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.

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.

Efeitos da hiperprolactinemia sobre o útero de camundongos no proestro / Hyperprolactinemia effects on the female mice uterus during proestrous

OBJETIVO: avaliar o efeito da hiperprolactinemia induzida pela metoclopramida sobre o endométrio e miométrio de camundongos fêmeas na fase de proestro. MÉTODOS: 24 camundongos fêmeas foram divididas aleatoriamente em dois grupos: GCtr/controle e GExp/tratadas com metoclopramida (6,7 µg/g por dia). Após 50 dias, os animais foram sacrificados na fase de proestro, e o sangue foi coletado para determinação dos níveis de estradiol, progesterona e prolactina. Os cornos uterinos foram removidos e fixados em formol a 10 por cento; foram, então, processados para inclusão em parafina. Cortes de 4 µm foram corados pela hematoxilina-eosina (H/E). Na análise morfológica, foi utilizado microscópio de luz, da marca Carl Zeiss, com objetivas variando de 4 a 400 X, para caracterização de cada corte histológico. Na análise morfométrica, foi avaliada a espessura do epitélio superficial, da lâmina própria e do miométrio, com auxílio de um analisador de imagem (AxionVision, Carl Zeiss) acoplado ao microscópio de luz (Carl Zeiss). A análise estatística foi realizada pela ANOVA seguida pelo teste Wilcoxon. O valor de p foi considerado significante quando < 0,05. RESULTADOS: os achados mostraram aumento dos níveis séricos de prolactina (295,6±38,0 ng/mL) e redução significante dos de progesterona (11,3±0,9 ng/mL) no GExp em comparação ao GCtr (45,5±5,2 ng/mL e 18,2±1,6 ng/mL, respectivamente) (p<0,001). Com relação aos níveis séricos de estradiol, não foram obtidas diferenças significantes entre os grupos (GExp=119,1±12,3 pg/mL e o GCtr=122,7±8,4 pg/mL, p=0,418). O estudo morfológico mostrou que o útero do GExp apresentou endométrio com epitélio superficial e lâmina própria mais desenvolvida quando comparado ao GCtr, o mesmo ocorrendo no miométrio. Os valores morfométricos das espessuras do epitélio luminal (8,0±1,1 µm) e do endométrio (116,2±21,1x10² µm) do GCtr foram inferiores ao GExp (10,2±0,8 µm e 163,2±23,3x10² µm com p<0,05) respectivamente. Já os dados ...

PURPOSE: to evaluate the effect of hyperprolactinemia induced by metoclopramide on the endometrium and myometrium of female mice in the proestrus phase. METHODS: 24 female mice were randomly divided in two groups: CtrG/control and ExpG/treated with metoclopramide (6.7 mg/g daily). After 50 days, the animals were sacrificed in the proestrus phase, and the blood was collected to determine the levels of estradiol, progesterone and prolactin. The uterine horns were removed, fixed in 10 percent formaldehyde and processed before being included in paraffin. Slices of 4 µm were stained by hematoxylin and eosin (H/E). In the morphological analysis, a Carl Zeiss light microscope, with objectives varying from 4 to 400 X was used for each histological slice characterization. In the morphometrical analysis, the superficial epithelium, the lamina propria and the myometrium thickness were evaluated, with the help of an image analyzer (AxionVision - Carl Zeiss) attached to the light microscope (Carl Zeiss). The statistical analysis was done by ANOVA, followed by the Wilcoxon test. P-value was considered as significant, when <0.05. RESULTS: our findings have shown an increase in the seric levels of prolactin (295.6±38.0 ng/mL) and significant decrease in the progesterone levels (11.3±0.9 ng/mL) in the ExpG, as compared to the CtrG (45.5±5.2 ng/mL and 18.2±1.6 ng/mL, respectively; p<0.001). Concerning the seric level of estradiol, significant differences between the groups were not obtained (ExpG=119.1±12.3 pg/mL and CtrG=122.7±8.4 pg/mL; p=0.418). The morphological study has shown that the uterus from the ExpG presented the endometrium with more developed superficial epithelium and lamina propria, as compared to the CtrG, the same happening with the myometrium. The thickness morphometrical values of the luminal epithelium (8.0±1.1 µm) and endometrium (116.2±21.1x10² µm) from the CtrG were lower than the ones from the ExpG (10.2±0.8 µm and 163.2±23.3x10² ...

