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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The presenting signs, symptoms, roentgenographic findings, endocrine evaluations, treatment, and results in 68 cases of presumed pituitary adenomas treated over an 18-year period are discussed. The most common symptoms were headache, acromegalic changes, visual symptoms, and amenorrhea. Most common physical findings were obesity, acromegaly, and visual field defects, usually bitemporal hemianopsia. Roentgenographic evidence of sellar erosion was almost universal but angiography and pneumoencephalography were required to evaluate suprasellar extension. Brain scan was not considered a particularly useful diagnostic tool. Endocrine status was best evaluated by a battery of tests including 17-OH, 17-KS, T3, T4, PBI, ACTH stimulation, and FSH and STH levels. (Prolactin levels are currently being obtained, also). Surgical specimens were obtained in 29 patients, with subsequent diagnoses of 22 chromophobe adenomas, five eosinophilie adenomas, one cystic adenoma, and one necrotic tumor. All five eosinophilic tumors came from acromegalic patients. Patients treated by operation alone or operation followed by radiotherapy generally had less "medical morbidity" than did patients who received radiotherapy alone.
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PMID:Review of 18 years' experience with pituitary tumors. 19 48

Seven acromegalic patients were treated with 20 mg bromocriptine daily for 3--8 weeks. Four responded with reduction but not normalization of plasma growth hormone (GH) whereas three showed no response. In all patients with subjective symptoms of joint stiffness, sweating and headache improvement occurred, but this was independent of GH response. Hyperacidity and/or obstipation occurred in five patients. These side effects were slight and transitory in four but severe in one. Prolactin levels were normal in all patients before treatment and became unmeasurable during bromocriptine.
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PMID:Experiences with bromocriptine treatment in acromegaly--a preliminary report. 27 38

A 25 year old woman had galactorrhea and secondary amenorrhea since her first pregnancy at 20 years. After several treatments with Clomiphene, menses reappeared for 2 months and she became pregnant. At admission, she was in her 4th pregnancy month and had headaches and bitemporal hemianopsia. Hypophysectomy was performed during 5th pregnancy month. Prolactin adenoma with hemorragic lesions was found. Parturition of normal twins occurred 8th month. Partial hypophyseal recovery took place for the following 2 years, but hyperprolactinemia reappeared too.
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PMID:[Proceedings: Prolactin adenoma revealed by gemellary? pregnancy after clomiphen therapy. Hypophysectomy during 5 th month of pregnancy (author's transl)]. 119 Jul 20

9 women and 6 men with prolactin-secreting pituitary tumors--prolactinomas (mean age 41 years, range 28-57), were treated conservatively with bromocriptine. The women usually presented with galactorrhea, menstrual disorders and headaches, and the men with headaches, decreased libido or impotence, and visual abnormalities. The symptoms had lasted from several months to 20 years, but were not correlated with tumor size. Between 77-100% of symptoms improved during bromocriptine. Prolactin levels, which correlated with the size of the tumor, averaged 1241 ng/ml before treatment and became normal in 80% of the patients. Tumor size decreased in 58% of those with macroprolactinomas. Lesions of decreased density were found in another 17% of the patients. Side-effects of bromocriptine were minor and disappeared despite continuation of therapy. The results of this series, as well as those of others, indicate that bromocriptine is the treatment of choice for micro- and macroprolactinomas.
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PMID:[Treatment of prolactin-secreting pituitary tumors with bromocriptine]. 234 Oct 64

Prolactin (PRL) responses to dopamine (DA) blockers and to direct and indirect DA agonists have been studied in 23 healthy women, 17 women with catamenial migraine and 17 with non-catamenial migraine in both their follicular and luteal phases. PRL responses to the DA blockers were greater in the follicular phase of both migraine groups than in controls. The inhibitory effect of nomifensine on PRL secretion was dampened in the follicular phase of both migraine groups. These findings demonstrate an increased PRL reserve in migraine and suggest the existence of a dopaminergic supersensitivity of the lactotrophic postsynaptic DA receptors. The impaired inhibitory effect of nomifensine on PRL secretion hints at a decrease of the presynaptic DA content in tuberoinfundibular DA neurons. In migrainous women 17-beta-oestradiol levels are higher in both ovarian phases, whereas progesterone concentrations and the progesterone to oestradiol ratio are lower than in healthy subjects in the luteal phase. These data suggest the existence of a change in the oestrogen-dependent modulation of pituitary DA receptors.
Cephalalgia 1986 Mar
PMID:Changes in the dopaminergic control of prolactin secretion and in ovarian steroids in migraine. 369 93

