Establishment and comparison of two methods to produce a rat model of mammary gland hyperplasia with hyperprolactinemia

Abstract This study aimed to establish and compare models of mammary gland hyperplasia (MGH) with hyperprolactinemia (HPRL) using two different methods. The models provide information on the relationship between mammary gland hyperplasia and associated hormones. Model A was constructed using intramuscular injections of estradiol benzoate injection (EBI), followed by progesterone (P), and then metoclopramide dihydrochloride (MDI). Model B was designed by administering MDI, follow by EBI, and then P intramuscularly. Model B showed higher MGH progression compared with model A. Notably, increase in estradiol (E2) was negatively correlated with prolactin (PRL) secretion. However, PRL levels in model B were significantly higher compared with the levels in model A. Estrogen (ER), prolactin receptor (PRLR), and progesterone receptor (PR) mRNA and protein expression levels in model B rats were positively correlated with changes in the corresponding hormone levels. However, E2, P, and PRL levels in model A showed no direct relationship with levels of the mRNAs of related hormones and protein expression levels. Our results suggest that model B is an appropriate model of MGH with HPRL that can be used to perform further studies about the interactions of the E2, P, and PRL hormones in this disorder.

Manejo preoperatorio de los adenomas hipofisarios. Lo que un residente de neurocirugía debe conocer / Preoperative management of pituitary adenomas. What a neurosurgery resident should know

Las lesiones selares son una patología con una incidencia de 3,2 a 4 / 100,000 y una prevalencia de 78 a 94 / 100,000. Un 10% son incidentalomas en la población adulta. Se cree que su prevalencia en el orden mundial actualmente va en aumento.En relación a las manifestaciones clínicas, cabe destacar que es una de las pocas enfermedades que pueden manifestarse tanto por signos y síntomas neurológicos (por ejemplo: hemianopsia bitemporal, síndrome de hipertensión endocraneana debido a hidrocefalia, entre otros), como también por síndromes endocrinológicos (por ejemplo: síndrome de Cushing, acromegalia, amenorrea-galactorrea, infertilidad).Todo paciente debe presentar un estudio clínico-radiológico completo, lo que permitirá un correcto diagnóstico y categorización del mismo.El objetivo del presente trabajo es proporcionar al neurocirujano en formación los conceptos claves que servirán de sustento para el manejo preoperatorio de un paciente con adenoma hipofisario.

Sellar lesions are a pathology with an incidence of 3.2 to 4 / 100.000 and a prevalence of 78 to 94 / 100.000. Normally, 10% of them are incidentalomas and adult patients are in the highest risk group. Because it ́s prevalence in the world is currently increasing, it is of extremely importance to study and understand this pathology. In relation to the clinical manifestations, it should be noted that it is one of the few diseases that can manifest through neurological signs and symptoms like bitemporal hemianopsia, endocranial hypertension syndrome due to hydrocephalus, as well as endocrinological syndromes like Cushing's, acromegaly, amenorrhea-galactorrhea and infertility. One of the most important things to notice is that the treatment success in this pathology comes with the correct diagnosis and characterization of it, for what all patients should have a complete clinical-radiological evaluation.In this study, we establish a guide with concepts and key tools to support the medical personal during a pre-surgical preparation of patients with pituitary adenoma.

Lacrimal gland atrophy and dry eye related to isotretinoin, androgen, and prolactin: differential diagnosis for Sjögren's syndrome / Atrofia das glândulas lacrimais e olho seco relacionados aisotretinoína, androgênio e prolactina: diagnóstico diferencial com a síndrome de Sjögren

ABSTRACT This report is of three cases of sicca syndrome, initially suspected to be Sjögren's syndrome, which was ruled out by clinical and laboratory investigations. The patients were a 24-year-old woman, a 32-year-old man, and a 77-year-old woman with chronic symptoms of sicca syndrome, including dry eye syndrome. The first case was associated with the use of isotretinoin, a retinoic acid. The second was associated with the use of anabolic androgenic steroids, and the third was related to a prolactin- secreting pituitary adenoma. All cases manifested sicca, including dry eye syndrome, after those events, and the manifestations persisted. Magnetic resonance imaging revealed bilateral atrophy of the lacrimal gland. The medical history, ocular examinations, laboratory exams, and magnetic resonance images confirmed dry eye syndrome; however, the exams were all negative for Sjögren's syndrome. The lacrimal gland was absent on magnetic resonance imaging in all three cases. The clinical history revealed that the signs and symptoms appeared after chronic exposure to retinoic acid, anabolic androgenic steroids, and a prolactin-secreting pituitary adenoma, respectively. Chronic isotretinoin, anabolic androgenic steroids, and prolactin-secreting pituitary adenoma or, in this last case, its inhibitory treatment, can cause lacrimal gland atrophy, sicca syndrome, and dry eye syndrome, and a differential diagnosis of Sjögren's syndrome. Further studies on doses, time, and other susceptibilities to the long-lasting adverse effects of retinoic acid, anabolic androgenic steroids, and the repercussions of prolactin-secreting pituitary adenoma are necessary to confirm and expand upon these associations.

