Prevalence of hyperprolactinaemia in female premenopausal blood donors.

OBJECTIVE: The prevalence of asymptomatic hyperprolactinaemia has been widely studied in certain populations such as antipsychotic drugs users, infertile women or patients with primary hypothyroidism, but data on the prevalence of hyperprolactinaemia and macroprolactinaemia in the healthy population are very scarce in the literature. We aimed to obtain an unbiased estimation of the prevalence in premenopausal women of: (i) hyperprolactinaemia and (ii) its aetiology, including macroprolactinaemia and stress-related hyperprolactinaemia, while considering simultaneously the use of hormonal contraceptives. DESIGN: Prevalence survey. SUBJECTS: Three-hundred and ninety-three consecutive premenopausal women reporting spontaneously for blood donation. MEASUREMENTS: We performed an exhaustive clinical history and physical examination, establishing the presence of hirsutism, acne, alopecia, menstrual dysfunction and reproductive history. We also measured serum prolactin (PRL) (ruling out macroprolactinaemia when indicated), thyrotrophin, total testosterone, androstendione, sex hormone binding globulin and dehydroepiandrosterone sulphate concentrations. RESULTS: Serum PRL concentrations were increased in 16 of 393 women (4·1% prevalence, 95% CI: 2·1-6·0). The prevalence of macroprolactinaemia was 0·6% (95% CI: 0-1) in the total female blood donor population and was 12·5% (95% CI: 6-31) among hyperprolactinaemic patients. The remaining hyperprolactinaemic women had stress-related hyperprolactinaemia as the more likely aetiology. Finally, the frequency of hyperprolactinaemia was similar in users and nonusers of hormonal contraceptives (4·5% and 3·9% respectively, P = 0·209). CONCLUSIONS: The prevalence of hyperprolactinaemia in healthy female blood donors is low and is not influenced by the use of hormonal contraceptives. Pathological causes are very rare with stress-related hyperprolactinaemia and macroprolactinaemia being the most frequent causes of hyperprolactinaemia in these women.

Disnea y estridor en paciente obesa por bocio multinodular / Dyspnea and stridor due to multinodular goiter

El bocio multinodular intratorácico es una enfermedad frecuente que puede originar síntomas compresivos con riesgo vital para el paciente. A continuación se presenta el caso de una paciente con estenosis traqueal por bocio multinodular y se discuten las diferentes posibilidades terapéuticas (AU)

Substernal multinodular goiter is a common entity that may cause life-threatening pressure symptoms. We report the case of a patient with tracheal stenosis due to multinodular goiter and discuss various treatment options (AU)

Dyspnea and stridor due to multinodular goiter in an obese woman.

Substernal multinodular goiter is a common entity that may cause life threatening pressure symptoms. We report the case of a patient with tracheal stenosis due to multinodular goiter and discuss various treatment options.

Bocio amiloide secundario a enfermedad de Crohn / Amyloid goiter secondary to Crohn’s disease

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Comparison of ethinyl-estradiol plus cyproterone acetate versus metformin effects on classic metabolic cardiovascular risk factors in women with the polycystic ovary syndrome.

CONTEXT: Oral contraceptives may worsen the metabolic profile of patients with polycystic ovary syndrome (PCOS), favoring the use of insulin sensitizers in these patients. OBJECTIVE: The aim of the study was to compare the effects of a contraceptive pill on metabolic classic cardiovascular risk factors with those of the insulin sensitizer metformin. DESIGN: We conducted a randomized, parallel, open-label clinical trial. SETTING: The study was conducted at an academic hospital. PATIENTS: Thirty-four consecutive PCOS patients were studied. INTERVENTIONS: Patients were randomized to oral treatment with metformin (850 mg twice daily) or with the Diane(35) Diario pill (35 microg of ethinyl-estradiol plus 2 mg of cyproterone acetate) for 24 wk. MAIN OUTCOME MEASURES: Hyperandrogenism, lipid profiles, and indexes of glucose tolerance and insulin sensitivity were measured at baseline and after 12 and 24 wk of treatment. RESULTS: Diane(35) Diario resulted in higher reductions in hirsutism score and serum androgen levels compared with metformin. Menstrual regularity was restored in all the patients treated with Diane(35) Diario compared with only 50% of those receiving metformin. Plasma apolipoprotein A-I and HDL-phospholipid levels increased with Diane(35) Diario, whereas metformin did not induce any change in the lipid profile. On the contrary, the insulin sensitivity index increased with metformin but did not change with Diane(35) Diario. No differences in the frequencies of abnormalities of glucose tolerance and dyslipidemia were found between both treatments. CONCLUSIONS: Diane(35) Diario appears to be superior to metformin for the control of hyperandrogenism and for the restoration of menstrual regularity in PCOS patients, and it is not associated with any clinically relevant worsening in the classic metabolic cardiovascular risk profile of these women.