Asunto(s)
Hiperprolactinemia , Femenino , Humanos , Hiperprolactinemia/terapia , Hiperprolactinemia/etiologíaRESUMEN
Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.
Asunto(s)
Adenoma , Hiperprolactinemia , Neoplasias Hipofisarias , Prolactinoma , Femenino , Masculino , Humanos , Prolactinoma/terapia , Prolactinoma/tratamiento farmacológico , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Calidad de Vida , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/terapia , Neoplasias Hipofisarias/complicaciones , Adenoma/diagnóstico , Adenoma/etiología , Adenoma/terapiaRESUMEN
AIM: Prolactinoma is a pituitary adenoma that secretes prolactin. Approximately 40% of all pituitary adenomas are prolactinomas. According to size, they are divided into micro, macro and giant prolactinomas. In women, prolactinomas cause irregularities of the menstrual cycle such as amenorrhea, galactorrhea, weight gain, in both sexes they cause sterility, hypogonadism, decreased libido and depression. In macroadenomas, symptoms due to the compression of the surrounding structures are also manifested, such as headache, vomiting, lower chiasmatic syndrome and ophthalmoplegia. Loss of the visual field due to compression of the optic chiasm is caused by a tumor larger than 10-15 mm with suprasellar spreading, which breaks through the diaphragma sellae. Giant prolactinomas are larger than 40 mm and make up 1-5% of all prolactinomas. CASE REPORT: In this article I present the case of a 38-year-old woman from Ukraine with advanced chiasmatic syndrome caused by a giant prolactinoma. The tumor is infiltrating the left cavernous sinus, causing left-sided amaurosis and right-sided temporal hemianopsia. CONCLUSION: Inferior chiasmatic syndrome is characterized by bitemporal hemianopsia, a deterioration of visual acuity, bilateral bow-tie descendent atrophy of the optic nerve disc, and hemianopic rigidity of the pupils. Macroprolactinomas occur more frequently in men than in women. The diagnosis is often delayed, probably because the symptoms of hyperprolactinemia are less obvious in men, while women tend to present earlier due to menstrual cycle irregularities. Prolactinomas usually have a good prognosis. Effective medical treatment with dopamine agonists is available. Knowledge of the prolactinoma symptoms could help the diagnosis of compressive lesions of the optic chiasm.
Asunto(s)
Hiperprolactinemia , Neoplasias Hipofisarias , Prolactinoma , Masculino , Embarazo , Femenino , Humanos , Adulto , Prolactinoma/complicaciones , Prolactinoma/diagnóstico , Prolactinoma/patología , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/terapia , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Agonistas de Dopamina , ProlactinaRESUMEN
BACKGROUND: Macroprolactinemia is a common cause of hyperprolactinemia (HPRL), with an average worldwide incidence of 18.9 %. This study aimed to explore the feasibility of ultrafiltration (UF) and polyethylene glycol (PEG) precipitation for macroprolactin screening, as well as the incidence and clinical characteristics of Chinese patients with macroprolactinemia. METHODS: In this study, 94 patients with HPRL and 206 healthy individuals were included. Gel filtration chromatography (GFC), PEG precipitation, and UF were used to screen for macroprolactin, and chemiluminescence was used to determine the prolactin levels. RESULTS: The detected incidence of macroprolactinemia in the patients with HPRL was 7.45% (7/94, GFC) and 5.32% (5/94, PEG precipitation). Patients with macroprolactinemia usually present with atypical clinical symptoms, moderately increased prolactin levels, and negative or microadenoma-positive pituitary images. In addition, the recovery of monomeric prolactin by PEG precipitation and UF was significantly correlated to that of GFC (r PEG = 0.493, P < 0.001; r UF = 0.226, P = 0.014), with a higher correlation coefficient between PEG precipitation and GFC. Furthermore, PEG precipitation had a smaller variation (95% confidence interval [CI]: -35.77% to 18.34%) than UF in monomeric prolactin recovery and substantial diagnostic consistency with GFC (Cohen's kappa coefficient = 0.647). The proportion of monomeric prolactin in patients with HPRL did not change significantly between the two visits within one year (P > 0.05). CONCLUSION: The incidence of macroprolactinemia in Chinese patients with HPRL is low in the present study. Based on our analysis, we recommend that only patients who are clinically suspected of having macroprolactinemia should be screened using PEG precipitation.