RESUMO O relato descreve três casos de síndrome de sicca, inicialmente suspeitos de serem a síndrome de Sjögren, que fo­ram negados pela investigação clínica e laboratorial. O primeiro associado ao uso de isotretinoína, um ácido retinóico, o segundo ao uso de esteroides androgênicos anabolizantes e o terceiro relacionado ao adenoma da hipófise secretora da prolactina, todos manifestaram sicca, incluindo a síndrome do olho seco após esses eventos e as manifestações persistem. A ressonância magnética revelou atrofia bilateral da glândula lacrimal. Eles eram uma mulher de 24 anos, um homem de 32 anos e uma mulher de 77 anos com sintomas crônicos da síndrome de sicca, incluindo a síndrome do olho seco. A história médica, o exame ocular, os exames laboratoriais e a ressonância magnética foram confirmados como síndrome do olho seco, no entanto, todos os exames foram negativos para a síndrome de Sjögren. A glândula lacrimal estava ausente na ressonância magnética nos três casos. A história clínica revelou que sinais e sintomas se manifestaram após exposição crônica ao ácido retinóico, esteróides anabolizantes androgênicos e adenoma secretivo da prolactina hipofisária, respectivamente. Isotretinoína crônica, esteroides anabólicos androgênicos e adenoma hipofisário secretor de prolactina ou, neste último caso, seu tratamento inibitório pode ser a causa da atrofia da glândula lacrimal, síndrome da sicca e síndrome do olho seco e diagnóstico diferencial da síndrome de Sjögren. Estudos adicionais sobre doses, duração e outras suscetibilidades aos efeitos adversos duradouros do ácido retinóico, esteroides androgênicos anabólicos e repercussões do adenoma da hipófise secretora da prolactina são necessários para confirmar e detalhar essas associações.

Hiperprolactinemia e infertilidad / Hyperprolactinemia and infertility

La prolactina es una hormona hipofisiaria implicada en diversas funciones tales como reproductivas, lactancia y metabólicas. El hallazgo de hiperprolactinemia es frecuente en mujeres que consultan por infertilidad, oscilando entre el 15 y el 20%. Sus manifestaciones clínicas incluyen trastornos del ciclo, galactorrea, infertilidad y osteoporosis. Cuando hay tumores que superan 1 cm de diámetro pueden asociarse a alteraciones visuales. Aunque la hiperprolactinemia puede ser producida por el embarazo, el consumo de algunos fármacos, los trastornos tiroideos, las alteraciones hepáticas y renales, su causa más frecuente es la presencia de adenomas hipofisiarios productores de prolactina. Pueden ser microadenomas cuando su tamaño es menor de 10 mm y que representan el 90% o macroadenomas cuando son de mayor tamaño. La prolactina se encuentra bajo un estrecho control de su secreción a través de un sistema de retroalimentación de asa corta que hace que se libere dopamina que frena su producción. También se han descrito péptidos liberados de prolactina entre los que se encuentra la TRH. El exceso en su producción inhibe directamente la pulsatilidad de la GnRH y disminución en los pulsos de LH. Este cambio conduce a ciclos anovulatorios. Para su manejo se encuentran aprobados en Colombia fármacos agonistas de la dopamina como bromocriptina y cabergolina, siendo este último más efectivo. El manejo con cirugía transesfenoidal se reserva para aquellos casos en los que el tratamiento farmacológico ha fallado.

Prolactin is an hypophyseal hormone implicated in various functions such as reproductive, lactation and metabolic. Finding hyperprolactinemia is frequent in women consulting for infertility, ranging between 15 and 20%. Its clinical manifestations include menstrual cycle irregularities, galactorrhea, infertility and osteoporosis. When tumors greater than 1 cm in diameter are present visual disturbances may appear. Although hyperprolactinemia may be produced by pregnancy, certain medications, thyroid disfunction, hepatic or renal disfunction, the most frequent cause is the presence of prolactin secreting adenomas. They can be micro adenomas when their diameter is less than 10 mm, representing 90% or macro adenomas when their size is greater. Prolactin secretion is under a close control through a short loop feedback system, that makes dopamine to be secreted which lowers its production. Releasing peptides have been described, including TRH. Excess in its production directly inhibits GnRH pulsatility lowering LH pulses. This change conducts to anovulatory cicles, For its treatment in Colombia dopamine agonists have been approved, including bromocriptine and cabergoline, the last one being mor effective. Surgical management with transesphenoidal approach is reserved for those cases in which pharmacological treatment has failed.

Identification and sequence analysis of prolactin receptor and its differential expression profile at various developmental stages in striped hamsters

Prolactin (PRL) plays critical roles in regulation of biological functions with the binding of specific prolactin receptor (PRLR). Revealing the expression patterns of PRLR at different developmental stages is beneficial to better understand the role of PRL and its mechanism of action in striped hamsters. In this study, the cDNA sequence of PRLR (2866-base-pairs) was harvested from the pituitary of mature female striped hamsters (Cricetulus barabensis) that contains an 834-base-pair 5′-untranslated region (1-834 bp), a 1848-base-pair open reading frame (835-2682 bp), and a 184-base-pair 3′-untranslated region (2683-2866). The 1848-base-pair open reading frame encodes a mature prolactin-binding protein of 592 amino acids. In the mature PRLR, two prolactin-binding motifs, 12 cysteines, and five potential Asn-linked glycosylation sites were detected. Our results showed that the PRLR mRNA quantity in the hypothalamus, pituitary, ovaries, or testis was developmental-stage-dependent, with the highest level at sub-adult stage and the lowest level at old stage. We also found that PRLR mRNAs were highest in pituitary, medium level in hypothalamus, and lowest in ovaries or testis. PRLR mRNAs were significantly higher in males than in females, except in the hypothalamus and pituitary from 7-week-old striped hamsters. Moreover, the PRLR mRNAs in the hypothalamus, pituitary, and ovaries or testis were positively correlated with the expression levels of GnRH in the hypothalamus. These results indicated that the PRLR has conserved domain in striped hamster, but also possesses specific character. PRLR has multiple biological functions including positively regulating reproduction in the striped hamster.

