Hyperprolactinemia in children during the peripubertal period--personal observations.

UNLABELLED: There can be many reasons for functional hyperprolactinemia, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and hypoglycemia. Prolactinoma is also a frequent cause. This study included 12 patients (10 girls and 2 boys) aged 14-17 years with hyperprolactinemia. Six patients were treated for PCOS, two for type 1 diabetes mellitus, and one patient suffered from Prader-Willi syndrome. In all patients, TSH, fT3, fT4, FSH, LH, testosterone, and E2 levels were measured. MRI of the pituitary was performed. Prolactin was measured with the metoclopramid dynamic test (MTC). IRI, C-peptide, oral glucose test, and minor pelvis ultrasound examination were performed in patients with PCOS. Pituitary adenoma was diagnosed in four out of 12 patients. In the remaining eight patients, functional hyperprolactinemia was found. All of these patients remain under pharmacological treatment with positive clinical results. CONCLUSIONS: 1. It is necessary to determine prolactin in each girl with unexplained amenorrhea irrespective of galactorrhea. 2. In some patients with prolactinoma the basal prolactin levels may be in the normal range, but they are increased in the MTC test. 3. In girls with various disorders of the menstrual cycle it is necessary to determine the level of prolactin with a provocative test.

Galactorrhoea causing severe skin breakdown and nipple necrosis following breast reduction.

Galactorrhoea is a relatively common condition but has rarely been reported following breast reduction surgery. Literature review has revealed only four cases. We present a case of galactorrhoea following breast reduction surgery carried out 10 weeks following childbirth, and 3 weeks following cessation of breast-feeding. This resulted in severe skin and areola tissue breakdown. Four operations were subsequently performed to achieve a satisfactory cosmetic outcome. Considerations and recommendations in the timing of such procedures following childbirth and breast-feeding are discussed.

La galactorrea como efecto secundario de la fluoxetina / Galactorrhea as side effect of fluoxetine

La fluoxetina es un antidepresivo utilizado ampliamente durante varios años. Los efectos secundarios relacionados con la prolactina han sido escasamente detectados. Se plantea un caso clínico de galactorrea inducida por fluoxetina y su evolución dosis-dependiente. (AU)

The infertile couple: a cohort study in Duhok, Iraq.

From January 2000 to May 2001 causes of infertility were studied for 250 couples, 193 (77.2%) of whom had primary infertility and 57 (22.8%) had secondary infertility. Male infertility was found in 36.8% of cases. The most common cause of female infertility was ovulation disorders (41%) while tubal obstruction contributed to only 5% of cases. Only 15% of the couples had unexplained infertility. Galactorrhoea and/or increased serum prolactin was seen in 60% of cases. Ultrasonographic detection of mature follicles was consistent with the results of cervical mucus study and endometrial biopsy in 90% of cases.

Unusual case presentation of lichen simplex chronicus, Hodgkin's lymphoma, and nonpuerperal hyperprolactinemia-galactorrhea.

OBJECTIVE: To report the association of nonpuerperal galactorrhea and severe pruritus with clinical stage IIB Hodgkin's lymphoma. METHODS: We present a detailed history, findings on physical examination, laboratory data, and results of diagnostic imaging in a 25-year-old woman. A review of the related literature and speculations about possible etiologic factors for this association are provided. RESULTS: Dermatologic evaluation of the patient revealed lichen simplex chronicus with multiple excoriations on the anterior chest area and lower extremities. High serum prolactin concentrations and easily expressible galactorrhea were present. Magnetic resonance imaging of the sella with 1-mm cuts, however, revealed a normal pituitary gland. Computed tomography showed multiple enlarged mediastinal lymph nodes, and a left supraclavicular lymph node biopsy revealed the presence of Reed-Sternberg cells and lymphocyte alterations consistent with the diagnosis of Hodgkin's lymphoma. After one cycle of chemotherapy for management of the lymphoma, parallel reductions in serum prolactin concentrations and galactorrhea were noted. CONCLUSION: Possible causes for this syndrome include afferent mammary nerve stimulation resulting from scratching of pruritic skin and cytokine-induced hypersecretion of prolactin attributable to the lymphoma. Although uncommon, this syndrome may serve as an important harbinger of developing Hodgkin's lymphoma, and its disappearance may signify a therapeutic response.