Presencia de macroprolactina en sueros con normo e hiperprolactinemia: comparación de dos métodos de detección / Comparison of two techniques to detect the presence of macroprolactin in serum

Background: Macroprolactin is biologically inactive but may be detected by immnoassays. This leads to errors in diagnosis and inadequate treatment of patients with hyperprolactinemia. Aim:To assess two techniques to detect the presence of macroprolactin. Material and Methods: Prolactin was measured by immunoassay in 57 serum samples (from 4 males and 53 females aged33 +/- 13 years), before and after precipitation with polyethyleneglycol (PEG) and separation by ultrafiltration. A significant level of macroprolactin was considered to be present when prolactin detected in the supernatant after PEG precipitation or in the ultrafiltrate was less than 40 percent of the initial concentration of prolactin. Results: Prolactin levels fluctuated from 5 to 411 ng/ml. The percentages of recuperation were independent of the initial prolactin concentration. In 12 and 14 percent of samples, using polyethyleneglycol and ultrafiltration respectively, there was a prolactin recuperation of less than 40 percent. Eight and 11 percent of samples with a prolactin concentration of more than 30 ng/ml, had a recuperation of less than 40 percent using polyethyleneglycol and ultrafiltration respectively. Conclusions: Approximately 10 percent of samples with a prolactin concentration over 30ng/ml have recuperation values suggestive of the presence of macroprolactin. There is a good concordance between precipitation using polyethyleneglycol or ultrafiltration.

Galactorrhea in a 14-year-old girl.

The authors report a 14-year-old girl who had galactorrhea with regular menstruation. Furthermore, this galactorrhea case was associated with hyperprolactinemia and prolactinoma. The patient tolerated and responded well to therapy with bromocriptine. The serum prolactin levels decreased from 103.27 ng/mL to 24.25 ng/mL after 8 weeks of treatment and 12.48 ng/mL after 6 months of treatment. No pituitary tumor was demonstrated after 12 months of therapy and the galactorrhea had not recurred 1 year after ending the bromocriptine treatment.

Aislamiento y caracterizacion de proteinas unidas a prolactina en el plasma de pacientes hiperprolactinemicos / Isolation and characterization of prolactin-binding proteins in plasma of hyperprolactinemic patients

Se analizaron los resultados de la purificación y caracterización de las proteínas que se encuentran unidas a la PRL en el plasma de pacientes hiperprolactinémicos. Se demostró la existencia del complejo proteico mediante incubación del plasma con PRL marcada con yodo radiactivo (PRL-I125), seguido por separación cromatográfica de gel filtración en Sephacryl S-300HR. Se comparó el patrón de elución con proteínas de pesos moleculares conocidos y la radiactividad incorporada se determinó por conteo de las radiaciones gamma. El complejo prolactina-proteína eluyó en un rango de pesos moleculares elevados. Se aislaron las proteínas unidas a la prolactina por cromatografía de afinidad en una columna de prolactina ovina (oPRL) unida a Sepharosa 4B activada con bromuro de cianógeno. La concentración de proteínas en 5 lotes analizados en forma sucesiva, fue de 180"74Fg/fraccionamiento. Las proteínas aisladas mostraron homología inmunológica con la IgG humana mediante el análisis por inmunodifusión radial en geles de agarosa. Según el patrón electroforético encontrado, las proteínas que se unen a la PRL en el plasma están formadas por 4 bandas de pesos moleculares, 2 de las cuales coinciden con las cadenas ligeras y pesadas de la IgG, mientras que las otras 2 presentan pesos moleculares aproximados de 68 y 80 kDa, respectivamente. Los resultados encontrados permiten identificar a las proteínas unida a la PRL como un complejo con una estructura molecular en la cual participa la IgG