Panhipopituitarismo secundario a hemorragia obstétrica profusa / Panhypopituitarism secondary to profuse obstetric haemorrhage

El síndrome de Sheehan o necrosis hipofisaria posparto, constituye la causa más importante de panhipopituitarismo, que de forma ocasional se asocia a hemorragia obstétrica profusa asociada a choque hipovolémico hemorrágico, ocasionando un colapso circulatorio intenso debido a isquemia de la adenohipófisis durante el parto o después del mismo, debido a que esta glándula endócrina sufre importantes cambios anatómicos e histológicos durante el embarazo, los cuales incrementan su volumen hasta en 40%. De esta forma, se produce una secreción reducida de las hormonas que ayudan a regular el crecimiento, la reproducción y el metabolismo, evidenciando en el examen hormonal detallado insuficiencia específicamente de la hormona de crecimiento, foliculoestimulante, luteinizante, estimulante de tiroides, adrenocorticotropica y prolactina predisponiendo a la paciente a inestabilidad hemodinámica a corto plazo así como desequilibrio hormonal permanente. Por esta importancia, es que se presenta el caso de una paciente que ingresó a la Unidad de Terapia Intensiva tras cesárea iterativa debido a acretismo placentario llegando a la histerectomía total intercurriendo con choque hemorrágico, quien cursó durante su estancia en la Unidad con ausencia de recuperación neurológica total y características propias de síndrome de Sheehan, confirmándose el mismo por los niveles hormonales bajos y la ausencia de imagen en la silla turca correspondiente a la necrosis hipofisaria evidenciado por resonancia magnética, realizándose además una sucinta revisión acerca de la literatura relacionada actual.

ABSTRACT Sheehan syndrome or postpartum pituitary necrosis is the most common cause of hypopituitarism and occurs secondary to profuse obstetric haemorrhage with subsequent hypovolemic hemorrhagic shock, with intense circulatory collapse, predisposing to pituitary ischemia during delivery or after the same, due to the hypertrophic changes that occur in this gland during pregnancy. In this syndrome exists a reduced secretion of the hormones that regulate growth, reproduction and metabolism. We present the case of a female patient admitted to the Critical Care Unit after iterative cesarean due to placenta accreta and total hysterectomy, in hypovolemic shock secondary to severe hemorrhage, being suspicious of Sheehan´s syndrome, with characteristic clinical features, low hormone levels and the absence of image in the Turkish chair corresponding to the pituitary necrosis.

Hyperprolactinemia associated with psychiatric disorders / Hiperprolactinemia asociada con trastornos psiquiátricos

Abstract Hyperprolactinemia may be associated with psychiatric disorders in the context of two scenarios: antipsychotic-induced hyperprolactinemia and psychiatric disorders arising from the medical treatment of hyperprolactinemia. Both situations are particularly common in psychiatric and endocrine clinical practice, albeit generally underestimated or unrecognized. The aim of this article is to provide tools for the diagnosis and treatment of hyperprolactinemia associated with psychiatric disorders to raise awareness, especially among psychiatrists and endocrinologists, so that these professionals can jointly focus on the appropriate management of this clinical entity.

Resumen La hiperprolactinemia puede asociarse con trastornos psiquiátricos en el contexto de dos escenarios: la hiperprolactinemia inducida por antipsicóticos y trastornos psiquiátricos surgidos por el tratamiento médico de la hiperprolactinemia. Ambas situaciones son particularmente comunes en la práctica clínica psiquiátrica y endocrinológica, aunque generalmente subestimadas o inadvertidas. El objetivo de este artículo es proporcionar herramientas de diagnóstico y tratamiento de la hiperprolactinemia asociada a trastornos psiquiátricos, para concientizar particularmente a psiquiatras y endocrinólogos a enfocar en conjunto el manejo apropiado de esta entidad.

O uso do cloridrato de piridoxina para induzir estro em cadelas / The use of pyridoxine chloridrate to induce estrus in female dogs

Os agonistas dopaminérgicos são utilizados para induzir estro em cadelas, pois atuam na síntese e liberação de prolactina. Objetivou-se avaliar o efeito da piridoxina como indutor de estro em cadelas por agir na neurotransmissão dopaminérgica. Foram selecionadas 40 cadelas em anestro, divididas em quatro grupos experimentais, tratadas com 10mg/kg/dia (G1) e 50mg/kg/dia (G2) de cloridrato de piridoxina, 5µg/kg/dia (G3) de cabergolina e grupo controle/placebo (G4) por até 20 dias. Foram realizadas citologias vaginais a cada 24h para acompanhamento do ciclo estral e análises hormonais (FSH, LH e PRL) no dia zero e 120h do início do tratamento. As cadelas do G3 (100%) manifestaram proestro após 12 dias de tratamento aproximadamente, tempo inferior aos demais grupos (P<0,05). Apenas uma cadela do G1 e uma do G2 ficaram gestantes contra oito fêmeas do G3 e nenhuma do G4 (P<0,05). As concentrações plasmáticas de prolactina foram reduzidas nas fêmeas do G2 e G3 (P<0,05). As demais avaliações hormonais não sofreram influência do tratamento (P>0,05). O cloridrato de piridoxina foi ineficiente para induzir estro em cadelas, mas foi capaz de suprimir a prolactina, de forma semelhante à cabergolina, quando utilizado na dose de 50mg/kg/dia.(AU)

