11/21. First reported pediatric case of systemic lupus erythematosus associated with prolactinoma.There is much interest in the possibility that prolactin influences disease activity in systemic lupus erythematosus (SLE). We present the first reported pediatric case of prolactinoma associated with SLE, in a 13-year-old white female. The diagnosis of SLE was based on the presence of arthritis, antinuclear antibodies, and double-stranded dna, and a chest radiograph showing pleural fluid. The diagnosis of pituitary prolactinoma was based on the histologic features and the presence of amenorrhea, galactorrhea, and an elevated serum prolactin level. Neurosurgical resection and medical therapy with bromocriptine mesylate were independently associated with decreased prolactin levels, loss of arthritis, and reduced levels of inflammatory mediators.- - - - - - - - - - ranking = 1keywords = galactorrhea (Clic here for more details about this article) |
12/21. Rapid re-enlargement of a macroprolactinoma after initial shrinkage in a young woman treated with bromocriptine.We report the case of a macroprolactinoma in a 32-year-old woman, who presented with secondary amenorrhea, galactorrhea, increased plasma prolactin level (3259 ng/ml), headache and bi-temporal visual field defect. magnetic resonance imaging showed a large pituitary tumor. The patient responded well to bromocriptine (7.5 mg/day) with improvement of clinical symptoms and normalization of plasma prolactin within a few weeks. After 4 months of treatment, tumor size was also reduced markedly. During continued treatment at the same dose of bromocriptine the plasma prolactin level remained normal, but after 8 months of treatment the patient suddenly complained of worsening of her visual fields, and magnetic resonance imaging indicated re-enlargement of the tumor. bromocriptine was discontinued and transsphenoidal pituitary surgery was performed. After surgery the visual field defect improved, but postoperative plasma prolactin level (1104 ng/ml) and magnetic resonance imaging indicated a residual tumor. Postoperative treatment with quinagolide (0.15 mg/day) resulted in disappearance of all clinical symptoms, normalization of prolactin level and a reduction in size of the residual tumor. This case demonstrates that a dissociation of the inhibitory effect of bromocriptine on tumor size and prolactin level may rarely develop during the course of drug treatment in a patient with macroprolactinoma.- - - - - - - - - - ranking = 1keywords = galactorrhea (Clic here for more details about this article) |
13/21. A case of a prolactinoma resistant to dopamine agonists.dopamine agonists are the drugs of choice in the treatment of prolactinomas, the most common type of pituitary adenomas. However, up to 25% of prolactinomas do not respond to these drugs and alternative treatments have to be considered. We describe a 37-year old female with a microprolactinoma who, although having received all available formulations of dopamine agonists over a period of 11 years, did not respond either clinically--diminution of galactorrhea and restoration of her menstrual cycle--or hormonally through normalisation of the elevated prolactin levels. Throughout the same period, the size of the adenoma remained unchanged.While on high doses of dopamine agonists, the patient presented with side effects such as nausea, vomiting, orthostatic hypotension and tachycardia without any symptoms of psychosis. Therefore, either the dose of the dopamine agonists was not toxic enough for the mesolimbic dopaminergic pathway to be activated or the patient was dopamine-resistant in this pathway as well.- - - - - - - - - - ranking = 1keywords = galactorrhea (Clic here for more details about this article) |
14/21. Development of a macroprolactinoma in association with hormone replacement therapy in a perimenopausal woman with presumed idiopathic hyperprolactinemia.OBJECTIVE: To describe a 48-year-old woman with presumed idiopathic hyperprolactinemia, who was found to have a macroprolactinoma after receiving hormone replacement therapy for almost 3 years. methods: We present a detailed case report, including a chronologic summary of clinical and laboratory findings as well as the drug history of our patient. The related literature is also reviewed. RESULTS: Premenopausal women with idiopathic hyperprolactinemia or microprolactinomas (<1 cm) are treated with dopamine agonists if fertility is desired or galactorrhea is bothersome. Otherwise, estrogens and progestational agents may be prescribed to regularize menses and prevent osteoporosis. Several case reports of prolactinoma formation or enlargement after exposure to exogenous estrogens have been published. In our patient, a perimenopausal woman with presumably idiopathic long-standing hyperprolactinemia, a macroprolactinoma developed within 3 years after initiation of hormone replacement therapy for management of perimenopausal symptoms. The only clue for ordering a pituitary imaging study in this case was a substantial increase in the level of the serum prolactin. Treatment with cabergoline normalized the patient's serum prolactin level and considerably decreased the size of her pituitary adenoma. CONCLUSION: It is postulated that exogenous estrogens could have an important role in tumor development or growth in some patients with idiopathic hyperprolactinemia. Therefore, it is recommended that women with idiopathic hyperprolactinemia or microprolactinomas treated with estrogens be considered for concomitant therapy with dopamine agonists. In all cases, serum prolactin levels should be diligently monitored.- - - - - - - - - - ranking = 1keywords = galactorrhea (Clic here for more details about this article) |