Asunto(s)
Hiperprolactinemia , Prolactina , Humanos , Pueblos del Este de Asia , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/terapia , Polietilenglicoles , Prolactina/sangre , UltrafiltraciónRESUMEN
Hyperprolactinemia should actively be investigated as a potential reason of infertility. Underlying prolactinomas may successfully be treated with dopamine agonists. However, patients with micro- or well-circumscribed macroprolactinomas (Knosp 0 or 1) should also be informed about transsphenoidal surgery offering cure in contrast to long-lasting medical therapy. Management prior to and during pregnancy is usually unremarkable but may pose some specific challenges.
Asunto(s)
Hiperprolactinemia , Neoplasias Hipofisarias , Prolactinoma , Embarazo , Femenino , Humanos , Prolactinoma/cirugía , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , Agonistas de Dopamina/uso terapéutico , Hiperprolactinemia/terapia , ProlactinaRESUMEN
Galactorrhea is the production of breast milk that is not the result of physiologic lactation. Milky nipple discharge within one year of pregnancy and the cessation of breastfeeding is usually physiologic. Galactorrhea is more often the result of hyperprolactinemia caused by medication use or pituitary microadenomas, and less often hypothyroidism, chronic renal failure, cirrhosis, pituitary macroadenomas, hypothalamic lesions, or unidentifiable causes. A pregnancy test should be obtained for premenopausal women who present with galactorrhea. In addition to prolactin and thyroid-stimulating hormone levels, renal function should also be assessed. Medications contributing to hyperprolactinemia should be discontinued if possible. Treatment of galactorrhea is not needed if prolactin and thyroid-stimulating hormone levels are normal and the discharge is not troublesome to the patient. Magnetic resonance imaging of the pituitary gland should be performed if the cause of hyperprolactinemia is unclear after a medication review and laboratory evaluation. Cabergoline is the preferred medication for treatment of hyperprolactinemia. Transsphenoidal surgery may be necessary if prolactin levels do not improve and symptoms persist despite high doses of cabergoline and in patients who cannot tolerate dopamine agonist therapy.
Asunto(s)
Galactorrea , Hiperprolactinemia , Neoplasias Hipofisarias , Embarazo , Humanos , Femenino , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Prolactina , Cabergolina/uso terapéutico , Galactorrea/diagnóstico , Galactorrea/etiología , Galactorrea/terapia , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , TirotropinaRESUMEN
BACKGROUND AND PURPOSE: To analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. PATIENTS AND METHODS: A retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. RESULTS: In 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. CONCLUSION: Hyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.
Asunto(s)
Galactorrea , Hiperprolactinemia , Masculino , Embarazo , Humanos , Femenino , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Prolactina , Estudios Retrospectivos , Atención Primaria de SaludRESUMEN
Prolactinomas are the most frequent pituitary adenomas. Prolactinoma may occur in different clinical settings and always require an individually tailored approach. This is the reason why a panel of Italian neuroendocrine experts was charged with the task to provide indications for the diagnostic and therapeutic approaches that can be easily applied in different contexts. The document provides 15 recommendations for diagnosis and 54 recommendations for treatment, issued according to the GRADE system. The level of agreement among panel members was formally evaluated by RAND-UCLA methodology. In the last century, prolactinomas represented the paradigm of pituitary tumors for which the development of highly effective drugs obtained the best results, allowing to avoid neurosurgery in most cases. The impressive improvement of neurosurgical endoscopic techniques allows a far better definition of the tumoral tissue during surgery and the remission of endocrine symptoms in many patients with pituitary tumors. Consequently, this refinement of neurosurgery is changing the therapeutic strategy in prolactinomas, allowing the definitive cure of some patients with permanent discontinuation of medical therapy.
Asunto(s)
Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/terapia , Prolactinoma/diagnóstico , Prolactinoma/terapia , Niño , Consenso , Dopaminérgicos/efectos adversos , Dopaminérgicos/uso terapéutico , Endocrinología , Medicina Basada en la Evidencia , Femenino , Humanos , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Italia , Masculino , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Hipofisarias/etiología , Embarazo , Prolactinoma/etiología , RadioterapiaRESUMEN
Hyperprolactinemia is a condition of elevated serum prolactin, which usually occurs in women as compared to men. Most patients present to primary care clinics with a history of galactorrhoea, oligomenorrhea, amenorrhoea or infertility. Literature search reveals that there were few idiopathic causes of hyperprolactinemia, which resolved by itself without specific pharmacological or surgical treatment. This case is of a 39-year-old woman presented with amenorrhea for four months after Implanon removal and concomitantly noted to have galactorrhoea for four years without any medical attention. The condition persisted after cessation of breastfeeding. After undergoing several investigations including imaging studies, the underlying cause of hyperprolactinemia was noted to be idiopathic. Due to the unclear cause of its aetiology, this case caused various challenges to the primary care. Exhaustive physiological and pathological causes of hyperprolactinemia have been ruled out. Nevertheless, with adequate treatment, she gained her normal menstrual and resolved galactorrhoea symptoms.
