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

Seventy tests of stimulation with hypothalamic thyreotrophic hormone liberation factor, and 35 bromocriptine inhibition tests were carried out on a routine basis in patients with latent or frank hyperprolactinaemia. Pathological hyperprolactinaemia does not have a single clinical pattern: frank, it takes the form either of an exteriorised pituitary adenoma (14 cases), or of an amenorrhoea-galactorrhoea syndrome with or without micro-adenoma (12 cases); latent, it takes the form either of isolated amenorrhoea (17 cases) or of dysovulatory sterility (16 cases). Amongst the dynamic tests available, it is worthwhile to make a choice, and in the case of frank hyperprolactinaemia, the authors propose use of the bromocriptine inhibition test in the first instance. The TRH test is reserved for verification of the results of neurosurgery. As far as latent hyperprolactinaemia is concerned, it may be identify only by the TRH test, with the resultant possibility of specific treatment.
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PMID:[Diagnosis of hyperprolactinaemias: respective value of response to THR and to bromocriptine (author's transl)]. 9 29

We have reviewed our experience in the radiographic and ophthalmologic evaluation of 1001 patients with symptoms suggesting the presence of a pituitary, prolactin-secreting adenoma. Twenty-seven patients had abnormal or suspicious radiographic examination of the sella turcica. Twenty-two of those had hyperprolactinemia. In only one instance was an abnormality noted on polytomography that was not seen on a conventional four-view study of the skull. Based on these findings, a four-view plain conventional radiographic assessment of the skull suffices as a screening procedure in patients with amenorrhea, galactorrhea, or both. Thin section tomography should be reserved to more thoroughly evaluate those patients with elevated serum prolactin concentrations and/or abnormal conventional radiographs. We found visual field testing to be of little value as an initial screening procedure in these patients.
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PMID:Evaluation of the pituitary. Patients with suspected prolactin-producing tumors. 56 9

The development of radioimmunoassay of steroid hormones in peripheral venous blood has led to a more direct index of gonadal production and concurrent monitoring of glandular function. While serial analyses of total urinary oestrogens can be correlated with luteinizing hormone (LH) excretion in treating amenorrhoea, radioimmunoassay of plasma oestrogens measures acute changes in ovarian responsiveness. For studies of androgens radioimmunoassay of plasma testosterone is the method of choice, but fractionation of urinary 17-oxosteroids may be useful and can be extended to include the pregnane series and corticoids. Urinary pregnanediol, however, may not reflect the endogenous secretion of progesterone and should be reserved for assessing induction of ovulation. Luteal function can be evaluated rapidly and specifically by radioimmunoassay of plasma progesterone. Although radioimmunoassay offers a new approach to ovarian physiology, its systematic application to disease is still in the future.
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PMID:The validity and significance of hormone levels in gynaecology. 99 86

The use of pulsatile GnRH to treat infertile women who do not ovulate has been shown to be safe, simple, and effective and the preferred method of inducing ovulation in appropriately selected patients who are resistant to treatment with clomiphene citrate. Treatment with GnRH is particularly effective for restoring ovulation in patients with idiopathic hypogonadotrophic hypogonadism and partially recovered weight-related amenorrhoea, but less successful in patients with polycystic ovary syndrome and organic hypothalamic pituitary disease. Based on personal experience, we advocate routine use of the subcutaneous route, using 15 micrograms per pulse every 90 min, and we monitor the patient's progress by serial ultrasound scanning and measurement of serum gonadotrophin and oestradiol concentrations. If the patient does not respond we recommend adding treatment with clomiphene citrate (Homburg et al, 1988b). Treatment with intravenous GnRH is reserved for women who do not respond to the above combination of drugs. We do not treat patients with GnRH until their body mass index is in the normal range (between 20-25) and we avoid GnRH treatment in patients with hypersecretion of LH during the follicular phase. If LH concentrations are raised, an alternative method of treatment is recommended, such as ovarian diathermy (Armar et al, 1990). Finally, the question of whether GnRH deficiency in patients with hypogonadotrophic hypogonadism is caused by a specific genetic lesion is not yet fully resolved. Yang-Feng et al (1986) used a cDNA clone encoding the human GnRH precursor molecule in order to assign the GnRH gene to a particular human chromosome. They found a single site for GnRH sequences in the human genome and that the gene coding for GnRH is located on the short arm of chromosome 8. Experiments in the congenitally hypogonadal mouse have shown that it is possible to restore gonadal development and gametogenesis by gene transfer (Mason et al, 1987). Clearly an abnormality at the level of the genome may be responsible for the secretory defect in patients with hypogonadotrophic hypogonadism, but it has yet to be defined (Weiss et al, 1989). Presumably elucidation awaits the development of more refined methods because both the genetics and the clinical associations of GnRH deficiency are most persuasive. Meanwhile replacement treatment with GnRH provides a simple and safe form of treatment for managing the clinical syndromes of GnRH deficiency.
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PMID:Induction of ovulation with pulsatile GnRH. 228 43