Dopaminergic agonists are used to induce estrus in female dogs as they act in the synthesis and release of prolactin. The objective of this study was to evaluate the effect of pyridoxine as an inducer of estrus by acting on dopaminergic neurotransmission. A total of 40 female dogs in anestrous were divided into four experimental groups treated with 10mg/kg/day (G1) and 50mg/kg/day (G2) of pyridoxine hydrochloride, 5µg/kg/day (G3) of cabergoline and control group/placebo (G4) for up to 20 days. Vaginal cytologies were performed every 24h for follow-up of the estrous cycle and hormonal analyzes (FSH, LH and PRL) on day zero and 120 hours after the start of treatment. The female dogs from G3 (100%) showed proestrus after 12 days of treatment, less time than the other groups (P< 0.05). Only one female from G1 and one from G2 were pregnant against eight from G3 and none from G4 (P< 0.05). Plasma concentrations of prolactin were reduced by treatment in females from G2 and G3 (P< 0.05). The other hormonal evaluations were not influenced by the treatment (P> 0.05). Pyridoxine chloridrate was inefficient to induce estrus in female dogs but was able to suppress prolactin when used at a dose of 50mg/kg/day.(AU)

Body self-image disturbances in women with prolactinoma

Objective: To evaluate body dissatisfaction and distorted body self-image in women with prolactinoma. Methods: Body dissatisfaction and distorted body self-image were evaluated in 80 women with prolactinoma. All patients were in menacme, 34% had normal body mass index (BMI), and 66% were overweight. Most patients (56.2%) had normal prolactin (PRL) levels and no hyperprolactinemia symptoms (52.5%). The Body Shape Questionnaire (BSQ) was used to assess the patients' dissatisfaction with and concern about their physical form, and the Stunkard Figure Rating Scale (FRS) was used to assess body dissatisfaction and distorted body self-image. The patients were divided according to PRL level (normal vs. elevated) and the presence or absence of prolactinoma symptoms. Results: The normal and elevated PRL groups had similar incidences of body dissatisfaction and distorted body self-image. However, symptomatic patients reported a higher incidence of dissatisfaction than asymptomatic patients. Distorted body self-image was less common among symptomatic patients. Conclusion: Symptomatic patients showed higher body dissatisfaction, but lower body self-image distortion. The presence of symptoms may have been responsible for increased body awareness. The perception of body shape could have triggered feelings of dissatisfaction compared to an ideal lean body. Therefore, a distorted body self-image might not necessarily result in body dissatisfaction in women with prolactinomas.

Resolution of headache after reduction of prolactin levels in hyperprolactinemic patients / Resolução de cefaleia após redução dos níveis de prolactina em pacientes com hiperprolactinemia

Abstract Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.

Resumo Os adenomas secretores de prolactina (PRL) estão associados à alta incidência de cefaleia. O papel da hiperprolactinemia no contexto da dor de cabeça não está claro, nem o efeito da redução dos níveis da PRL na cefaleia. Métodos: O presente estudo longitudinal avaliou pacientes hiperprolactinêmicos (69), quanto à presença e às características da cefaleia antes e após o tratamento da hiperprolactinemia. Resultados: Cefaleia foi relatada por 45 (65,2%) pacientes, independente da etiologia da hiperprolactinemia. O fenótipo de enxaqueca foi mais prevalente (66,6%). Os medicamentos usados ​​no tratamento da cefaleia não foram alterados durante o estudo. A primeira linha de tratamento da hiperprolactinemia foram os agonistas dopaminérgicos. Na última reavaliação, o nível de PRL sob tratamento estava dentro da faixa de referência em 54,7% dos casos, observando-se resolução completa ou parcial da cefaleia em 75% dos casos. A mediana de PRL neste momento em pacientes com resolução completa da cefaleia foi de 17 ng/mL, nos que relataram recuperação parcial foi de 21 ng/mL, e naqueles em que a cefaleia não se alterou foi de 66 ng/mL, com uma diferença significativa entre o grupo com resolução completa da cefaleia versus o grupo com cefaleia inalterada (p=0,022). Nos casos com resolução completa da cefaleia, a queda mediana nos níveis de PRL foi de 89% e nos casos com resolução parcial de cefaleia de 86%, ambos significativamente diferentes (p<0,001) da queda nos casos com cefaleia inalterada. Conclusão: Os dados permitem concluir que, nesta série, na maioria dos casos, a redução do nível de PRL foi seguida pela cessação ou alívio da dor.

Adenoma hipofisario ectópico del seno esfenoidal persistente tras cirugía manejado con tratamiento conservador / Ectopic pituitary adenoma in the sphenoid sinus persistent after surgery managed with conservative treatment

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.

Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.

Quiste de bolsa de Rathke e hiperprolactinemia, una causa infrecuente de amenorrea primaria / Rathke cleft cysts and hyperprolactinemia, an uncommon cause of primary amenorrhea

El quiste de la bolsa de Rathke es una lesión epitelial benigna de la región selar, formada a partir de remanentes embrionarios. La mayoría de los casos son asintomáticos, aunque pudiera presentarse con cefalea, disfunción hipofisaria y trastornos visuales, muy infrecuentemente como apoplejía hipofisaria. Se presenta el caso de una paciente que, habiendo presentado amenorrea primaria, se le realiza el diagnóstico de quiste de la bolsa de Rathke con hiperprolactinemia, logrando menarquia luego del tratamiento con cabergolina.

Rathke's cyst is a benign epithelial lesion of the sellar region, formed from embryonic remnants. Most cases are asymptomatic although it could present with headache, pituitary dysfunction and visual disorders, very infrequently as pituitary stroke. We present the case of a patient who, having presented primary amenorrhea, is diagnosed with Rathke's cyst with hyperprolactinemia, achieving menarche after treatment with cabergoline.

