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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 15 women with either isolated amenorrhea or amenorrhea associated to galactorrhea the basal levels of PRL allowed a clear differentiation into three groups. The first group (n = 3) had normal PRL levels (x +/- SD, 8.0 +/- 4.8 ng/ml), the second group (n = 4) had moderately elevated PRL (25.6 +/- 6.5 ng/ml), and the third group (n = 8) had very high PRL (176.0 +/- 76.1 ng/ml). All the patients in the third group had a pituitary adenoma. In the three groups the basal levels of FSH and LH and their response to GnRH were measured with the purpose of uncovering possible relationships between these results and the levels of PRL, and the tumoral or non-tumoral origin of the hyperprolactinemia when it was present. No statistically significant differences were found amongst the three groups. The results suggest that hyperprolactinemia has no influence upon gonadotrophin release or the endogenous release of GnRH. The measurement of plasma gonadotrophins and their response to GnRH appears to be of no clinical value for the differential diagnosis of the hyperprolactinemias.
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PMID:[Variations of the plasma levels of gonadotrophins (FSH and LH) and of its response to stimulation with gonadotrophin releasing hormone (GnRH) with different plasma levels of prolactin (PRL) in women with the syndrome of galactorrhea-amenorrhea (author's transl)]. 678 94

A case report is presented of the need for both bromocriptine and human menopausal gonadotropin (hMG) for induction of ovulation in a patient who developed partial hypopituitarism and persistent hyperprolactinemia even after a transsphenoidal pituitary microadenectomy. The patient, a 27-year old white female, initially presented in 1979 with a history of amenorrhea and galactorrhea after discontinuing oral contraceptives (OCs). Her menstrual cycles had been regular since her menarch at age 13 until she began taking OCs at age 20. Preoperative endocrine evaluation in 1979 revealed serum luteinizing hormone (LH), 9.1 mIU/ml; serum follicle stimulating hormore (FSH), 6.4 mIU/ml; serum thyroid stimulating hormone (TSH), 3.8 mIU/ml; serum prolactine (PRL), 300 ng/ml; serum thyroxine (T4), 6.4 mcg/dl; and an attenuated PRL response to thyrotropin releasing hormone (TRH). Radiographic studies revealed a pituitary tumor of approximately 1 cm in diameter. In July 1979 a transsphenoidal hypophysectomy was performed. Pathologic examination revealed a pituitary adenoma with a monomorphic basophilic cell population with fibrosis and chronic inflammation. The patient required prednisone therapy postoperatively for 3 months secondary to compromised adrenal status. Prednisone therapy was discontinued in October 1979 after a normal cortisol (F) response to induced hypoglycemia was documented. The patient's serum PRL levels remained elevated at 111 ng/ml in August 1979 and 269 ng/ml in October 1979. Her amenorrhea and galactorrhea persisted. Bromocriptine therapy, 2.5 mg 3 times daily, was instituted in October 1979. She became normoprolactinemic, with a serum PRL of 6 ng/ml, and the galactorrhea disappeared but the amenorrhea persisted. In February 1981 she was referred for further consultation on her fertility status. Bromocriptine therapy was discontinued. In April 1981 she underwent a thorough endocrine evaluation. The results indicate that GnRH stimulation was unable to elicit a pituitary gonadotropin response anywhere near normal levels of FSH and LH, thus suggesting pituitary hypogonadotropism. Growth hormone release was subnormal in response to the insulin induced hypoglycemia and L-dopa ingestion. Hyperprolactinemia was obvious but the patient's serum TSH, T4, and adrenocorticotropin (ACTH) levels were normal. A diagnosis of hyperprolactinemia with partial hypopituitarism and gonadotropin deficiency was made. Bromocriptine therapy was reinstituted at 2.5 mg twice daily in June 1981, with good results. In November 1981 her serum PRL was normal, and as she was desirous of pregnancy, ovulation induction with bromocriptine and Pergonal was carried out. The patient is now 6 months pregnant and doing well. This case illustrates the poor functional results for surgery for pituitary microplactinomas.
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PMID:Partial hypopituitarism and hyperprolactinemia: successful induction of ovulation with bromocriptine and human menopausal gonadotropins. 681 37