Asunto(s)
Galactorrea , Hiperprolactinemia , Adulto , Amenorrea/etiología , Amenorrea/terapia , Femenino , Galactorrea/etiología , Galactorrea/terapia , Humanos , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Atención Primaria de SaludRESUMEN
BACKGROUND: Rathke's cleft cysts are benign cystic lesions of the sellar region, which may cause headache, pituitary deficiencies and visual disturbances from mass effect. Their management is not standardized yet. This study is about establishing a consensus for medical care of RCC. MATERIAL AND METHODS: We performed a retrospective observational study of all patients that were diagnosed or followed for RCC between 2008 and 2018 (11 years), in the neurosurgical and the adult endocrine departments of our institution. The study's average time length of follow-up is 72.9 months (from 2 to 385 months). RESULTS: The 57 included patients were divided into 2 groups: group A, which included 39 patients that were conservatively managed and group B, which included 18 surgically treated patients. Group A showed either an improvement or a spontaneous resolution of headaches in 56.1% of the cases (P<0.01); a resolution of hyperprolactinemia in 70% of the cases (P=0.21); and of hypogonadism, ACTH deficiency, growth hormone deficiency in 100% of the cases. There was no spontaneous improvement of visual disturbances (P<0.01) or diabetes insipidus (P=0.29) during follow-up. Regarding group B, surgery allowed improvement or complete resolution of headaches in 60% of the cases; visual troubles in 100% of the cases (P<0.01); and hyperprolactinemia in 100% of the cases. Pituitary deficiencies were not improved by surgery. CONCLUSIONS: This study offers guidance in decision-making regarding the management of RCC patients. Surgery is particularly suitable for treating visual disturbances caused by RCC. Regular follow-up is more appropriate than surgery concerning headaches, hyperprolactinemia, endocrine disruptions and diabetes insipidus.
Asunto(s)
Quistes del Sistema Nervioso Central/diagnóstico por imagen , Quistes del Sistema Nervioso Central/terapia , Tratamiento Conservador/métodos , Procedimientos Neuroquirúrgicos/métodos , Adolescente , Insuficiencia Suprarrenal/diagnóstico por imagen , Insuficiencia Suprarrenal/cirugía , Insuficiencia Suprarrenal/terapia , Adulto , Anciano , Quistes del Sistema Nervioso Central/cirugía , Estudios de Cohortes , Diabetes Insípida/diagnóstico por imagen , Diabetes Insípida/cirugía , Diabetes Insípida/terapia , Femenino , Estudios de Seguimiento , Cefalea/diagnóstico por imagen , Cefalea/cirugía , Cefalea/terapia , Humanos , Hiperprolactinemia/diagnóstico por imagen , Hiperprolactinemia/cirugía , Hiperprolactinemia/terapia , Hipopituitarismo/diagnóstico por imagen , Hipopituitarismo/cirugía , Hipopituitarismo/terapia , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/terapia , Estudios Retrospectivos , Adulto JovenRESUMEN
METHODS: 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. 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.