In 103 sexually mature women with disturbance of ovulation, a possible relationship between Kupperman menopausal complaints and endocrinological status was investigated to find the cause of climacteric syndrome. The Kupperman index was increased as the disturbance of ovulation was advanced from the stage of anovulatory cycle to amenorrhea I and further to amenorrhea II. In parallel with the advance in disturbance of ovulation, serum FSH and LH levels rose significantly, and serum estrone (E1) and estradiol (E2) levels dropped. Prolactin (PRL) showed a tendency to decrease. There were some hormonal patterns characteristic of individual complaints; hot flush was associated with increased FSH and LH, and decreased E1 and E2; difficulty in falling asleep, excitability, and fatigability, with increased FSH and LH, and decreased E2; nervousness, with increased LH and decreased E2; headache, with increased LH and PRL, and decreased E2; feeling of cold, with decreased E2 and PRL; and numbness and shoulder stiffness, with decreased E2. In sexually mature women, the complaints associated with abnormal levels of two or more kinds of hormones seemed to be most specifically related with decreased E2, followed by increased LH. Fatigability and headache developed specifically in the ovulatory phase of women with normal menstrual cycles (105 subjects), suggesting that these two complaints are closely related to increased LH. These results indicate that the majority of Kupperman menopausal complaints have their individually specific endocrinological cause, and that they may develop even in sexually mature women if those specific conditions exist. In climacteric syndrome in a narrow sense (i.e., dysautonomic type), each complaint may also have its specific endocrinological cause.
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PMID:[Serum hormone level and Kupperman menopausal complaints in sexually mature women with disturbance of ovulation]. 391 22

Prolactin (PRL) and the placental hormones, estradiol (E2), estriol (E3), progesterone (PG), chorionic gonadotropin (HCG), and placental lactogen (HPL) were serially measured throughout pregnancy and early postpartum in three patients with prolactinomas in whom pregnancy was achieved by one of the three modalities of treatment: bromocriptine administration (patient I), irradiation of the pituitary (patient II), and human gonadotropin administration after excision of the adenoma (patient III). It was found that PRL in patient I reached the high pretreatment levels in the 2nd month of pregnancy and increased to further abnormal concentrations in the last 2 months, but fell at the onset of labor 1 week after an episode of severe headache. The PRL changes in this patient were attributed successively to tumor expansion and apoplexy. In patient II PRL decreased after irradiation, but was not normalized. During pregnancy it remained moderately increased presenting minor fluctuations. The third patient with postoperative GH and TSH pituitary insufficiency had low pretreatment PRL levels which remained practically unchanged throughout pregnancy. The two last patients gave birth to identical twins. The placental hormones were found normal in all three patients but E2 and PG were relatively increased during the last weeks of pregnancy in the twin pregnancies. Amniotic fluid and umbilical cord PRL and E2 concentrations were normal. The patients presented agalactia and suckling did not induce a PRL increase. We conclude that a) serial PRL measurements during pregnancy reflect the changes occurring in the prolactinomas and are essential in monitoring the patients bearing these tumors; b) maternal hyperprolactinemia or failure of PRL to increase during pregnancy do not influence either the secretion of placental hormones or PRL concentration in amniotic fluid and the newborn; and c) hyperprolactinemia during pregnancy is of maternal pituitary origin.
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PMID:Prolactin and placental hormone levels during pregnancy in prolactinomas. 611 69

During the last four years 12 Prolactin (PRL) secreting adenomas whose first clinical manifestation appeared before the age of 15 years have been studied. The first signs were a decreased growth rate and arrest of pubertal development in 4 girls and 2 boys in whom the adenoma occurred before or during puberty. In the other six cases (5 girls and 1 boy) the first signs were secondary amenorrhea and galactorrhea in girls and in the boy gynecomastia followed by galactorrhea. Symptoms of the tumour (headaches, and visual disturbances) were almost invariable (11/12) and led to the diagnosis in two cases. Plasma PRL levels were always elevated (80 to more than 5,000 ng/ml) and did not rise in response to TRH. 11 out of 12 were large tumours and pituitary tomography showed that tumour was circumscribed in five cases and invasive in the other seven. The prognosis is related to the short term outcome. The condition may be cured by surgery only (25% cases only) or by surgery and bromocriptine.
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PMID:[Prolactin adenomas in children (author's transl)]. 739 49