Valores falsamente baixos de prolactina no ensaio immunofluorométrico em pacientes hiperprolactinêmicos: efeito gancho / Falsely low values of prolactin in the fluoroimmunoassay in hyperprolactinemic patients: hook effect

Valores falsamente baixos de prolactina podem resultar do "efeito gancho" em ensaios imunométricos. A causa do "efeito gancho" em ensaio imunométrico, executado com uma etapa, é um excesso de antígeno que impede a ligaçäo simultânea dos anticorpos das fases sólida e líquida e uma mesma molécula de antígeno. Nós estudamos o "efeito gancho" em soro de cinco pacientes com prolactinoma e em líquido de um prolactinoma cístico, utilizando ensaio imunofluorométrico com uma e duas etapas. No ensaio com uma etapa, o soro e o anticorpo monoclonal marcado foram adicionados seqüencialmente e incubados nos poços de microtitulaçäo contendo o anticorpo monoclonal de captura. No ensaio com duas etapas, o soro foi inicialmente incubado com o anticorpo de captura, seguindo-se lavagem e, entäo, foi acrescentado o anticorpo marcado. O valor mais elevado na curva padräo de prolactina, neste ensaio, é 217 ng/mL e valores acima deste indicam a necessidade de diluiçäo. Os valores normais de prolactina sérica neste ensaio säo de 0 a 15 ng/mL. Os valores de prolactina medidos pelo ensaio com uma etapa foram de 0,3 a 31,5 ng/mL e medidos pelo ensaio com duas etapas foram todos acima de 217 ng/mL. Após a diluiçäo, os valores reais obtidos nos 6 pacientes foram de 1.320 a 2.601.780 ng/mL. Em todos os seis casos, obtivemos valores falsamente baixos de prolactina utilizando o ensaio com uma etapa. Se estes valores tivessem sido aceitos, nossos pacientes teriam sido diagnosticados como normoprolactinêmicos, hiperprolactinemia näo tumoral ou pseudoprolactinoma (macroadenoma hipofisário näo-funcionante com hiperprolactinemia devido à compressäo de haste) ao invés de prolactinomas. Portanto, nós recomendamos que os ensaios de prolactina sejam executados em duas etapas e, se necessário, com amostras diluídas para evitar valores falsamente baixos de prolactina devido ao "efeito gancho".

Correlaçäo entre os níveis séricos de prolactina e infertilidade por fator ovulatório / Correlation between serum levels of prolactin and infertility by ovulatory factor

Com o objetivo de se avaliar a freqüência de hiperprolactinemia no Ambulatório de Esterilidade do CAISM/UNICAMP, foram revisados 489 prontuários de pacientes estéreis, no período de 1988 a 1993. Foram avaliados o padrao menstrual, níveis séricos de prolactina na fase folicular precoce, anatomia patológica das biópsias de endométrio realizadas na segunda fase do ciclo menstrual e presença ou nao de fator ovulatório no diagnóstico de esterilidade. Os autores concluíram que nao houve correlaçao direta entre padrao menstrual e níveis de prolactina e que níveis aumentados até 30 por cento do seu valor normal devem ser cautelosamente avaliados antes de serem considerados responsáveis por alteraçoes ovulatórias. Entretanto, niveis de prolactina aumentados acima de 30 por cento do valor normal devem ser considerados, notadamente se houver alteraçoes na funçao ovulatória.

Idiopathic hyperprolactinemia in a 15-year-old boy: a case report and literature review.

