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

Bromocriptine, a long acting dopamine agonist, has been used to treat 73 patients with active acromegaly for between 3 and 25 months. Clear clinical improvement occurred in 71 patients (97%). This included improvement in facial appearance, reduction in hand and foot size and sweating, relief of headaches and increased energy and libido. Abnormal visual fields became normal in two patients, but one of these was given concomitant radiotherapy. A significant reduction in growth hormone occurred in 58 patients (79%), but only 15 patients had levels persistently below 5microgram/l. Carbohydrate tolerance improved with the reduction in growth hormone and of 23 patients with diabetes mellitus before treatment, glucose tolerance became normal in 15 and improved in a further 5. Administration of bromocriptine should begin slowly in order to minimise early side effects. Long term side effects have been minor to date and the deaths of two patients whilst taking the drug were not considered to have been caused by it. Bromocriptine offers a major advance in the management of acromegaly, but further careful follow-up is required to determine whether serious side effects will be a problem with the long term use of high doses.
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PMID:Acromegaly--results of long term treatment with bromocriptine. 34 61

Fifty-one female patients with prolactin producing tumors (PRL 1100 to 88,000 microU/ml) and 26 male patients with prolactin producing tumors (PRL 6500 to 400,000 microU/ml) were studied. Only 25% of the females had visual field defects which were present in 70% of the males. All females had amenorrhea but only 35 had galactorrhea. Hypopituitarism was rarely seen in the females but in most of the male patients. Twenty-four females and all male patients were operated (transphenoidal or transfrontal operation). PRL normalized in only eight females and in none of the males. Two patients became pregnant postoperatively, four after postoperative treatment with bromocriptine. Bromocriptine induced regular menses in 4 other patients operated by transsphenoidal route. Eight patients with microadenoma (PRL less than 4000 microU/ml) were treated with bromocriptine alone of whom two became pregnant. The males were also treated with bromocriptine leading to a significant fall of the PRL level accompanied by improvement of libido, sexual potency and headache. Two patients received radiation postoperatively, which led to a fall of PRL and improvement of visual fields. Since PRL levels remained low after withdrawal of bromocriptine for several months an antiproliferative effect of this drug is suggested. Thus differential therapy of PRL producing tumors is possible: In females selective neurosurgery can alone or combined with medical therapy normalize PRL secretion and ovarian function. In patients with microadenoma bromocriptine alone can be successful. In patients with inoperable large tumors radiation should be advocated. Additional bromocriptine therapy may be helpful to stop tumor growth and alleviate the effects of hyperprolactinemia.
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PMID:Treatment of patients with prolactinomas. 75 42

Bromocriptine, an ergot alkaloid dopamine agonist, is a recent common treatment for suppression of lactation in postpartum women. A case is presented of a postpartum woman prescribed bromocriptine for suppression of lactation who developed hypertension, headaches, blurry vision, seizures, and pituitary hemorrhage. Differential diagnosis and a literature review are considered.
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PMID:Bromocriptine associated with postpartum hypertension, seizures, and pituitary hemorrhage. 187 30

Forty-eight pregnancies were observed in 35 patients with hyperprolactinaemia divided into 3 groups according to their initial radiological appearances: normal sella turcica (Group I, n = 11), microadenoma (Group II, n = 12) or macroadenoma without suprasellar expansion, visual defect or pituitary deficiency (Group III, n = 12). Twenty-seven patients were treated with Bromocriptine (Br) from the outs six by adenomectomy + Br, one by adenomectomy alone complicated by meningitis and by corticotropic and thyrotropic hormone deficiencies, followed by amenorrhea despite normalisation of the hyperprolactinaemia requiring induction of a first pregnancy with Clomid. As regards the pregnancies induced by Br (43/48), Br was withdrawn at an early stage in Group I and in the majority of cases in Groups II and III. In all, 37 pregnancies came to term; after Br therapy we observed 5 spontaneous abortions and 3 premature deliveries; 2 caesarian sections were performed before term (one case of hypertension and one adenomatous expansion); one early termination was performed for a tumoral complication. One congenital abnormality (oesophageal atresis) was detected. These observations support the results of extensive studies showing no effects of Br on the outcome of pregnancy and no detectable teratogenic effects with this drug. Five pituitary complications occurred during pregnancy after withdrawal of Br; 1 case of headaches with expansion of a macroadenoma cured by adenometry after prophylactic caesarian section before term; 1 case of optic chiasma compression (Group III) which responded to emergency surgery and 2 cases of pituitary apoplexy (Groups II and III) which responded favourably to Br and in which pregnancy continued normally.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pregnancy and hyperprolactinemia. Review of therapeutic measures apropos of a series of 35 patients]. 356 10

An 11-year-old male presented with a 2-year history of headache and lethargy. Serum PRL was elevated at 14,000 mU/l and computerized tomography showed a pituitary macroadenoma. Visual fields and fundi were normal and the testes showed early pubertal changes. There was normal responsiveness of serum cortisol but absence of GH response to hypoglycaemia. After bromocriptine therapy for 4 months serum PRL had fallen to 90 mU/l and the tumour was not visible on repeat computerized tomography. After 7 months treatment, repeat pituitary function testing showed restoration of GH response to hypoglycaemia. Treatment with bromocriptine was continued and there was spontaneous progression of normal puberty; the serum testosterone continued to rise, and height maintained the 50th centile. Bromocriptine therapy should be considered as initial therapy in the management of prolactinomas in prepubertal patients.
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PMID:Normal growth and pubertal development during bromocriptine treatment for a prolactin-secreting pituitary macroadenoma. 366 15