Identification of a silent pituitary somatotropic adenoma based on a paradoxic response of growth hormone on a thyrotropin-releasing hormone or gonadotropin-releasing hormone provocation test.

Preoperative endocrinologic identification and surgical removal of a silent somatotropic adenoma among patients with either amenorrhea or galactorrhea, or both, are beneficial for the restoration of menstruation and ovulation. Paradoxic rises of serum growth hormone in either a thyrotropin-releasing hormone or a gonadotropin-releasing hormone provocation test and high serum growth hormone levels were noted in the 3 patients with a silent somatotropic adenoma.

Transsphenoidal surgery for pituitary gigantism and galactorrhea in a 3.5 year old child.

The management of pituitary macroadenomas which lead to gigantism may require multiple therapeutical approaches, including medical treatment, surgery, and radiation therapy. Transsphenoidal surgery (TSS) during early childhood that achieves total removal of a growth hormone (GH) secreting tumor is rarely reported. The surgeon is confronted with special problems regarding the infantile anatomy. In this case, a 3.5 year old child, the youngest successfully treated by TSS so far, suffered from a GH- and prolactin (PRL) secreting macroadenoma of the pituitary gland. The girl initially presented with an increasing growth rate, later with breast development, and finally, at the age of 2.8 years, with galactorrhea and secretion of blood from the nipples. Increased levels of GH [122 micrograms/l], insulin-like growth factor (IGF-1) [830 micrograms/l], insulin-like growth factor binding protein 3 (IGFBP-3) [8.6 mg/l] and PRL [590 micrograms/l] were found. MRI scans revealed a macroadenoma of 2.7 cm diameter. An eight-week trial of relatively low dose dopamine agonists led to a reduction of PRL, while the GH- and IGF-1 levels remained unchanged; the tumor showed only little shrinkage. Since there was chiasma compression, we opted for early TSS. A complete tumor removal was achieved despite the difficulties of a narrow approach. After TSS, low levels of GH, IGF-1, and PRL documented a complete tumor removal, but persistent diabetes insipidus and anterior lobe deficits resulted from surgery. In summary, if primary medical therapy alone is unable to adequately reduce hormone hypersecretion and tumor size in early childhood, TSS is recommended. Thus, radiation therapy may be reserved for surgical failure.

Spontaneous remission in idiopathic hyperprolactinemia.

In this report we describe a 37 year old lady who was demonstrated to have hyperprolactinemia causing amenorrhea-galactorrhea syndrome. Computerized tomography scan done twice did not reveal any sellar or suprasellar abnormality and there was no clinical or biochemical evidence of primary hypothyroidism. She had regression of galactorrhea, resumed regular menstrual cycles, and conceived twice on bromocriptine therapy. Following her second delivery she noticed spontaneous remission of galactorrhea and, prolactin levels estimated multiple times were normal.

Circulating nitric oxide levels in galactorrheic, hyperprolactinemic, amenorrheic women.