A 15-year-old boy with idiopathic hyperprolactinemia is described. He was markedly obese, in early puberty, and had gynecomastia and galactorrhea. Serum prolactin level was high, up to 220 pg/ml. Thyroid function test was normal. Idiopathic hyperprolactinemia was diagnosed on the basis of elevated prolactin level, and no demonstrable pituitary tumor was revealed by computerized tomography brain scan and magnetic resonance imaging. Bromocriptine was started initially at the dose 2.5 mg/day, then increased to 7.5 mg/day. Galactorrhea disappeared and prolactin level decreased to < 10 ng/ml. A review of the literature indicates that idiopathic hyperprolactinemia in adolescent males is extremely rare. To our knowledge, this patient is the youngest reported case of hyperprolactinemia in Thailand.

Prolactin levels in infertility and bromocriptine therapy in hyperprolactinaemia.

Serum prolactin levels were estimated in 100 infertile patients along with the other investigations for infertility. Hyperprolactinaemia was noted in 41% of the infertile patients. Prevalence of hyperprolactinaemia was greater in patients with ovulatory cycles ie, 55% compared to 31.66% in patients with anovulatory and oligo-ovulatory cycles. Fifty per cent of the patients with regular menses had hyperprolactinaemia. Conception occurred in 9 out of 18 hyperprolactinaemic infertile patients (a pregnancy rate of 50%) treated with bromocriptine. Eleven patients (group 1) were treated with bromocriptine from day 5 to day 30 throughout the menstrual cycle and 5 conceptions occurred. Six patients (group 2) with ovulatory cycles were treated with bromocriptine during the luteal phase, from the day of ovulation till next menses and 4 conceived. One patient of prolactinoma treated with bromocriptine failed to conceive. Bromocriptine therapy restricted to the luteal phase in ovulatory patients has yielded successful results. Based on these observations it is suggested that all patients of infertility need serum prolactin estimation.

Hyperprolactinaemia and reproductive failure.

63 cases of hyperprolactinaemia (55 women and 8 men) were studied. Of the 55 women, 39 presented with infertility, while five were unmarried and had menstrual abnormalities. All eight men were partners of an infertile union. The principal modes of presentation of hyperprolactinaemia in women were infertility (74.6%) and menstrual disorders (27.6%). Galactorrhoea was evident in 28.6% and 10.7% had headache. There was no significant correlation between the level of prolactin and the duration of amenorrhoea. Changes in pituitary gonadotrophin levels were observed in 30.2% of cases, the common feature being an elevated LH level. Treatment with bromocriptine restored normal cycles, and the incidence of pregnancies was 38.5%. 14 normal infants were born and one patient miscarried.

Importancia de las isoformas de prolactina sobre la función ovárica en mujeres hiperprolactinémicas / Importance of the prolactin isoforms over the ovarian function in hyperprolactinemic women

El objetivo de este trabajo fue estudiar la importancia de la heterogeneidad molecular de prolactina PRL en muestras de suero de mujeres hiperprolactinémicas sobre la función ovárica. La heterogeneidad molecular de PRL se estudió en muestras de suero en siete pacientes hiperprolactinémicas idiopáticas, mediante cromatografías de filtración en gel (Sephadex G-100). De estas pacientes, cuatro de ellas tenían ciclos menstruales conservados y tres presentaban amenorreas. Los patrones cromatográficos obtenidos de cuatro pacientes con hiperprolactinemia y ciclos menstruales normales mostraron una predominancia de la forma de PRL big-big, de alto peso molecular 79 por ciento Sin embargo, las pacientes con hiperprolactinemia y amenorrea presentaron un patrón cromatográfico con predominancia de PRL little, o de bajo peso molecular 69 por ciento Estos resultados sugieren que la heterogeneidad molecular de PRL estaría asociada con desórdenes en el ciclo menstrual y por ende con la función ovárica, ya que la función ovárica normal en pacientes hiperprolactinémicas parece estar asociada a niveles aumentados de PRL big-big y la función ovárica alterada a niveles altos de PRL little