Hiperprolactinemia, amenorrea secundaria y trastornos del ciclo menstrual / Hyperprolactinemia, secondary amenhorrea and menstrual cycle disorders

La hiperprolactinemia es la enfermedad endocrina más frecuente del sistema hipotálamohipófisis-ovario; es una entidad de mucho interés por sus manifestaciones clínicas y diversidad de ellas principalmente los trastornos del ciclo e infertilidad secundaria, como por sus efectos a largo plazo. Es necesario que estas pacientes tengan una evaluación sistemática basada en una historia clínica dirigida y complementada con exámenes de laboratorio, en donde la determinación de PRL sea un requisito indispensable. Es importante descartar causas secundarias como el uso de medicamentos, adicciones, estados de estrés y principalmente tumores funcionantes de hipófisis. Se debe evaluar la historia clínica y complementarla con exámenes de laboratorio para tomar una decisión adecuada de tratamiento.

Hyperprolactinemia is the most frequent endocrine disease of the hypothalamus pituitary ovary system, is an entity of great interest for its clinical diversity of manifestations, mainly menstrual cycle disorders and secondary infertility. It is necessary that these patients have a systematic evaluation based on a guided clinical history and supplemented with laboratory tests, where the determination of PRL is an indispensable requirement. It is important to rule out secondary causes such as the use of medications, stress and mainly functioning tumors of the pituitary gland. The clinical history should be evaluated, complemented with laboratory tests to make an adequate decision on their treatment.

Importancia de la anamnesis exhaustiva ante una ginecomastia unilateral inexplicada en un niño / Importance of the exhaustive anamnesis to an unexplained unilateral gynecomastia in a child

La ginecomastia es el crecimiento de la mama por un desequilibrio hormonal entre estrógenos y andrógenos. Un crecimiento importante y unilateral requiere descartar patologías subyacentes. Una causa poco frecuente es la traumática, que provoca aumento de tamaño por estimulación repetida. Se presenta el caso de un niño de 6 años con ginecomastia unilateral. Se destaca como único hallazgo en las pruebas complementarias hiperprolactinemia. Rehistoriando, se detecta una continua autoestimulación mamaria manual y oral a través de mordiscos de meses de evolución. Tras el cese del estímulo, se observa la involución de la mama y la normalización de los niveles de prolactina séricos.

Gynecomastia consists of breast enlargement due to a hormonal imbalance between estrogens and androgens. Unilateral and important breast growth requires ruling underlying pathologic disorders out. Mechanical cause is uncommon, causing enlargement by repeated stimulation. We report a 6-year-old boy with unilateral gynecomastia. Hyperprolactinemia is the only abnormal finding at laboratory tests. After repeated inquiries, a continuous breast selfstimulation is detected. Its relation with gynecomastia is verified because prolactin normalizes and breast regressed in further revisions, after stopping stimulus.

Características clínicas y manejo de la macroprolactinemia como causa de hiperprolactinemia / Clinical characteristics and management of macroprolactinemia as cause of hyperprolactinemia

La macroprolactinemia se define como la presencia de cantidades elevadas de esta isoforma de la prolactina en suero, en conjunto con concentraciones normales de prolactina monomérica. Se trata de una entidad bastante común, considerada entre las tres primeras causas de hiperprolactinemia. Su origen parece responder a mecanismos autoinmunes y el seguimiento de los pacientes afectos durante periodos de 10 años ha demostrado que es una condición crónica. La prueba de elección para el diagnóstico es la cromatografía líquida en columna de gel, pero este es un método costoso que generalmente es suplido por la prueba de precipitación con polietinglicol. Por mucho tiempo ha prevalecido el concepto de que estos pacientes son esencialmente asintomáticos, pero reportes recientes señalan la presencia de síntomas de hiperprolactinemia como parte significativa del cuadro, aunque la literatura actual muestra criterios divergentes. En estos pacientes la realización de resonancia magnética nuclear hipofisaria parece ser un procedimiento innecesario, basado en la escasa frecuencia de resultados positivos. El tratamiento farmacológico con agonistas dopaminérgicos muestran respuestas contradictorias en cuanto a la desaparición de los síntomas y la normalización de los niveles de prolactina. Por tanto, la inexistencia de un consenso en la literatura científica en lo referente a las manifestaciones clínicas y el manejo, obliga a una conveniente valoración individual de cada caso(AU)

Macroprolactinemia is defined as the presence of high quantities of this prolactin isoform in serum, together with normal concentrations of monomeric prolactin. It is a common entity, considered among the three first causes of hyperprolactinaemia. The origin seems to respond to autoimmune mechanisms and the affected patients follow-up during ten years periods has shown that it is a chronic condition. The standard gold test to the diagnostic is gel-filtration chromatography, but it is an expensive method that is generally supplied by the polyethylene glycol precipitation test. During a long time, the concept that these patients are essentially asymptomatic has prevailed, but recent reports stamps the presence of hyperprolactinemia symptoms as a significant part of the entity, although current literature shows divergent criteria. In these patients, performing pituitary magnetic resonance seems to be an unnecessary procedure, based on the rare frequency of positive results. Pharmacological treatment with dopamine agonists shows contradictory responses with regard to symptoms disappearance and prolactin levels normalization. Therefore, the lack of consensus in the scientific literature with regard to the clinical manifestations and the management, requires a convenient individual assessment of each case(AU)

Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

Low estrogen doses normalize testosterone and estradiol levels to the female range in transgender women

OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate in transgender women. METHODS: The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject. RESULTS: Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. CONCLUSION: In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.