Asunto(s)
Cefalea/sangre , Cefalea/prevención & control , Hiperprolactinemia/terapia , Prolactina/sangre , Adenoma/complicaciones , Adenoma/terapia , Adulto , Análisis de Varianza , Agonistas de Dopamina/uso terapéutico , Femenino , Cefalea/etiología , Humanos , Hiperprolactinemia/complicaciones , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/terapia , Valores de Referencia , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Prolactina/sangre , Hiperprolactinemia/terapia , Cefalea/prevención & control , Cefalea/sangre , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/terapia , Valores de Referencia , Hiperprolactinemia/complicaciones , Adenoma/complicaciones , Adenoma/terapia , Análisis de Varianza , Estudios Longitudinales , Resultado del Tratamiento , Estadísticas no Paramétricas , Agonistas de Dopamina/uso terapéutico , Cefalea/etiologíaRESUMEN
INTRODUCTION: Sexual dysfunction is one of the most frequently occurring side-effects of antipsychotic medication, impacting both quality of life and adherence to treatment. Despite this, limited evidence-based guidance on treatment options is available. AIM: To synthesize and analyze the evidence on management of antipsychotic-related sexual dysfunction, specifically taking note of the more recently developed antipsychotics that have been incorporated in studies over the past decade. METHODS: EMBASE, Medline, and PsychINFO databases were searched using search terms related to sexual or erectile dysfunction, treatments, and antipsychotics. 2 reviewers independently assessed papers for the inclusion criteria for randomized controlled trials (RCTs) of treatments for antipsychotic-related sexual dysfunction, including adjunctive medications and a switch of antipsychotic. Studies were excluded if participants did not have recorded sexual dysfunction at baseline. MAIN OUTCOME MEASURE: The primary outcome measure was any change in sexual function. RESULTS: 6 RCTs were identified, all of which investigated different interventions; hence, it was not possible to synthesize the data quantitatively. Results were overall limited by small sample size, brief treatment duration, and the potential for bias. 2 studies, one assessing adjunctive sildenafil and the other adjunctive aripiprazole, reported a reduction in antipsychotic-related sexual dysfunction. CLINICAL IMPLICATIONS: Due to the lack of high-quality data, no clinical recommendations can be made. STRENGTHS & LIMITATIONS: A comprehensive search strategy was used with an extensive number of relevant search terms including "erectile dysfunction" and newer antipsychotics such as aripiprazole. In light of evidence that prolactin is not a reliable marker for sexual dysfunction, this review focused its inclusion criteria on participants presenting with sexual dysfunction rather than with hyperprolactinemia, which should give its recommendations more validity. However, only 6 RCTs were identified, and results were overall limited by small sample size, brief treatment duration, and the potential for bias. CONCLUSION: Our findings highlight the paucity of high-quality research in this area, and conjecture that it may be difficult to recruit participants with antipsychotic-related sexual dysfunction. Future research may be necessary to unlock and address these difficulties. Furthermore, fully powered future studies should focus on the management of sexual dysfunction rather than the surrogate marker of hyperprolactinemia. Allen K, Baban A, Munjiza J, et al. Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review. J Sex Med 2019;16:1978-1987.
Asunto(s)
Antipsicóticos/efectos adversos , Hiperprolactinemia/inducido químicamente , Calidad de Vida , Disfunciones Sexuales Fisiológicas/inducido químicamente , Antipsicóticos/uso terapéutico , Sustitución de Medicamentos , Disfunción Eréctil/inducido químicamente , Disfunción Eréctil/terapia , Humanos , Hiperprolactinemia/terapia , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Disfunciones Sexuales Fisiológicas/terapiaRESUMEN
Prevalence and incidence of prolactinomas are approximately 50 per 100,000 and 3-5 new cases/100,000/year. The pathophysiological mechanism of hyperprolactinemia-induced gonadotropic failure involves kisspeptin neurons. Prolactinomas in males are larger, more invasive and less sensitive to dopamine agonists (DAs). Macroprolactin, responsible for pseudohyperprolactinemia is a frequent pitfall of prolactin assay. DAs still represent the primary therapy for most prolactinomas, but neurosurgery has regained interest, due to progress in surgical techniques and a high success rate in microprolactinoma, as well as to some underestimated side effects of long-term DA treatment, such as impulse control disorders or impaired quality of life. Recent data show that the suspected effects of DAs on cardiac valves in patients with prolactinomas are reassuring. Finally, temozolomide has emerged as a valuable treatment for rare cases of aggressive and malignant prolactinomas that do not respond to all other conventional treatments.
Asunto(s)
Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/epidemiología , Neoplasias Hipofisarias/terapia , Prolactinoma/diagnóstico , Prolactinoma/epidemiología , Prolactinoma/terapia , Agonistas de Dopamina/uso terapéutico , Femenino , Humanos , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/epidemiología , Hiperprolactinemia/etiología , Hiperprolactinemia/terapia , Incidencia , Kisspeptinas/metabolismo , Masculino , Neuronas/metabolismo , Neuronas/patología , Neoplasias Hipofisarias/complicaciones , Prevalencia , Prolactina/análisis , Prolactina/sangre , Prolactinoma/complicaciones , Calidad de VidaRESUMEN
Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. Although many conditions can lead to hirsutism, polycystic ovary syndrome and idiopathic hyperandrogenism account for more than 85% of cases. Less common causes include idiopathic hirsutism, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, medications, hyperprolactinemia, thyroid disorders, and Cushing syndrome. Women with an abnormal hirsutism score based on the Ferriman-Gallwey scoring system should be evaluated for elevated androgen levels. Women with rapid onset of hirsutism over a few months or signs of virilization are at high risk of having an androgen-secreting tumor. Hirsutism may be treated with pharmacologic agents and/or hair removal. Recommended pharmacologic therapies include combined oral contraceptives, finasteride, spironolactone, and topical eflornithine. Because of the length of the hair growth cycle, therapies should be tried for at least six months before switching treatments. Hair removal methods such as shaving, waxing, and plucking may be effective, but their effects are temporary. Photoepilation and electrolysis are somewhat effective for long-term hair removal but are expensive.
