Resolution of dopamine agonist-resistant hyperprolactinemia by hysterectomy: a case report.

Prolactin-producing uterine leiomyomas are very rare. Although hyperprolactinemia rapidly improves after removal of such leiomyomas, no preoperative diagnostic test has been established for prolactin-producing uterine leiomyomas. A 45-year-old Japanese woman, gravida 3 para 3, was referred to our hospital for further examination of hyperprolactinemia resistant to a dopamine agonist. A pituitary prolactinoma was undetectable by brain magnetic resonance imaging. A bromocriptine loading test revealed an increased serum prolactin concentration after loading. Examination for the detection of an ectopic prolactinoma revealed a 9.0 cm diameter uterine leiomyoma that had measured 6.6 cm in diameter about six months before the first visit to our hospital. The hyperprolactinemia rapidly improved after hysterectomy. A prolactin-producing uterine leiomyoma should be considered as a possible cause of hyperprolactinemia resistant to dopamine agonists. Responsiveness to dopamine agonists; deterioration of hyperprolactinemia may be diagnostic for prolactin-producing uterine leiomyomas, although further research is required.

Steroid Pulse Therapy for De Novo Minimal Change Disease During Pregnancy.

BACKGROUND Nephrotic syndrome occurs very rarely, in only about 0.01%-0.02% of all pregnancies, and de novo minimal change disease during pregnancy is especially rare. Nephrotic syndrome and, especially, minimal change disease are highly responsive to steroids, and preterm labor may be avoidable if the maternal condition is improved with steroid therapy. Therefore, prompt diagnosis and proper management are critical to maternal and fetal outcome when severe proteinuria occurs during pregnancy. CASE REPORT A 30-year-old pregnant Japanese woman presented with systemic edema, oliguria, and severe proteinuria and hypoalbuminemia at 25 weeks of gestation, although she was normotensive. The patient had high urinary protein selectivity. Her illness was diagnosed as de novo nephrotic syndrome with high steroid responsiveness rather than pre-eclampsia. She began steroid pulse therapy the day after admission. Complete remission was confirmed after 3 weeks. The patient did not relapse during pregnancy and delivered a healthy male baby at 37 weeks of gestation. A renal biopsy at a relapse after delivery confirmed minimal change disease. CONCLUSIONS In pregnant women with de novo minimal change disease, serious maternal and/or fetal complications may occur if severe proteinuria and hypoalbuminemia are unabated for an extended time. Evaluation of urinary protein selectivity is noninvasive and useful for prediction of steroid responsiveness. Results of urinary protein selectivity can be obtained earlier than results of renal biopsy. Renal biopsy during pregnancy is not always necessary for initiation of steroid therapy. Rapid initiation of steroid pulse therapy may enable quicker achievement of remission and prevent serious perinatal complications.

Encephalomalacia in surviving twin after single fetal death diagnosed at 18 weeks of gestation in monochorionic twin pregnancy.

PATIENT: Female, 28 FINAL DIAGNOSIS: Single intrauterine fetal death Symptoms: - MEDICATION: - Clinical Procedure: - Specialty: Obstetrics and Gynecology. OBJECTIVE: Rare disease. BACKGROUND: Single fetal death in monochorionic twin pregnancy may result in poor perinatal outcome of the surviving twin, including neurologic sequelae, other organ injury, and death. In most reported cases of poor perinatal outcome in the surviving twin, monochorionic co-twin death occured after more than 20 weeks of gestation, while few with earlier occurrence have been presented. CASE REPORT: A 28-year-old primigravid woman was referred to our hospital at 18 3/7 weeks of gestation for perinatal management of single fetal death in a monochorionic-diamniotic twin pregnancy. Our first evaluation by ultrasonography revealed a dead twin sized at 16 weeks of gestation, and an alive one with normal size and appearance, together with 1 placenta and 2 amniotic cavities with normal fluid amounts. At 20 3/7 weeks of gestation, ultrasonography showed that the surviving twin had bilateral ventriculomegaly and dilatation all around the subarachnoid cavity despite a normal head size. Fetal magnetic resonance imaging revealed remarkable atrophy of the cerebral cortex. After counseling, the patient and family chose termination of pregnancy, and artificial abortion was performed at 21 weeks of gestation. The aborted fetuses were not anomalous. Autopsy pathological findings confirmed encephalomalacia in the surviving twin. CONCLUSIONS: Recent development of imaging device make it possible that several abnormalities in central nervous system can be detected in detail at earlier gestational age. It is important to keep this condition in mind even though single fetal death occurred at early gestational age.