Cases reported "Lactation Disorders"

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1/18. Pituitary function testing in amenorrhea-galactorrhea-hyperprolactinemia.

    Fifteen patients, age 16 to 55, presented with amenorrhea-galactorrhea-hyperprolactinemia. Pituitary function was evaluated by bolus injections of insulin, luteinizing hormone-releasing hormone (LHRH), and thyrotropin-releasing hormone (TRH) in 13 and by LHRH and TRH in 2. Responses to growth hormone (GH), thyroid-stimulating hormone (TSH), cortisol (F), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin were measured. GH, TSH, and F responses were normal in most cases. LH responses were decreased (P less than 0.025) in patients with abnormal sellar tomography, whereas FSH responses tended to decrease with elevated prolactin levels. Prolactin responses were absent in five of the seven cases which could be evaluated. The clinical value of such testing appears to be limited to an individualized basis, although some prognosis of ovulatory response to bromocriptine therapy may be obtained from the gonadotropin response.
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ranking = 1
keywords = sella
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2/18. Primary empty sella, galactorrhea, hyperprolactinemia and renal tubular acidosis.

    Discussed here is a 41 year old woman with galactorrhea associated with the empty sella syndrome and mild renal tubular acidosis. Basal serum prolactin (PRL) levels were normal, but a 24 hour serum PRL secretory profile demonstrated an increased mean PRL concentration. serum PRL was appropriately suppressed by the administration of L-dopa; however, chlorpromazine stimulation resulted in a blunted serum PRL response. Pituitary luteinizing hormone, follicle stimulating hormone, ACTH and thyroid stimulating hormone levels were normal. Thus, galactorrhea associated with an enlarged sella does not establish the diagnosis of a pituitary tumor, and pneumoencephalography must be performed to exclude the empty sella syndrome.
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ranking = 7
keywords = sella
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3/18. Primary amenorrhea associated with hyperprolactinemia: four cases with normal sellar architecture and absence of galactorrhea.

    hyperprolactinemia is an uncommon cause of primary amenorrhea. The diagnosis should be sought even in the absence of galactorrhea and sellar abnormality, particularly when thelarche and pubarche have occurred. Reduction of serum PRL levels followed by menarche can be anticipated within a few months of starting bromocriptine therapy in the majority of cases.
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ranking = 5
keywords = sella
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4/18. Resolution of acromegaly, amenorrhea-galactorrhea syndrome, and hypergastrinemia after resection of jejunal carcinoid.

    A young woman presented with acromegaly and amenorrhea-galactorrhea with hypersomatotropinemia and hyperprolactinemia. In addition, she had hypergastrinemia with abnormal secretory dynamics and evidence of a large pituitary tumor with suprasellar extension and erosion of the floor of the sella turcica. Evaluation of secretory diarrhea revealed a large abdominal tumor, which on removal was found to be a carcinoid of the jejunum. Postoperatively, the acromegaly, amenorrhea-galactorrhea, and hypergastrinemia resolved, and the pituitary returned to normal size, with regrowth of the sella floor. The carcinoid tumor was shown by immunoperoxidase staining to contain GH-releasing hormone.
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ranking = 4.4339282662556
keywords = turcica, sella
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5/18. Galactorrhoea and hypogonadism associated with a radiologically-inapparent prolactin-secreting pituitary tumour.

    A 38 year old man was investigated because of impotence, gynaecomastia and galactorrhoea. Hyperprolactinaemia and hypogonadism were documented. Pituitary function was otherwise normal as was tomographic examination of the sella turcica. In the absence of direct evidence of pituitary involvement (hyperprolactinaemia can suppress gonadal function) and to exclude ectopic prolactin production, venous blood was drawn at multiple sites. The highest prolactin levels were found in the superior vena cava and above, indicating an intracranial source. At transsphenoidal hypophysectomy a microadenoma was removed; tumour cells contained typical prolactin secretory granules on electron microscopy. In the light of this report the appropriateness of dividing hyperprolactinaemia into "tumourous" and "idiopathic" subgroups on the basis of sella size must be reconsidered. Functional tests do not distinguish between the subgroups although prolactin levels tend to be higher when the sella is enlarged. Only a quantitative rather than a qualitative difference may exist between the subgroups.
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ranking = 8.8453466147228
keywords = sella turcica, turcica, sella
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6/18. galactorrhea and amenorrhea in a patient with an empty sella.