Mecanismos moleculares mediadores da citoproteção de células beta pancreáticas induzidos por prolactina / Role of HSPB1 in PRL-induced cytoprotective effects on beta cells

A manutenção da célula de ilhotas in vitro aparece como uma estratégia atraente para aumentar o resultado do transplante de ilhotas pancreáticas. Entretanto, o destino das ilhotas em cultura é determinado pelo equilíbrio entre mediadores pró e antiapoptóticos. Nós mostramos anteriormente que os níveis de HSPB1 são aumentados pela prolactina (PRL) tanto nas células beta pancreáticas humanas quanto nas células de insulinoma murino MIN6. Além disso, mostramos que os efeitos pró- sobrevivência induzidos pela prolactina nas células beta pancreáticas são mediados pela HSPB1. Uma vez que o papel da HSPB1 nas células beta não foi estudado diretamente, procuramos explorar os mecanismos moleculares pelos quais a HSPB1 medeia a citoproteção da célula beta induzida pela PRL. Para isso, células MIN6 derivadas de um insulinoma de camundongo e cultura primária de ilhotas pancreáticas murinas (I), silenciadas ou superexpressando HSPB1 foram submetidas à privação de soro e então pré- tratadas na presença ou na ausência de PRL (300 ng / mL) e expostos a ou citocinas (IL-1ß (0,8 ng / mL), IFN-γ (4 ng / mL) e TNF-α (8 ng / mL) por 16 ou 24 h. Após esses períodos de tempo foi avaliada a viabilidade celular. De fato, as células silenciadas para HSPB1 tiveram maiores porcentagens de morte celular em comparação aos controles. No entanto, a superexpressão de HSPB1 sozinha imita os efeitos citoprotectores da Prolactina em ambas as células MIN6 e nas culturas primárias das ilhotas. Estes resultados mostram o papel fundamental da HSPB1 no efeito citoprotetor inibindo a apoptose inducida pelo tratamento com citocinas pró-inflamatórias. Além disso, os lisados de células Min6 tratadas com citocinas na presença ou na ausência de PRL durante 6 h foram sujeitos a imunoprecipitação de HSPB1. Proteínas coimmunoprecipitadas separadaspor SDS-PAGE e posteriormente identificadas por nano-HPLC acoplado à espectrometria de massas. Células pré-tratadas com PRL apresentaram um enriquecimento de proteínas que coprescipitaram com HSPB1 relacionadas em processos de resistência ao estresse oxidativo, degradação proteica e metabolismo de carboidratos. Células MIN6, silenciadas ou superexpressando HSPB1 foram expostas á menadiona e peróxido de hidrogênio e parâmetros oxidativos foram analisados. O silenciamento de HSPB1 promoveu células mais sensíveis ao estresse oxidativo e levou a uma redução da capacidade antioxidante, enquanto que prolactina induziu citoproteção mediada por HSPB1 contra o estresse oxidativo. A superexpressão de HSPB1, no entanto, levou a efeitos opostos. O tratamento com PRL, o silenciamento ou superexpressão de HSPB1 não mudou a expressão de enzimas antioxidantes, mas os níveis proteicos de HSPB1 estão relacionados com a modulação da razão GSH/GSSG e a atividade de G6PD. Dado de estudos recentes reportam que o perfil respiratório das ilhotas prévias ao transplante pode predizer seu desempenho e que não se sabe nada sobre se a PRL poderia modular a função mitocondrial nas células beta; no presente projeto foi investigado se o tratamento hormonal poderia aumentar a eficiência mitocondrial das células beta. Observamos que o tratamento com citocinas pró-inflamatórias produziu uma diminuição na eficiência do consumo de oxigênio mitocondrial estar relacionado à síntese de ATP. Esses resultados foram significativamente revertidos a valores similares ao obtidos nas células submetidas Às condições de máxima viabilidade após o tratamento com PRL. Além disso, os resultados mostraram que os níveis elevados de HSPB1 medeiam este efeito, uma vez que a falta desta proteína anulou significativamente a recuperação da função mitocondrial induzida pelo tratamento hormonal. Visto que as taxas de síntese de ATP mitocondrial são as responsáveis pela elevação na sua concentração intracelular e que esse evento está diretamente relacionado com a secreção de insulina nas células beta, analisamos se diferentes níveis proteicos de HSPB1 poderia modificar a função secretora de células beta. Para isso foram calculados os índices de estímulo da secreção de insulina em resposta ao aumento da concentraçãode glicose no meio de cultura tanto em células parentais MIN6 como em culturas primárias de ilhotas pancreáticas murinas que foram submetidas ou não ao silenciamento ou superexpressão de HSPB1. Nossos resultados mostraram que nem a presença de citocinas, Prolactina, ou a ausência ou superexpressão de HSPB1 nas culturas celulares analisadas apresentaram diferença significativa em relação aos índices de estímulo da secreção e conteúdo de insulina. Esses resultados sugerem que nem a falta, nem a superexpressão de HSPB1 poderia alterar a função de célula beta. Nós mostramos a relevância da HSPB1 em ambos os efeitos pró- sobrevivência da PRL contra a morte da célula beta induzida tanto por citocinas quanto por indução de estresse oxidativo. Este último efeito poderia também estar relacionado com a participação da HSPB1 na recuperação da função mitocondrial observada após o tratamento hormonal corroborando assim parte dos resultados obtidos nos experimentos de immunoprecipitação. Finalmente, nossos resultados destacam a importância de mais estudos visando um entendimento mais profundo das funções da HSPB1 nas células beta, uma vez que elas poderiam levar à mitigação da morte da célula beta através da regulação positiva de uma via de proteção endógena, que não é dependente da modulação do sistema imunológico