Asunto(s)
Hiperplasia Suprarrenal Congénita/complicaciones , Síndrome de Cushing/complicaciones , Hirsutismo/etiología , Hiperandrogenismo/complicaciones , Hiperprolactinemia/complicaciones , Neoplasias/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Enfermedades de la Tiroides/complicaciones , Hiperplasia Suprarrenal Congénita/diagnóstico , Hiperplasia Suprarrenal Congénita/terapia , Antagonistas de Andrógenos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Anticonceptivos Hormonales Orales/uso terapéutico , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Eflornitina/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Hormona Liberadora de Gonadotropina/agonistas , Remoción del Cabello , Hirsutismo/diagnóstico , Hirsutismo/terapia , Humanos , Hiperandrogenismo/diagnóstico , Hiperandrogenismo/terapia , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/terapia , Leuprolida/uso terapéutico , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Neoplasias/diagnóstico , Neoplasias/terapia , Inhibidores de la Ornitina Descarboxilasa/uso terapéutico , Síndrome del Ovario Poliquístico/diagnóstico , Síndrome del Ovario Poliquístico/terapia , Espironolactona/uso terapéutico , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/terapiaAsunto(s)
Hiperprolactinemia/diagnóstico , Hiperprolactinemia/terapia , Humanos , Hiperprolactinemia/etiología , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/terapia , Prolactinoma/complicaciones , Prolactinoma/diagnóstico , Prolactinoma/terapiaRESUMEN
Hyperprolactinemia (HPrl) is considered as a rare endocrinopathy in childhood. In children and adolescent girls, there are three major categories of HPrl causes; physiological, pathological and iatrogenic. Through hypogonadotropic hypogonadism, prolactin hypersecretion and production leads to the typical functional syndrome which is observed in female children and adolescents; delayed puberty, primary or secondary amenorrhea and/or galactorrhea. Regarding prolactinomas, clinical signs manifest with mass compression of the optic chiasm and anterior pituitary gland or prolactin hypersecretion. Targeted identification of HPrl is of significant importance for proper management and follow-up. The aim of this review is to focus on the evaluation of HPrl in adolescent and young girls. In addition, we aimed to summarize the current knowledge regarding the proper management of such cases.
Asunto(s)
Hiperprolactinemia/diagnóstico , Adolescente , Niño , Femenino , Humanos , Hiperprolactinemia/complicaciones , Hiperprolactinemia/terapiaRESUMEN
Objective: We aimed to report the characteristics at admission, diagnosis, treatment, and follow-up of cases of pediatric hyperprolactinemia in a large multicenter study. Methods: We reviewed the records of 233 hyperprolactinemic patients, under 18 years of age, who were followed by different centers. The patients were divided as having microadenomas, macroadenomas, drug-induced hyperprolactinemia and idiopathic hyperprolactinemia. Complaints of the patients, their mode of treatment (medication and/or surgery) and outcomes were evaluated in detail. Results: The mean age of the patients with hyperprolactinemia was 14.5 years, and 88.4% were females. In terms of etiology, microadenomas were observed in 32.6%, macroadenomas in 27%, idiopathic hyperprolactinemia in 22.7% and drug-induced hyperprolactinemia in 6.4%. Other causes of hyperprolactinemia were defined in 11.3%. Common complaints in females (n=206) were sorted into menstrual irregularities, headaches, galactorrhea, primary or secondary amenorrhea and weight gain, whereas headache, gynecomastia, short stature and blurred vision were common in males (n=27). Median prolactin levels were 93.15 ng/mL, 241.8 ng/mL, 74.5 ng/mL, 93.2 ng/mL, and 69 ng/mL for microadenomas, macroadenomas, idiopathic hyperprolactinemia, drug-induced hyperprolactinemia, and other causes of hyperprolactinemia, respectively. Of 172 patients with hyperprolactinemia, 77.3% were treated with cabergoline and 13.4% with bromocriptine. 20.1% of the patients with pituitary adenomas underwent pituitary surgery. Conclusion: We present the largest cohort of children and adolescents with hyperprolactinemia in the literature to date. Hyperprolactinemia is more common in females and cabergoline is highly effective and practical to use in adolescents, due to its biweekly dosing. Indications for surgery in pediatric cases need to be revised.