudinal study conducted in order to compare the levels of prolactin in 15 mothers (study group) with more than two weeks of having suspended the breastfeeding, and trained to relactate according to the method recommended by World Health Organization: nipple and breast stimulation, technique of dripping and drip and mechanical and manual removal, and 25mothers (control group) that breastfeeding exclusively, whose children less than six months, were hospitalized with various diseases, in the Division of Pediatric of University Hospital in Maracaibo, from November 2010 to October 2011. The mothers had between 15 and 25 years of age in both groups (p =0.58), the main cause of the abandonment of breastfeeding was insufficient milk production (46.67%). The time of occurrence of milk secretion was 6+1.60 days. Prolactin levels in the study group mothers in the first 24 hours of admission was 35.58+18.04 ng/ml, and in the control group 129.83+ 35.01 ng/ml, statistically significant (p=0.01). Initiated the milk secretion was 121.20+16.90 ng/ml, statistically significant (p =0.01 compared to base line study group, but when was compared to the control group was not statistically significant (p =0.13). It concludes that in this group of mothers who left nursing, once started relactation had significantly higher prolactin levels, similar to the levels in mothers exclusively breastfeeding.

Challenges and pitfalls in the diagnosis of hyperprolactinemia / Desafios e armadilhas no diagnóstico da hiperprolactinemia

The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22.

A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve-se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outras doenças, muitos podem apresentar galactorreia ou distúrbios menstruais, bem como anormalidades neurorradiológicas. Finalmente, os médicos devem estar cientes de que incidentalomas hipofisários são encontrados em pelo menos 10% da população adulta. Arq Bras Endocrinol Metab. 2014;58(1):9-22.

Thyroid autoimmunity in patients with hyperprolactinemia: an observational study / Autoimunidade tireoidiana em pacientes com hiperprolactinemia: um estudo observacional

Objective : To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. Materials and methods : The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. Results : The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). Conclusion : HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity. .

Objetivo : Verificar se existe uma relação entre a hiperprolactinemia e distúrbios primários da tireoide, focando em pacientes com características autoimunes. Materiais e métodos : Os prontuários de 100 pacientes com hiperprolactinemia (HPRL) foram examinados retrospectivamente. Foram analisados registros de ultrassonografia da tireoide (USG), níveis séricos basais de hormônio tireoestimulante, tiroxina livre, triiodotironina livre e anticorpos antitireoglobulina (anti-Tg) e antitireoperoxidase (anti-TPO). Foram obtidos de 100 controles, pareados por idade e sexo com pacientes com HPRL, USG, testes de função da tireoide (TFTs) e painel de autoanticorpos. Resultados : A média de PRL em pacientes foi de 93 ng/mL (variação: 37-470). Vinte e cinco pacientes (25%) e 22 controles (22%) foram positivos para títulos de anti-Tg e/ou anti-TPO (P = 0,739). A mediana de PRL sérica foi de 98 (37-470) ng/mL em pacientes positivos para autoanticorpos tiroidianos e 92 (40-470) ng/mL em pacientes negativos (P = 0,975). Entre os indivíduos positivos para autoanticorpos, as anormalidades da TFTs foram mais frequentes em pacientes HPRL (60%; de 25 pacientes, 14 com hipotireoidismo subclínico e um com hipertireoidismo) do que nos controles (9,1%; de 22 pacientes, 2 com hipertireoidismo subclínico) (P < 0,001). Vinte e sete pacientes com HPRL e 31 controles apresentavam bócio (27 contra 31%; P = 0,437). Quarenta e seis pacientes (46%) e 50 (50%) controles tiveram uma ou mais das características de problemas de tireoide, como bócio, autoanticorpos antitireoide e anormalidades da função tiroidiana (P = 0,888). Conclusão : A HPRL pode estar associada à disfunção da tireoide mais grave em pacientes com autoimunidade contra a tireoide. .