Variaçöes da prolactina durante o ciclo menstrual em mulheres normais / Changes of prolactin during menstrual cycle in normal women

No presente trabalho foram medidos os níveis plasmáticos de prolactina (PRL), durante o ciclo menstrual ovulatório, em 17 mulheres voluntárias normais. Amostras de sangue foram colhidas nos »4§, 7§, 11§, 12§, 14§, 15§, 16§, 17§, 18§, 18§, 22§, 25§, 28§, e 31§, dias do ciclo. A ovulaçäo foi confirmada através da presença do pico de LH no meio de ciclo, elevaçäo de progesterona (P) plasmática na segunda fase (acima de 5ng/ml e pela temperatura basal. Os níveis de PRL, LH, FSH, E2, P e testosterona (T) foram medidos por radioimunoensaio em todas as amostras colhidas. Os resultados mostraram que houve grande variaçäo nos níveis de PRL entre as pacientes e uma variabilidade em cada paciente durante o ciclo. Os níveis variaram de 5,0 a 41 ng/ml, com média de 13,55ñ 5,81 ng/ml. Quando se agruparam os valores de PRL por fases do ciclo, observou-se que durante o período periovulatório houve ascensäo dos seus valores, seguida da fase lútea tardia, porém, diferença significativa em relaçäo as demais fases. Näo houve correlaçäo entre os níveis de PRL e de E2 (r=0,0467 ou entre PRL e testosterona (r= 0,0053)

Aspectos fisiopatológicos del síndrome de amenorrea galactorrea-normoprolactinémico / The physiopathological aspects of teh normoprolactinemic amenorrhea-galactorrhea syndrome

Para entender en parte la fisiopatología de mujeres con amenorrea-galactorrea-normoprolactinémica (Grupo I: N=5), se establecieron comparaciones Vs. Mujeres con moderada (II; N = 4) y severa hiperprolactinemia y evidencia de tumor (III; N = 4). Se midio PRL y LH en condiciones basales y se valoró la influencia indirecta de dopamina (DA) sobre hipófisis e hipotálamo al emplear un bloqueador a nivel de receptor de DA, metoclopramida (MCP). Fue evidente una mayor disponibilidad de DA a nivel de los lactótropos, ya que después de MCP el grupo I incremento enormemente los niveles de prolactina (PRL), aunque los niveles de PRL basales eran normales. Indirectamente y por la respuesta de LH se detectó una influencia negativa de DA sobre las neuronas productoras de hormona liberadora de gonadotropinas (GnRH) ya que MCP incremento LH en los tres grupos (mayor en I y III) lo cual ha sido relacionado a un mayor recambio de DA a nivel tuberoinfundibular propio de los estados hiperprolactinémicos. La respuesta de LH - PRL a bromocriptina no mostro diferencias que consignar en ninguno de los tres grupos

Hiperprolactinemia y su correlato clínico: estudios a nivel del mar y altura / Hyperprolactinemia and its clinical following: studies at sea level and altitude

Se estudian 2 grupos poblacionales; uno a nivel del mar (Lima) y otro en la altura (Cerro de Pasco). En Lima se revisaron 130 historias clínicas y su seleccionaron para análisis retrospectivo los de 68 pacientes con anormalidades menstruales y/o galactorrea, que fueron vistas en el Hospital General Base Cayetano Heredia entre febrero de 1985 y julio de 1987. En Cerro de Pasco se captaron 44 mujeres del Hospital Daniel A. Carrión con anormalidades del ciclo menstrual y/o galactorrea. Los niveles séricos de PRL a nivel del mar son significativamente mayores a los de altura.la prevalencia de hiperprolactinemia a nivel del mar es mayor.los niveles de PRL no varía significativamente a través del ciclo menstrual tanto en Lima como Cerro de Pasco. A nivel del mar existe una buena correlación clínica entre hiperprolactinemia y los transtornos menstruales del ciclo más galactorrea