34 adolescents referred for excessive height prediction (HP) (11 boys with HP greater than 196 cm, 23 girls with HP greater than 180 cm) were treated for 9-15 months with bromocriptine (5-7.5 mg/day). Minor and transient side effects were observed in 20% of the subjects at the beginning of the treatment. Treatment had to be stopped in 1 boy complaining of asthenia and headache. Puberty developed normally, 19 girls experienced menarche during treatment and 1 continued regular menses. Bromocriptine treatment induced: (1) a significant decrease (p less than 0.001) in growth velocity from (mean +/- SEM) 8.6 +/- 0.4 to 5.3 +/- 1.5 cm/year in boys and from 7.1 +/- 0.2 to 4.6 +/- 0.6 cm/year in girls; (2) a twofold mean increase in skeletal maturation rate. Adult HP was reduced significantly from 202 +/- 1.4 to 195.4 +/- 1.2 cm in boys, and from 184 +/- 0.7 to 179.8 +/- 0.7 in girls. These results confirm our previous report suggesting that bromocriptine is a valuable alternative to sex steroid treatment in order to limit the final height in excessively tall adolescents.
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PMID:Bromocriptine treatment in tall adolescents: two years of clinical experience. 389 13

As an unusual complication of bromocriptine treatment for prolactinoma, CSF rhinorrhea has been reported in the relevant literature. The authors, on the contrary, experienced cessation of CSF rhinorrhea during bromocriptine treatment. A 37-year-old man with invasive prolactinoma underwent a frontal craniotomy for removal of pituitary adenoma on February 2, 1978. Postoperative CT showed residual adenoma within the sella and the sphenoid sinus. Postoperative irradiation was started on February 27 and given in a total dose of 5,000 rad. On March 30, 1979, the patient noticed clear fluid dropping out of his nostrils, the fluid contained glucose and CSF rhinorrhea was suspected. The CSF rhinorrhea was considered due to the regrowth of adenoma in the paranasal sinuses. On June 27, 1979, the patient developed headache together with fever and CSF rhinorrhea. On examination, the patient was drowsy and showed marked nucheal rigidity. Under the diagnosis of meningitis caused by CSF rhinorrhea antiseptic chemotherapy was started. Hypocycloidal tomogram showed extensive destruction of the sella and a soft density mass in the sphenoid and the ethmoid sinuses. CT also showed intrasphenoidal and lateral extension of the adenoma. To repair of the CSF leak, transsphenoidal surgery was performed on August 2, 1979 when the patient was in favorable condition. The sphenoid sinus was full of adenoma and it was removed, however, the exact location of the CSF leak could not be identified. The sphenoid sinus was packed with muscle tissue. Bromocriptine treatment was postoperatively started with 5 mg per day on August 25, 1979. The patient sustained CSF rhinorrhea which was decreased by lumbar drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cessation of cerebrospinal fluid rhinorrhea by bromocriptine treatment of a patient with invasive prolactinoma]. 646 39

Twenty-three hyperprolactinemic infertile cases become pregnant after surgical treatment and/or bromocriptine administration, and 18 of them accomplished normal full-term deliveries. Serial ophthalmological examination which had been performed monthly throughout pregnancy revealed that four cases bearing pituitary adenomas developed visual disturbances which manifested themselves in the latter part of gestational period. The objective signs detected in these cases were bitemporal hemianopsia, temporal and nasal visual defects and the disappearance of central isopter. Another patient with microadenoma complained of headache at 16 weeks of gestation and it became more severe as gestation progressed. Bromocriptine (1.25 mg/day) was effective in diminishing this symptom. Although all these cases recovered from visual disturbances and headache after delivery, two of them were operated on transsphenoidally when radiological evidence of pituitary enlargement was found in the postpartum period. It is generally accepted that nearly 20% of hyperprolactinemic patients have pituitary adenomas. In view of the limited accuracy of techniques used in diagnosing pituitary tumor, it is legitimate to postulate that most hyperprolactinemic infertile patients have microadenoma to some extent. For this reason, a detailed follow up of visual field and neurological signs throughout pregnancy of hyperprolactinemic patients is important in early detection of changes in pituitary size.
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PMID:[Visual and neurological disturbances accompanying with pregnancies of hyperprolactinemic patients]. 686 25

Twenty-eight women with hyperprolactinaemia and amenorrhoea received bromocriptine treatment which resulted in 31 term pregnancies. Bromocriptine treatment was stopped as soon as pregnancy was established. Nineteen of the women had radiological signs of a pituitary tumour. The pregnancies were clinically uneventful in all cases except one who developed headache. Post-partum sellar X-ray showed pregnancy-induced enlargement of the pituitary fossa in 4 of the 28 women. Regression of the radiological changes occurred in 3 of the 4 women within 2 years after the delivery. The women with abnormal sellar X-rays had no difference in the mean prolactin levels before treatment and after pregnancy and lactation while all the women with normal sellae had lower prolactin levels after pregnancy than before. Three women resumed regular spontaneous menstruations after pregnancy and lactation but only one conceived again. Thus, serious pituitary tumour complications are rare in hyperprolactinaemic women with bromocriptine-induced pregnancies. The pregnancy does not worsen the condition. Resolution of hyperprolactinaemia after bromocriptine-induced pregnancy is an unfrequent finding.
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PMID:Effects of bromocriptine-induced pregnancy on prolactin-secreting pituitary tumours. 729 65

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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