Lymphocytic adenohypophysitis (LAH) is an autoimmune disorder of the pituitary gland with a predilection for the peripartum period and often mimics a pituitary adenoma. We sought to define the clinical, endocrinologic and radiographic characteristics differentiating peripartum LAH from pituitary adenoma to enable the use of noninvasive diagnosis and appropriate therapy. From published reports and our own case, the clinical histories and laboratory and radiographic studies of 45 patients fulfilling the diagnosis of peripartum LAH were reviewed. History of infertility or menstrual irregularity, symptomatology, endocrinologic evaluation, diagnostic imaging and associated medical conditions were analyzed. For comparison, 806 patients with pituitary adenoma and pregnancy from published series were evaluated. The spontaneous pregnancy rate in pituitary adenoma patients was 2.4% vs. 100% in LAH patients. Visual disturbances and headaches were significantly more frequent in patients with LAH. Prolactin levels were significantly lower in patients with LAH than in those with pituitary adenomas (34.6 +/- 46.3 [SD] vs. 393.0 +/- 300.4, P < .0001). Abnormalities in thyroid and/or adrenal function were also more common in patients with LAH (57.5% vs. 2.5%, P < .001). There were no distinguishing characteristics on radiographic studies. History and endocrinologic evaluation can differentiate between LAH and pituitary adenoma in the peripartum patient.
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PMID:Differentiating lymphocytic adenohypophysitis from pituitary adenoma in the peripartum patient. 762 53

Cabergoline is a synthetic ergoline which shows high specificity and affinity for the dopamine D2 receptor. It is a potent and very long-acting inhibitor of prolactin secretion. Prolactin-lowering effects occur rapidly and, after a single dose, were evident at the end of follow up (21 days) in puerperal women, and up to 14 days in patients with hyperprolactinaemia. In the only comparative study to date, cabergoline 0.5 to 1.0 mg twice weekly was more effective than bromocriptine 2.5 to 5.0 mg twice daily in the treatment of hyperprolactinaemic amenorrhoea, restoring ovulatory cycles in 72% of women and normalising plasma prolactin levels in 83%, compared with 52 and 58%, respectively, for bromocriptine. In the prevention of puerperal lactation, a single dose of cabergoline 1.0mg was as effective as bromocriptine 2.5mg twice daily for 14 days. A significantly lower incidence of rebound lactation in the third postpartum week was seen with cabergoline. Unpublished data suggest cabergoline 0.25mg twice daily for 2 days is effective in suppressing established puerperal lactation in about 85% of women. Nausea, vomiting, headache and dizziness are characteristic adverse events of the dopaminergic ergot derivatives. Cabergoline appears to be better tolerated than bromocriptine in both patients with hyperprolactinaemia and postpartum women. Most patients intolerant of other ergot derivatives can tolerate cabergoline. Bromocriptine use in the puerperium has been associated with an increased risk of serious thromboembolic events. However, there are no such reports with cabergoline and whether these events will become associated with other dopaminergic agents is unknown. The teratogenic potential of cabergoline has not been extensively investigated in humans. Ten congenital abnormalities have been reported in 199 cabergoline-associated pregnancies. Although there is no pattern to these abnormalities, the limited experience with cabergoline in pregnancy means the drug cannot be considered as a first-line therapy for the treatment of infertility associated with hyperprolactinaemia. At this stage of its development, cabergoline will prove useful in patients with hyperprolactinaemia who have failed treatment with, or are intolerant of, other dopamine agonists such as bromocriptine. If drug treatment is required for the prevention or suppression of puerperal lactation, cabergoline offers significant advantages over bromocriptine and should become the drug treatment of first choice for this indication.
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PMID:Cabergoline. A review of its pharmacological properties and therapeutic potential in the treatment of hyperprolactinaemia and inhibition of lactation. 772 32


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