To study the effect of pregnancy and lactation on the clinical course of patients with pituitary adenoma and the influence of maternal hyperprolactinemia and bromocriptine treatment on fetal and neonatal development, prolactin levels were serially determined and abnormalities of newborn babies were examined. Ninety-nine patients with hyperprolactinemic amenorrhea were treated by surgery, bromocriptine therapy, and a combination of them; thus 34 patients conceived and gave birth to 43 babies. Almost all patients progressed uneventfully except for 2 cases who manifested diabetes insipidus and acute visual impairment. After the end of lactation, prolactin levels declined to lower values than before attempting pregnancy, except in 3 patients. Furthermore, those diagnosed as functional hyperprolactinemia before pregnancy were not found to have developed microadenoma. These results suggest that there is little influence on growth and activity of tumor throughout pregnancy and lactation. All of the newborns were normal and their growth up to 2 years after birth showed no special abnormalities. It was therefore concluded that maternal hyperprolactinemia or bromocriptine therapy in early pregnancy do not cause any deleterious effect on fetal and neonatal development.
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PMID:Successful pregnancies in patients with hyperprolactinemia--clinical and endocrinological studies on mothers and babies. 685 1

Infertility caused by hyperprolactinemic amenorrhea may be complicated by pituitary adenoma. In a group of 36 women with amenorrhoea-hyperprolactinemia-syndrome were 15 infertility-patients. 10 of them had prolactin levels above 100 ng/ml. In 6 patients a prolactinoma was removed microsurgically. In every case further treatment was necessary to get normal cycles. 8 of these 10 infertility-patients became pregnant.
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PMID:[Sterility in hyperprolactinemic amenorrhea]. 686 76

The syndrome of amenorrhoea-galactorrhoea has been known for years, but new diagnostic methods opened up a new approach to the treatment of patients with this syndrome. Whether the increasing awareness of hyperprolactinaemia is due only to the impact of these newer diagnostic methods, or whether there is an increasing incidence due to modern civilization, is unsettled. The clinical picture is variable and therefore a high-risk group should be delineated, namely those patients with amenorrhoea-galactorrhoea and hyperprolactinaemia. Since this condition responds very well to treatment with bromergocriptine, and since there is a 5% (micro-adenomas) - 35% incidence of tumour extension during pregnancy, this high-risk group should be scrutinzed for a possible pituitary adenoma. The treatment of pituitary adenomas is at the present stage best labelled as an emotional matter, more particularly for micro-adenomas. This is certainly so for the patient not interested in pregnancy. The long-term outcome in patients with hyperprolactinaemia effectively treated with bromergocriptine is not known. The group with macro-odenomas interested in pregnancy should be treated by some form of destructive procedure. For the rest, the future will tell.
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PMID:[Pituitary adenomas (prolactinomas) and amenorrhea-galactorrhea]. 700 9

There are an estimated 8-10 million oral contraceptive (OC) users in the U.S. Investigation of the effects of OCs on neoplasia is not easy; currently 4 investigative methods are used: 1) case reports, 2) disease rate and trends, 3) case-control studies, which are the main source of careful retrospective information, and 4) cohort studies, which compare the incidence of disease in patients exposed to suspected environmental factors, and in those who are not exposed. Major risk factors for carcinoma of the breast are female sex, age, genetic predisposition, previous benign breast disease, and previous cancer of one breast; undetected breast cancer may be present for many years before diagnosis, and risk is increased in patients with chronic cystic mastitis or fibrocystic disease of the breast. Clinical observations have suggested a strong association between endocrine influence and the incidence or progression of breast cancer; current evidence tends to support the role of estrogens in the etiology of carcinoma of the breast with respect to long-term estrogen administration, but this evidence is not valid for young patients who are on combined OCs. Most studies have documented a decreased risk of benign breast disease with length of OC use persisting for 4 years; these studies, however, did not analyze lesions by histologic type. Studies that show a protective effect on benign disease do not show the same protective effect for breast cancer. Data from cohort studies show no association of OCs with breast cancer. Since 1972 a number of reports have associated OCs with liver tumors, stating that risk increases with duration of use. A national survey revealed that the frequency of malignant tumors increased with age, but that the frequency of benign lesions had a peak in the 26-30 age group which corresponds to increased use of OCs. Benign tumors are dangerous because they tend to rupture spontaneously. The association between pituitary adenoma, causing postpill amenorrhea, and OC use is very controversial. OC use may also cause endometrial hyperplasia; postmenopausal estrogen use has also been associated with endometrial carcinoma, although the causal relationship has never been proven; progestogens may be useful in the therapy of some endometrial carcinomas. Carcinoma of the cervix seems to be more influenced by age at 1st intercourse and by multiple sexual partners than by OC use; several case-control studies have shown that there is no significant difference between incidence among OC users and nonusers. Data about the association between OCs and ovarian carcinoma are reassuring but incomplete. OCs should not be used in patients with positive chorionic gonadotropin titers who have been treated for hydatidiform mole.
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PMID:Neoplasia and hormonal contraception. 702 11