The success of islet transplantation has improved lately. Unfortunately, it is still compromised by cell loss. Maintaining islet cell in vitro appears as an attractive strategy to increase the outcome of pancreatic islet transplantation. However, islet fate in culture is determined by the balance between pro- and anti- apoptotic mediators. We have previously shown that Heat Shock Protein B1 (HSPB1) levels are increased by prolactin (PRL) on both human pancreatic beta cells and MIN6 murine insulinoma cells. Furthermore, we have demonstrated the prolactin-induced pro-survival effects on pancreatic beta-cells are mediated by HSPB1. Since HSPB1 role in beta cells has not been directly studied, we set out to explore the molecular mechanisms by which HSPB1 mediates PRL-induced beta cell cytoprotection. For this purpose, MIN6 insulinoma mouse cells and primary culture of murine pancreatic islets (I) wild type, HSPB1 silenced or overexpressing the chaperone were subjected to serum starvation and then pre-treated in the presence or in the absence of PRL (300 ng/mL) and exposed to or cytokines (IL-1ß (0,8 ng/mL), IFN-γ (4 ng/mL) and TNF-α (8 ng/mL)) for 16 or 24h. Then, we analyse cell viability. HSPB1silenced cells presented higher percentages of cell death compared to controls. However, the overexpression of HSPB1, independently of hormonal treatment, was able mimic the cytoprotective effects of Prolactin. These results point at the key role of HSPB1 in the cytoprotective effect against proinflammatory cytokines-induced beta cell death. In addition, lysates from Min6 cells incubated for 6 hours in the presence of a cocktail of cytokines and/or PRL were subjected to HSPB1 immunoprecipitation. Co-precipitated proteins were identified by SDS-PAGE coupled to mass spectrometry. We found an enrichment of proteins relatedto signaling pathways involved in a response against oxidative and endoplasmic reticulum stress induction. Moreover, we also identified antiapoptotic effects and carbohydrate metabolism related proteins. Indeed, HSPB1 knockdown rendered cells more sensitive to oxidative stress and led to a reduced antioxidant capacity, while prolactin induced an HSPB1- mediated cytoprotection against ROS induced beta-cell apoptosis. One again, HSPB1 overexpression mimic PRL- induced cytoprotection. While hormonal treatment, HSPB1 silencing or overexpression did not change the expression of antioxidant enzymes; this conditions influenced reduced glutathione cell content and G6DP activity. Since recent studies have pointed that islets respiratory profile prior to transplantation may predict their performance; we also investigated whether PRL treatment could increase beta-cell mitochondrial efficiency. We observed a cytokine-induced increase of mitochondrial oxygen consumption rate not related to ATP synthesis, which was significantly decreased upon PRL treatment. HSPB1 was a key mediator of this effect since the lack of this protein significantly abrogated PRL-induced mitochondrial function recovery. The secretory function was then analysed in wild type MIN6 cells as well as in primary cultures of pancreatic islets either HSPB1 silenced or overexpressing the chaperone. Cells were subjected to serum starvation and then pre-treated in the presence or in the absence of PRL and exposed to cytokines for 16 or 24h. We didn´t found significant differences in both glucose induced-insulin secretion and insulin content between the hormonal treatment, HSPB1 silencing or overexpression. These results suggest that neither lack, nor overexpression of HSPB1 could alter beta cell function. Altogether our results have shown the importance of HSPB1 on PRL prosurvival effects as well as on maintenance of mitochondrial efficiency against both cytokine treatment and oxidative-stress-induced beta cell damage. These results are in accordance with the PRL-induced enrichment of HSPB1 interacting proteins displaying functions related to protein degradation, oxidative stress protection or mitochondrial carbohydrate metabolism.Finally, our results outline the importance of further studies aiming at a deeper understanding of HSPB1 functions on beta cells, since they could lead to the mitigation of beta cell death through the up-regulation of an endogenous protective pathway, which is not dependent on the modulation of the immune system

Avaliação do papel de HSPB1 na modulação da autofagia induzida por PRL em células-beta / Unveiling the role of HSPB1 in PRL-induced autophagy modulation in beta-cells

O diabetes mellitus tipo 1 é uma doença metabólica, caracterizada pela desregulação glicêmica, que ocorre devido a um ataque autoimune. A insulinoterapia é o tratamento clássico para o DM1. Contudo, alguns pacientes que apresentam essa doença não respondem de forma eficiente a este tratamento e apresentam episódios frequentes de hipoglicemia severa e despercebida (pacientes hiperlábeis). Essas complicações comprometem de forma significativa a qualidade de vida dessas pessoas. O transplante de ilhotas é uma importante alternativa para o tratamento de pacientes hiperlábeis com DM1. No entanto, essa terapia apresenta restrições como a necessidade de mais de um doador por transplante e significativa morte das ilhotas devido ao estresse provocado pelo procedimento de isolamento, além da morte promovida pelo sistema imune do paciente nos primeiros momentos pós-transplante. A autofagia é um mecanismo de reciclagem de componentes citoplasmáticos que é fundamental para a homeostase celular. Em condições de estresse, este mecanismo é ativado acima do seu nível basal, promovendo a degradação de agregados proteicos e organelas defeituosas, evitando assim, danos celulares que comprometam a viabilidade da célula. Trabalhos realizados por nosso grupo têm mostrado a citoproteção que PRL promove em células-beta, reduzindo a apoptose induzida por citocinas pró-inflamatórias. Também demonstramos o papel essencial de HSPB1 na inibição de apoptose induzida por PRL após o tratamento com citocinas. Além disso, resultados recentes de nosso laboratório mostraram um aumento nos níveis de autofagia em células-beta após sua exposição a citocinas, bem como uma restauração a níveis normais na presença de PRL. Visando um melhor entendimento do papel da PRL na modulação da autofagia em células-beta, o objetivo desse projeto foi estudar se HSPB1 também é essencial no mecanismo de regulação da autofagia induzido por PRL.Para tal, fizemos experimentos em modelos de células-beta MIN6, MIN6 silenciadas para HSPB1 (MIN6-shHSPB1) e MIN6 com sequencia short hairpin aleatória (MIN6- SsC), medindo a morte celular através de ensaios de viabilidade, e ensaios de western blot para avaliar os níveis de marcadores de autofagia e fluxo autofágico (degradação de autofagossomos), tratando as células com citocinas, prolactina e indutores ou inibidores de autofagia. Os resultados mostraram que a modulação da autofagia ocasionada pela prolactina em células-beta se dá, em parte, através de HSPB1. O tratamento com prolactina foi capaz de inibir a morte celular induzida por citocinas, mesmo na presença de cloroquina, um bloqueador de autofagia, o que nos levou a concluir que a autofagia não é uma via envolvida na citoproteção de células beta induzida por PRL. Os resultados gerados nesse estudo contribuíram para uma melhor compreensão dos eventos moleculares induzidos por PRL em células-beta, e poderão permitir a inferência de novas abordagens que melhorem a citoproteção, cultura e transplante dessas células em pacientes com diabetes tipo 1