OBJECTIVE: To test the hypothesis that nitric oxide production is decreased in hyperprolactinemic, amenorrheic patients with estrogen (E) deficiency, augmenting the possible risk of cardiovascular disorders. SETTING: Cairo University Hospitals. DESIGN: Prospective, case-controlled study. PATIENT(S): Twenty-five galactorrheic, hyperprolactinemic patients with amenorrhea of more than 6 months and with low serum E2, as well as 30 healthy, fertile women (controls) matched for age and body mass index. INTERVENTION(S): Bromocriptine was administered orally to hyperprolactinemic patients, and blood samples were collected before and 6 weeks after treatment. MAIN OUTCOME MEASURE(S): Total nitric oxide production was determined photometrically using Greiss reagent after preliminary conversion of nitrate to nitrite by nitrate reductase. RESULT(S): Serum E2 and nitric oxide levels in hyperprolactinemic, amenorrheic patients (62.5 +/- 3.2 [SE] pg/mL [229 +/- 11.7 pmol/L] and 18.4 +/- 2.5 mumol/L, respectively) were significantly lower than E2 (114 +/- 6.4 pg/ml, [418 +/- 23.5 pmol/L]) and nitric oxide (41.2 +/- 4.1 mumol/L) levels observed in normal women during the follicular phase. The decrease of nitric oxide was associated with elevation of blood pressure. Treatment of hyperprolactinemia with bromocriptine restored normal values of serum nitric oxide and E2, and normal blood pressure. CONCLUSION(S): Hyperprolactinemia with E deficiency exhibits a significant decrease in nitric oxide production, and this decrease may subject the patient to certain cardiovascular disorders and disturbed ovarian function.

Hyperprolactinaemia and galactorrhoea associated with primary hypothyroidism in a bitch.

An endocrinopathy characterised by hyperprolactinaemia and galactorrhoea was found to be associated with primary hypothyroidism in an entire bitch. Clinical diagnosis was confirmed by lowered baseline T4 blood levels, reduced response to the thyroid stimulating hormone (TSH) test, elevated prolactin and TSH values, and echographic and scintigraphic examinations. Levothyroxine treatment resulted in a clinical improvement (especially of the galactorrhoea), and levels of prolactin, thyroxine, TSH, triglycerides and total cholesterol plasma returned to normal.

Long-term follow-up of women with amenorrhea-galactorrhea treated with bromocriptine.

The present study is aimed at investigating whether long-term use of bromocriptine on patients affected by amenorrhea and galactorrhea may improve the clinical picture after discontinuation of treatment. For this reason 26 patients with amenorrhea and galactorrhea have been studied. Sixteen had high PRL values and 10 were normoprolactinemic. The normoprolactinemic patients underwent a TRH test. All the patients underwent computed skull axial tomography (CT scan) and were treated with bromocriptine, at a daily dosage variable from 2.5 to 10 mg for an average period of 26 months. After discontinuation of treatment, follow-up was carried-out for 20 months. Eighty-seven percent of the patients affected by amenorrhea, galactorrhea and hyperprolactinemia had regular menses, in 75 of the patients galactorrhea completely disappeared. Of the ten patients with normoprolactinemic amenorrhea and galactorrhea, only those who positively responded to the TRH test had regular menstruation and showed disappearance of galactorrhea. Upon discontinuation of treatment amenorrhea recurred in 68% of the cases whereas galactorrhea recurred in 80%. CT scans revealed disappearance of 3 microadenomas and reduction in size of the macroadenoma. Long-term use of bromocriptine represents the first choice treatment for the syndrome of galactorrhea-amenorrhea. In case of relapse, treatment must be continued for an undefined period of time.

Isolated galactorrhea in sarcoidosis: a case report.

Neuroendocrine disorders are rare. A case of hypothalamopituitary sarcoidosis is presented in which hyperprolactinemia and galactorrhea occurred in isolation.

Occult hyperprolactinemia in infertile women.