    A report of a patient with amenorrhea and galactorrhea who was shown, by tomopneumoencephalogram, to have an empty sella is presented. Endocrinologic testing revealed only a blunted human growth hormone response to insulin-induced hypoglycemia and acyclicity of plasma gonadotropins. Thyroid testing, ACTH, and metopirone responses were normal. In addition, plasma prolactin levels were found to be within the normal range. Most significantly, after the pneumoencephalogram the patient's menses returned and have continued at regular monthly intervals for 6 months. During this time there has been a significant decrease in the galactorrhea. This is the first patient described with an empty sella and galactorrhea. The clinical and endocribologic aspects of the empty sella are discussed.
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ranking = 7
keywords = sella
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7/18. galactorrhea in a 12-year-old boy with a chromophobe adenoma.

    A 12-year-old with galactorrhea is presented. He was in early puberty, had gynecomastia, and was markedly obese. Roentgenograms of the skull showed an asymmetrically enlarged sella trucica, but pneumoencephalography did not indicate suprasellar extension of the pituitary tumor. Preoperative studies of anterior pituitary function were normal except for persistent hyperprolactinemia. By transsphenoidal approach, a microadenoma of the pituitary was removed. lactation ceased within a week, and four months postoperatively the patient had normal anterior pituitary function studies. A review of the literature indicates that galactorrhea in males is very rare. The most frequently documented cause, excluding drug ingestion, is a pituitary tumor.
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ranking = 2
keywords = sella
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8/18. galactorrhea, amenorrhea, hyperprolactinemia, and an empty sella.

    Increased serum prolactin (hPRL) and increased volume of the sella turcica as detected by roentgenography are compatible with a pituitary adenoma. The empty sella syndrome can increase sella volume, but is usually associated with minimal, if any, endocrine dysfunction. The present case details a young woman with amenorrhea, galactorrhea, elevated serum hPRL, and roentgenographic evidence of an enlarged sella turcica. pneumoencephalography with hypocycloidal polytomography is interpreted as both an empty sella, and evidence of a pituitary adenoma. The etiology and endocrine findings in the empty sella syndrome are discussed.
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ranking = 21.690693229446
keywords = sella turcica, turcica, sella
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9/18. Clinical, biochemical, and radiologic reversibility of hyperprolactinemic galactorrhea-amenorrhea and abnormal sella by thyroxine in a patient with primary hypothyroidism.

    A case of primary hypothyroidism associated with postpartum galactorrhea-amenorrhea is reported. The configuration of the sella was compatible with pituitary adenoma, but prolactin dynamics did not support an autonomous secretory state. Replacement therapy with thyroxine led to complete reversal of clinical, radiologic, and biochemical abnormalities.
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ranking = 5
keywords = sella
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10/18. Estrogen-induced galactorrhea in man.

    A 36-year-old man had estrogen-induced galactorrhea and oligospermia. He had been taking an unknown amount of estrogen for a year. While hypogonadism, manifested by decreased libido and potency, was apparent at the time of estrogen administration, galactorrhea appeared two months after estrogen was discontinued. Normal skull film, tomogram views of the sella turcica, and computerized axial tomography scan suggested that long-term estrogen administration caused sustained hyperprolactinemia with levels that ranged between 21 and 83 ng/mL throughout the ensuing year. Prolonged thyroid-stimulating hormone and prolactin luteinizing hormone response to luteinizing hormone-releasing hormone were believed to be evidence of a derangement in the hypothalamic control of pituitary hormone secretion. A year after he stopped taking estrogen, the patient gradually regained his potency, his prolactin level declined, the galactorrhea disappeared, and spermatogenesis returned to normal.
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ranking = 6.8453466147228
keywords = sella turcica, turcica, sella
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