Type 1 diabetes mellitus is a metabolic disease characterized by glycemic dysregulation, which occurs due to an autoimmune destruction of beta-cells. Insulin therapy is the gold standard treatment for DM1. However, some DM1 patients do not respond efficiently to this treatment and suffer frequent episodes of severe hypoglycemia unawareness. Since this complication jeopardizes the quality of life of these people, Islet transplantation is a therapeutic alternative indicated to treat these patients. However, besides the lack of enough organ donors, the loss of beta cells during both the isolation as well as the infusion of islets into the recipient induce a great estresse and thus a significant cell death is one of the drawbacks of this procedure. Autophagy is a mechanism of recycling cytoplasmic components and is essential for cellular homeostasis. Under estresse conditions, this mechanism is activated above basal levels, promoting the degradation of protein aggregates and defective organelles, thus avoiding cell damage that could compromise cell viability. Studies carried out by our group have shown not only that PRL promotes cytoprotection in beta-cells, reducing pro-inflammatory cytokines-induced apoptosis, but also that HSPB1 plays an essential role in this inhibition of apoptosis mediated by PRL after treatment with cytokines. Moreover, recent results from our laboratory showed an increase in autophagy levels in beta-cells after exposure to cytokines, as well as a restauration to normal levels in the presence of PRL. In order to better understand the role of PRL in the modulation of autophagy in these cells, the aim of this project is to study whether HSPB1 is also essential in the mechanism of autophagy regulation induced by PRL. Using MIN6 beta cell models where HSPB1 was silenced (MIN6-shHSPB1) or not (MIN6-SsC), we studied cell death by viability assays. Moreover, western blot assays were performed in order to assess levels of autophagy and autophagic flux markers in the cells.Our results showed that HSPB1 in one of the mediators of PRL-induced modulation of autophagy. Nevertheless, since hormonal treatment was still able to inhibit cytokinesinduced cell death even in the presence of chloroquin, an autophagy blocker, we conclude that autophagy is not a signaling pathway involved in PRl-induced beta-cell cytoprotection. Altogether, the results shown in this study may help to increase the knowledge of the molecular events induced by PRL in beta-cells, and may allow to infer new approaches to improve cytoprotection, culture and transplantation of these cells into type 1 diabetic patients

Grado de conocimiento sobre lactancia materna en embarazadas primigestas / Degree of knowledge about breastfeeding in primigravida pregnant women

Objetivo: determinar el grado de conocimiento sobre lactancia materna en embarazadas primigestas. Métodos: se realizó una investigación explicativa, prospectiva y transversal en primigestas atendidas en la consulta prenatal y que fueron sometidas a una encuesta en la cual se recolectaron las características generales (edad, estado civil y tipo de trabajo o profesión) y se evaluó el conocimiento sobre la lactancia materna a través del análisis de diferentes aspectos de esta práctica. Resultados: se seleccionaron 80 embarazadas con edad promedio de 19,7 +/- 5,1 años, la mayoría estaban casadas (55,3%) y eran amas de casa (48,7%). Mostraron alto conocimiento sobre contraindicaciones (78,8%) y posiciones correctas de lactancia (73,8%), y bajos en cuanto a extracción manual y almacenamiento de la leche materna (12,5%). La asociación entre la edad y las ventajas de lactancia materna exclusiva se encontró que era negativa, débil y significativa (r = -0,227; p < 0,05). También se observó asociación significativa, negativa y débil entre el estado civil y las ventajas de la lactancia materna exclusiva (r = -0,245), y positiva y débil con las posiciones correctas de lactancia (r = 0,290; p < 0,05). Conclusión: los resultados de la investigación demuestran que las embarazadas primigestas tienen un alto grado de conocimiento sobre ciertos aspectos de la lactancia materna, pero se deben hacer esfuerzos por mejorar la comprensión de otros aspectos importantes

Objective: To determine knowledge´s degree about breastfeeding in primigravid pregnant women. Methods: An explicative, prospective and transversal research was done in primigravid pregnant women who attended to Antenatal consult and were submitted to a questionnaire in which general characteristics (age, marital status and type of job or profession) were recorded and knowledge about breastfeeding was evaluated through analysis of different aspects of this practice. Results: Eighty pregnant women were selected with a mean age of 19.7 +/- 5.1 years and most of them were married (55.3%) and were housewife (48.7%). They showed high knowledge about contraindications (78.8%) and right positions for breastfeeding (73.8%) and lower knowledge about manual extraction and storage of maternal milk (12.5%). Assotiation between age and advantages of exclusive breastfeeding was found negative, weak and significant (r = -0.227; p < 0.05). There was also found a significant, negative and weak association between marital status and advantages of exclusive breastfeeding (r = -0.245; p < 0.05) and positive and weak with right breastfeeding positions (r = 0.290; p < 0.05). Conclusions: The results of research shows that primigravid pregnant women have a high knowledge´s degree about certain aspects of breastfeeding, but efforts should be done to improve understanding of other aspects related to this practice