Polycystic ovary syndrome and hyperprolactinemia.

Analysis of the evidence linking PCOS and hyperprolactinemia suggests that these conditions have independent origins. Elevated prolactin serum levels are documented in the early studies of patients with polycystic ovaries. However, recent investigators using serial serum sampling have excluded transient elevations of prolactin and have shown a less frequent association of these disorders. Treatment of individuals with both PCOS and hyperprolactinemia is distinct from the management of the individual with only one of these conditions. Upon evaluating the therapeutic alternatives for dysfunctional uterine bleeding and hirsutism in these patients, the effect of exogenous estrogen and progesterone on the secretion of prolactin must be considered. The addition of a dopamine agonist (e.g., bromocriptine or cabergoline) to a regimen of clomiphene citrate must also be considered as ovulation induction options for these women. Finally, future discoveries about the relationship between PCOS and hyperprolactinemia will require a better understanding of how the hypothalamus regulates the pituitary secretion of LH and prolactin.

Percutaneous large-core biopsy of papillary breast lesions.

OBJECTIVE: This study was undertaken to assess the accuracy of percutaneous large-core biopsy in evaluating papillary breast lesions. MATERIALS AND METHODS: A retrospective review of imaging-guided large-core breast biopsy of 1077 consecutive lesions revealed that papillary lesions were diagnosed in 34 (3%) cases. Surgical correlation (n = 22) or minimum 2 years' mammographic follow-up (n = 4) were available for 26 papillary lesions. Mammographic and histologic findings in these 26 cases were reviewed. RESULTS: Percutaneous biopsy histology had benign findings in nine lesions, atypical in 10, and malignant in seven. Of seven lesions yielding benign papilloma at percutaneous biopsy, none (0%) had carcinoma at surgery or mammographic follow-up. Surgery revealed carcinoma in one of two lesions yielding papillomatosis at percutaneous biopsy. This lesion was a spiculated mass; surgical biopsy, recommended because of mammographic-histologic discordance, revealed a radial sclerosing lesion and ductal carcinoma in situ (DCIS). Of 10 papillary lesions with atypical ductal hyperplasia at percutaneous biopsy, surgery revealed DCIS in three (30%). Of seven lesions in which percutaneous biopsy yielded papillary DCIS, surgery revealed DCIS in all seven; three (43%) also had invasive carcinoma. CONCLUSION: Among our patients, diagnosis by percutaneous core biopsy of benign papillary lesions proved to be accurate when concordant with imaging findings. Surgical excision was indicated when diagnosis by percutaneous biopsy revealed atypical papillary lesions or papillary DCIS. A larger series with longer follow-up is required to assess the clinical course of benign papillary lesions without atypia that are not excised after percutaneous large-core breast biopsy.

Biobehavioral effects of weight cycling.

An association between weight cycling and mortality and morbidity has been pointed out in epidemiological studies. However, the mechanisms underlying this association are difficult to demonstrate, and earlier studies have been contradictory. In this work we investigated several mechanisms which have been suggested as possible mediators for the association between weight cycling and a number of prevalent diseases. Fat consumption, fat preference, fat distribution and metabolism, lipid profile, oral glucose tolerance test (OGTT), blood pressure and steroid hormone determinations were performed in 28 women with or without a weight cycling history, who were matched for weight and age. No differences were found between cyclers and non-cyclers for any of the behavioral, physiological, metabolical and health parameters measured, with the exception of an increase in subcutaneous abdominal fat in the cyclers. It was concluded that, in generally healthy young women, weight cycling does not differentially increase risk factors that are harmful for health. However adverse effects might still be detectable in situations where women are biologically challenged.