84 patients with elevated serum PRL levels, ranging from 25 to 253 ng/ml, were treated with an antiserotonin agent, metergoline, at the dose of 12 mg/day for 90 days. The clinical complaint was of amenorrhea in 70 cases (plus galactorrhea in 44 cases) and of anovulation in 14 cases (plus galactorrhea in 6 cases). Hyperprolactinemia was due to a pituitary adenoma in 18 cases; in 53 cases it was of unknown origin, while in 7 cases it followed treatment with neuroleptics or with oral contraceptives and in 6 cases it followed a puerperium. In patients with amenorrhea, metergoline induced the appearance of menses in 61 cases (94%), and of ovulation in 46 cases (82%). In 13 of the 14 patients with anovulation, ovulation was restored. Galactorrhea disappeared in 40 out of 50 patients. Metergoline normalized serum PRL levels (less than 20 ng/ml) in 46 cases and significantly reduced serum PRL levels in all but 3 of the remaining patients. In spite of suggested nonhormonal contraceptive measures, 14 patients became pregnant; 2 had abortions and the remaining 12 patients completed by vaginal delivery, uneventful pregnancies. These results indicate metergoline as a safe and effective drug in the management of hyperprolactinemic amenorrhea and anovulation. 49 patients were followed for 2 additional months, receiving no treatment (24 cases) or metergoline at a reduced daily dosage (8 mg/day, 25 cases). Within 60 days, 60% of the first group had relapse of the clinical condition and a rebound elevation of serum PRL levels while only 20% of the second group experienced relapse of amenorrhea and rebound elevation of serum PRL levels (p less than 0.01).
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PMID:Metergoline in the management of hyperprolactinemic amenorrhea and anovulation. 703 5

A case is reported of a prolactin-secreting pituitary adenoma in a young woman who had been referred for evaluation of amenorrhea with a history of in utero exposure to diethylstilbestrol. Following prolactin suppression ans stimulation tests bromocriptine (Parlodel), 2.5 mg orally, twice a day was prescribed. Followup at 1, 2, and 3 years after diagnosis with the use of sector scans of the sella turcica showed a decrease in size of the tumor from 12 x 12 mm in 1980 to 9 x 6 in 1982, over 50% reduction. Serum prolactin level measured 3 months after initiation of treatment was reduced by about 2/3 to 124 ng/ml. The direct role of estrogen in pituitary tumorigenesis in animals has been suggested both by the demonstration of estrogen receptors in the cytosol of estrogen-induced prolactinomas and growth inhibition of a transplantable estrogen-induced prolactin-secreting pituitary tumor by the administration of tamoxifen. In this case bromocriptine, a dopaminergic agonist, was successful in reducing both serum prolactin levels and tumor size.
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PMID:Prolactin-secreting pituitary adenoma: occurrence following prenatal exposure to diethylstilbestrol. 716 14

A case is reported of a 24-year-old woman with amenorrhea and galactorrhea and markedly elevated serum prolactin levels who underwent operative resection of a pituitary adenoma. Ultrastructural examination revealed the classic features of an oncocytoma. Immunocytochemical staining was positive for prolactin. Following excision of the tumor, serum prolactin levels returned to normal and the galactorrhea became minimal. This is the first case of a pituitary oncocytoma in which secretion of prolactin was both clinically and immunocytochemically documented.
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PMID:Prolactin-secreting pituitary oncocytoma with galactorrhea--amenorrhea syndrome: a histologic, ultrastructural, and immunocytochemical study. 719 48

A study on the statistical correlation between (OCs) oral contraceptives and similar mixtures of steroids and the development and maintenance of hyperprolactinemia is presented. 91 cases with hyperprolactinemia-amenorrhea were compared to a group of 91 women with amenorrhea and normal prolactinemia. Matched pairs regarding duration of amenorrhea, parity, gonadal function and thyroid function were used. It was shown that OCs and similar combinations of estrogen and progesterone do not increase the relative risk for functional or adenomatous hyperprolactinemia. There was no evidence that existing adenomas were deteriorating during OC use. However, 2 cases with pituitary adenoma following long-term high dosage estrogen therapy were found. The presented results show that low dosage steroid medications do not increase the risk for the development or maintenance of hyperprolactinemia. (author's modified)
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PMID:[Oral steroid contraception in hyperprolactinemia (author's transl)]. 721 61


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