The incidence of endometriosis appears to be increasing, but is possibly due simply to the more widespread use of diagnostic laparoscopy. Whilst a clear pathogenetic role for endometriosis resulting in tubo-ovarian distortion and infertility is obvious, a causal role for mild endometriosis in infertility has not been established. Any one of several factors may result in both endometriosis and infertility. Nevertheless, endometriosis is best treated at the time of diagnosis in order to limit progression of the disease. The preferred method of treatment is medical, with surgery being reserved for those endometriotic lesions not responding to medical treatment. Conservative surgery will not eradicate microscopic foci, and it is possible that the surgery itself may result in adhesion formation. The choice of medication should be individualized, as the side-effects may not be readily tolerated by some women. Maintenance of amenorrhoea may not be essential to therapeutic efficacy, as normally sited and ectopically sited endometrial tissue may respond to hormonal manipulation in different ways.
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PMID:Endometriosis and infertility: treatment is always necessary. 332 56

46 late interruptions of pregnancy (16 to 33 weeks of amenorrhea) were performed with the use of prostaglandins E1 ovules, of 1 mg, placed in the posterior vaginal cul-de-sac every 12 hours. It concerned 13 deaths in utero or extremely premature rupture of the membranes, 25 fetal indications (9 chromosomal abnormalities and 16 severe malformations), and 8 maternal indications. The efficacy was good either with ovules alone (84.7%) or associated with a balloon probe (5.3%). Expulsion is faster in the case of fetal deaths (average = 8 hours), than in therapeutic interruptions of pregnancy (average = 20 hours). The necessary doses did not exceed 3 mg of PgE1. There were very few side effects, essentially gastro-intestinal in nature and the course was simple. No obstetrical complication was noted. This method is therefore particularly effective with minimal side effects. Easy to use, it must be reserved for very precise indications.
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PMID:[Use of prostaglandin E1 ovules in the therapeutic interruption of pregnancy in the 2d and 3d trimesters. Apropos of 46 cases]. 358 58

A patient complaining of abnormal lactation and amenorrhea should be evaluated for a pituitary tumor. The work-up includes a thorough history and physical examination, serum prolactin and thyroid-stimulating hormone (TSH) determinations, and radiographic assessment of the pituitary gland. The treatment of choice for hyperprolactinemia leading to abnormal lactation is bromocriptine mesylate, even when small pituitary tumors are present. Surgery is reserved for patients who fail to respond to medical treatment and have tumors larger than 1 cm.
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PMID:Treatment of galactorrhea-amenorrhea. 407 65

Antiphospholipid antibodies (antiprothrombinase and anticardiolipin) carry with them for mothers the risks of repeated fetal loss and of disorders of the blood clotting mechanism both before and after delivery. All the same screening does not have to be carried out routinely but should be reserved for patients who have already lost one fetus (intrauterine death after 12 weeks of amenorrhoea) and/or venous or arterial thrombosis. The diagnosis depends on a strict methodology and strict criteria for making a positive diagnosis. The treatment of these antibodies (with corticosteroids and intravenous immunoglobulin) or the prevention of possible thrombotic complications (using platelet antiaggregation/heparin) has to be decided taking into account the level of antibodies, previous obstetric and thrombotic history and the lupus symptomatology as shown by the patients. The overall success rate of treatment is between 53 and 81%.
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PMID:[Antiphospholipid syndrome. Proposition for management]. 834 53

According to the polish but not foreign manuals of gynecology the women with menarche provoked by hormones are qualified as the paraprimary amenorrhoic patients. Our study demonstrate that menarche in the lot of subsequently normally menstruating and delivered women was provoked by hormones. For that reason it was possible to qualified into the above mentioned paraprimary amenorrhoic group the only patients with permanently evoked menstruations. The numerous and heterogenous causes of the appearance amenorrhoea paraprimaria and secundaria are similar in both groups as well as serious disorders and results of the therapy. The clinical usefulness this classification is conditional upon the changes in qualification of the patients. The name amenorrhoea primaria would be reserved only for patients with permanently induced menstruation.
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PMID:[Amenorrhea paraprimaria--a symptom or disease?]. 968 72

Hyperprolactinemia is the most common endocrine disorder of the hypothalamic-pituitary axis. While it can occur in men, it occurs more commonly in women. The prevalence of hyperprolactinemia ranges from 0.4% in an unselected normal adult population to as high as 9-17% in women with reproductive disorders. There are many possible causes of hyperprolactinemia, falling into three general categories: physiologic, pharmacologic and pathologic. When specific treatable underlying causes have been eliminated and in cases of severe hyperprolactinemia, the most likely cause is a prolactin (PRL)-secreting pituitary adenoma. Microadenomas should be treated medically, with a dopamine agonist, if there is an indication for therapy (such as amenorrhea, infertility or bothersome galactorrhea). If there is no indication for therapy, microadenomas may be followed conservatively, as growth is uncommon. Macroadenomas may grow larger; medical therapy is recommended initially, with neurosurgical evaluation reserved for specific clinical situations, such as failure of medical therapy and evidence of mass effect despite medical therapy. In the United States, the dopamine agonists indicated for treatment of hyperprolactinemia are bromocriptine and cabergoline. Bromocriptine is usually given once or twice daily, while cabergoline has a long duration of action and is given once or twice weekly. Results of comparative studies indicate that cabergoline is clearly superior to bromocriptine in efficacy (PRL suppression, restoration of gonadal function) and tolerability.
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PMID:Guidelines for the diagnosis and treatment of hyperprolactinemia. 1064 14


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