OBJECTIVE: To define the hypersensitive status of PRL secretion in normoprolactinemic infertile women and determine the incidence of occult hyperprolactinemia among them. DESIGN: The potential for PRL secretion was examined in 463 women. SETTING: Outpatient clinic in a university hospital. PATIENTS: Three hundred sixty-seven infertile women and 96 healthy volunteers. INTERVENTIONS: Patients were treated with bromocriptine, 2.5 or 5 mg/d for 3 months. MAIN OUTCOME MEASURES: Prolactin response to thyrotropin-releasing hormone (TRH), circadian rhythm, and serum PRL changes during the menstrual cycle. RESULTS: Approximately 15% of infertile women showed an exaggerated response to TRH, and 95% among them had clinical disorders such as galactorrhea, luteal insufficiency, and menstrual disturbances. Bromocriptine proved effective in 90% of these women. Transient hyperprolactinemia was observed at night in 80% of normal PRL responders who had galactorrhea. Bromocriptine was effective in 75% of these women. Transient hyperprolactinemia during the menstrual cycle was observed in 43% of normal PRL responders with luteal insufficiency, 85% of whom responded to treatment with bromocriptine. CONCLUSION: In infertile women, the TRH test helps in the selection of patients who may respond to bromocriptine. Among normal PRL responders, 60% of patients with galactorrhea and 47% of those with luteal insufficiency recovered after bromocriptine treatment. From these results, patients who exhibit clinical abnormalities such as galactorrhea and luteal insufficiency should undergo extensive PRL testing.

[Infertility in women with galactorrhea]. / Besplodie u zhenshchin s galaktoreei.

Clinico-hormonal examinations of patients with sterility, galactorrhea, and regular menstrual cycle revealed endocrine abnormalities in only ten of 53 patients (18%). These abnormalities presented as latent hyperprolactinemia and hypothyrosis. Sterility causes in the rest 43 patients (82%) were benign uterine and ovarian tumors, external genital endometriosis, residual symptoms after genital inflammations. These data point to a necessity of examining this patients population with the use of hormonal and endoscopic methods of examination.

[Drug-induced hyperprolactinemia and galactorrhea]. / Medikamentös induzierte Hyperprolaktinämie und Galaktorrhöe.

A 21 year old female treated for recurring gastric troubles with dopamine-antagonists (domperidone, metoclopramide) developed a clinically manifest hyperprolactinemia (3055 microU/l; normal value < 650 microU/l) with galactorrhea only two days after a new two day course of metoclopramide. The drug was withdrawn and within days mastodynia and galactorrhea subsided. A control of plasmatic prolactin two weeks later yielded a normal value (358 microU/l). After administration of metoclopramide or domperidone hyperprolactinemia is regularly observed and galactorrhea has been described earlier. It is unclear why this patient inspite of repeated administration of one dopamine antagonist remained asymptomatic whereas the other after a short time and only a few doses led to galactorrhea. It is conceivable that differences in passage into the cerebrospinal fluid or the better penetration of the blood-brain barrier favored the development of galactorrhea under metoclopramide. This case served to discuss the pathophysiologic background of drug-induced hyperprolactinemia.

[Heterogeneity of immunoreactive prolactin in hyperprolactinemia of various origin]. / Geterogennost' immunoreaktivnogo prolaktina pri giperprolaktinemii razlichnogo geneza.

Study of molecular heterogeneity of immunoreactive prolactin in patients with macro- and microprolactinomas and idiopathic hyperprolactinemia has shown heterogeneity of the total blood immunoreactive prolactin pool in all the examined patients. This pool included three basic forms with molecular masses about 23, 50, and over 100 kD (23K-, 50K-, 100K-prolactin), whose ratios essentially differed in individual patients. Physiologically the most active monomeric 23K form of prolactin predominated in the blood of patients with hyperprolactinemia due to hypophyseal micro- and macroadenomas, parallelled by manifest signs of galactorrhea and hypogonadism; the content of this form may reach 95% of the total immunoreactive hormone. Patients with hyperprolactinemia of obscure origin present with quite the contrary ratio of prolactin immunoreactive forms with the predominance of high-molecular 100K form of the hormone, whose share may reach 80-90%. Such cases of hyperprolactinemia may be associated with the absence of clear-cut clinical manifestations, including such as galactorrhea and menstrual cycle disorders, and with inefficacy of traditional therapy. Such cases were tentatively classified as 'the high-molecular prolactin syndrome' and need further research.