Diagnosis of prolactinoma in two male-to-female transsexual subjects following high-dose cross-sex hormone therapy.

Male-to-female transsexual persons use oestrogens + antiandrogens to adapt their physical bodies to the female sex. Doses are usually somewhat higher than those used by hypogonadal women receiving oestrogen replacement. Particularly in cases of self-administration of cross-sex hormones, doses may be very high. Oestrogens are powerful stimulators of synthesis and release of prolactin and serum prolactin levels are usually somewhat increased following oestrogen treatment. Prolactinomas have been reported in male-to-female transsexual persons, both after use of high and conventional doses of oestrogens but remain rare events. We report two new cases of prolactinomas in male-to-female transsexual persons, one in a 41-year-old subject who had used nonsupervised high-dose oestrogen treatment since the age of 23 years and another one in a 42 year old who had initiated oestrogen treatment at the age of 17 years. Their serum prolactin levels were strongly increased, and the diagnosis of a pituitary tumour was confirmed by imaging techniques. Both cases responded well to treatment with cabergoline treatment whereupon serum prolactin normalised. Our two cases are added to the three cases of prolactinomas in the literature in persons who had used supraphysiological doses of oestrogens.

Curriculum changes in dental education in Latin America.

In Latin America great emphasis has been placed upon relating dental education directly to community needs. Curricula are no longer defined solely by professionals, for society too is playing a greater part in curriculum design. Educational objectives are being met through the solution of community problems. Emphasis upon the tooth as the focus of dental education has been abandoned. The old approach of finding the right patient to satisfy the student's training in technique is being replaced by a philosophy of total dental care. In this way there is better integration of knowledge, skills and attitudes in dental education. An emphasis on primary care is now very much to the fore in Latin America. New categories of personnel have been brought into the teaching programmes and their contributions monitored. The physical facilities for dental care have been greatly modified in recent years. The importance of staff development programmes to the acceptance and implementation of new curriculum ideas is stressed.