Estudio de factores obstétricos, nutricionales y hormonales y su influencia en el desarrollo de cáncer de mama / Association between obstetric factors, hormone levels and nutritional status with the development of breast cancer

Background: Recent studies suggest that the age at first pregnancy, number of children and the lapse between births may protect against breast cancer. Furthermore, serum levels of estrogen, prolactin and progesterone appear to contribute to the development of this tumors in obese women. Aim: To verify whether the variables age at first pregnancy, number of children, birth interval, hormone levels and nutritional status are associated with the age at diagnosis of breast cancer. Material and Methods: Retrospective analysis of medical records of550female patients, diagnosed and treated for breast cancer at a hospital in Spain between 2009 and 2012. Results: We found a significant and positive association between age at diagnosis of cancer and the variables age at first pregnancy, parity and interval between pregnancies. There was also a significant correlation (p < 0.000) between serum levels of estrogen, prolactin and progesterone and nutritional status of patients. Conclusions: In this sample, age at first pregnancy or number of children, hormone levels and nutritional status are related to the age of onset of cancer.

Comparison of Serum Prolactin Level between I.V. Ranitidne and I.V Cimetidine Administration in Albino Rabbits and Possible Role of Histamine 1 and 2 Receptors in Prolactin Secretion.

The serum prolactin levels of eighteen normal rabbits are measured by using method of RIA. The values before drug treatment are taken as the control values of each group. Prolactin levels after 15, 30 and 45 minutes of i.v. Ranitidine treated group, when compared to its own control values, are not significantly raised whereas those levels after i.v. cimetidine are raised significantly in the paired t-test. Prolactin levels of i.v.cimetidine group , when compared with iv ranitidine group by unpaired t-test, are significantly raised [t = 2.737, 4.215 and 2.834 at 10,15, 45 minutes intervals respectively, at 10 degree of freedom, (p < 0.05)]. In the comparison between i.v. cimetidine and i.v. cimetidine pretreated with i.v. diphenhydramine groups (by unpaired t- test), presence of diphenhydramine HCl can cause statistically significant reduction at 30,45 minutes (at 10 degree of freedom. t- 2.666 and 2.440 respectively, (p < 0.05). The result shows that i.v.cimetidine can significantly liberate prolactin from the Ant. Pituitary, unlike i.v. ranitidine. Central H1 and H2 receptors contribute in prolactin secretion.

Physiological and histopathological studies on bisphenol-a compound as xenoestrogen in male albino rats

Xenoestrogens are compounds like estrogens in effect but not in structure which are mimicking the action of endogenous estrogen and activate estrogen receptor. Xenoestrogens are chemically distinct industrial products potentially able to disrupt the endocrine system by mimicking the action of endogenous steroid hormones. Among such compounds, the ubiquitous environmental contaminants bisphenol-A [BPA] may promote adverse effects in humans triggering estrogenic signals in target tissues. Bisphenol- A is widely used in food and drinks packaging. The present study is carrying out to evaluate the effect of bisphenol-A on sexual hormonal pattern in male albino rats. 64 adult male Sprague-Dawley rats [100-120 g] were divided to four groups [16 rats/group].Group [1]: control group without any treatment. Group[2]: positive control group was injected subcutaneously [s.c] with sesame oil daily. Group [3]: received BPA daily with low dose [10 mg/kg/day s.c]. Group [4]: received BPA daily with high dose [30 mg/kg/day s.c]. The experiment durated 30 days, half rats of each group were sacrificed after 15 days of treatment and the other half of groups after 30 days. The blood was collected, serum was separated and used for estimation of [hormonal levels, prolactin, gonadotrophin and testosterone] and some biochemical parameters [liver enzymes, kidney function, protein and lipid profile]. Testis, liver and kidney were taken for the histopathological examination. Biochemical results showed significant elevation in prolactin and FSH levels and significant reduction in LH and testosterone levels in all groups compared to the control group. Increased serum enzymes [ASAT, ALATand ALP] levels with increased concentration of urea and creatinine were detected in all the treated groups compared to the control group. Decline in protein profile and elevation in the concentration of lipid profile, while HDL was decreased in all the treated groups. Histopathological results showed dystrophic changes in the form of congestion in the blood vessels of the testis, liver and kidney of rats with thickening of walls of the blood vessels especially in the testis. In liver, focal inflammatory areas, with dilated and congested central and portal veins were found. Vacuolar degenerative changes in hepatocytes were seen. In the kidney, mild nephritis, sclerotic changes in glomerular tuft, hyaline casts in the lumen of epithelial cells which lining convoluted tubule were noticed. From the previous results we concluded that bisphenol-A has dangerous effects on the testis, liver and kidney tissues. Also it disrupted sexual hormonal pattern and affect biochemical and lipid parameters. So, we recommended minimizing the utililizing of these compound to protect people from its hazardous effects