15/21. Somatotropic adenomas without acromegaly.Seventeen somatotropic adenomas removed from patients without acromegaly were studied. Thirteen of them presented as a prolactinoma with amenorrhea and/or galactorrhea and elevated serum PRL levels. According to basal serum GH levels, the patients were divided into two groups, namely Group I: GH slightly elevated (n = 4) and group II: GH less than or equal to 5 micrograms/l (n = 13). The tumoral GH secretion was proved by immunocytochemistry in all cases and by intratumoral RIA, in vitro study and/or in situ hybridization in five of them. Pathological, clinical and biochemical relationships suggested two anatomoclinical aspects. In group I, the tumors were small, well-differentiated somatotropic adenomas with clinically silent GH hypersecretion. It is probably an early stage of the disease. In group II, the tumors were large with normal GH serum levels. They were poorly differentiated and secreted very low amounts of GH. In nine of them, PRL and/or PRL mRNA expression were also detected. These tumors do not secrete enough GH to increase serum levels and cause acromegaly. The somatotropic adenomas without acromegaly correspond to two anatomoclinical aspects of the disease.- - - - - - - - - - ranking = 1keywords = galactorrhea (Clic here for more details about this article) |
16/21. acromegaly as the amenorrhea-galactorrhea syndrome.The presence of amenorrhea with galactorrhea, elevated prolactin levels, and a pituitary tumor does not always imply the diagnosis of a prolactinoma. Other pituitary disorders, including acromegaly, should be considered.- - - - - - - - - - ranking = 5keywords = galactorrhea (Clic here for more details about this article) |
17/21. Ectopic prolactinoma within the sphenoid sinus.A case of an ectopic prolactin-producing tumor located within the sphenoid sinus is reported. It was discovered in a girl who experienced secondary amenorrhea without galactorrhea. We discuss the different diagnoses proposed before immunocytochemical staining results were available. This case presented unusual radiological, surgical, and histopathological aspects.- - - - - - - - - - ranking = 1keywords = galactorrhea (Clic here for more details about this article) |
18/21. Changes in the prolactin serum isoforms secreted by a pituitary adenoma associated with therapy.Variations in serum molecular forms of prolactin (PRL) from an adolescent woman presenting amenorrhea-galactorrhea are reported. Persistent hyperprolactinemia and hypoestrogenism were demonstrated as well as the presence of a pituitary tumor with suprasellar extension. bromocriptine was given at progressive doses up to 37 mg daily, decreasing the hyperprolactinemia and galactorrhea. After 2 years of treatment the patient noticed symptoms of gastric intolerance, bromocriptine was discontinued and a rebound of hyperprolactinemia was observed. lisuride was administered instead resulting in a new decrease in PRL serum levels, disappearance of galactorrhea and beginning of regular menses. serum gel chromatographic analysis was carried out before and during lisuride treatment. The first chromatographic analysis showed a predominance of high molecular weight (approximately 66 KD) PRL, accounting for more than 90% of the immunoreactive PRL. The second chromatography showed the major peak of immunoreactive PRL displaced to the right (molecular weight of 22 KD), which was eluted near the PRL standard. With these chromatographic patterns it is concluded that the pituitary macroprolactinoma secreted different molecular forms of PRL and treatment with lisuride appeared to exert some effect on the PRL molecular size secreted by the pituitary.- - - - - - - - - - ranking = 3keywords = galactorrhea (Clic here for more details about this article) |
19/21. prolactinoma associated with transient growth hormone deficiency but persistent growth retardation.A 14.8 year old boy was evaluated for galactorrhea of two months duration and growth deceleration for greater than three years. He was 3.7 standard deviations (SD) below the mean for age in height and euthyroid with uncompromised vision, bilateral galactorrhea, and pubertal arrest. MRI demonstrated a 10 x 8 mm left pituitary mass. Bone age was 11.5 years. serum prolactin (PRL) decreased by more than 85% after 5 weeks of treatment with bromocriptine (Br). After five months, the prolactinoma (PRLoma) measured 5 x 4 mm. Hypothalamic-pituitary function indicated growth hormone (GH) deficiency and hypogonadotropic hypogonadism as assessed by ITT-TRH-GnRH-clonidine. After nine months of Br, despite return of adequate gonadotropin and GH secretion as assessed by repeat ITT-TRH-GnRH-clonidine, pooled 12 hour nocturnal spontaneous GH secretion, and clinical progression of puberty, there was no linear "catch-up growth" (growth rate = 4.4 cm/yr and height 4.2 SD below the mean for age). Growth rate increased following supplemental GH administration without untoward effect. We conclude that there may be discordance/lag between reduction in secretion and size of PRLomas and growth despite resolution of other anterior pituitary dysfunction. Other possibilities are discussed.- - - - - - - - - - ranking = 2keywords = galactorrhea (Clic here for more details about this article) |
20/21. Two-step development of a pituitary adenoma: from hyperprolactinemic syndrome to Cushing's disease.In this report we describe the case of a young female patient with amenorrhea-galactorrhea syndrome apparently due to pituitary PRL-secreting adenoma who, after three years of dopaminergic therapy without any shrinkage of the tumor, developed true Cushing's disease. Progression from hyperprolactinemia to hypersecretion of ACTH has been rarely described and it may be due to different possibilities. However, histopathological and immunohistochemical studies of the adenoma showed a pattern of PRL negative and ACTH positive cells, excluding mixed pituitary tumor. In order to explain the progression from hyperprolactinemia with amenorrhea-galactorrhea to an ACTH hypersecretion syndrome, it must be hypothesized either pituitary stalk compression or the influence of paracrine regulation factor(s) (such as Galanine) due to an "initially silent" corticotropinoma. This case confirms that the presence of hyperprolactinemia in a patient with pituitary tumor and amenorrhea-galactorrhea syndrome is insufficient to confidently conclude for prolactinoma. Furthermore, it underlines the importance both of clinically monitoring the patient with prolactin pituitary adenoma if dopaminergic therapy does not reduce tumor volume, and of accurately and repeatedly measuring the other pituitary hormonal secretions.- - - - - - - - - - ranking = 3keywords = galactorrhea (Clic here for more details about this article) |
| <- Previous || Next -> |