Spontaneous remission of Cushing syndrome after termination of pregnancy.

A 27-year-old women developed Cushing syndrome during pregnancy. The course of pregnancy was characterized by abnormally low urine and plasma estrogen levels despite the presence of a living fetus. The signs and symptoms of Cushing syndrome disappeared spontaneously within 2 months after delivery. Hormonal studies, however, suggested the presence of an adrenal tumor. An adrenocortical adenoma was found at surgery and removed.

Successive transperitoneal migration of ova in a woman with extensive pelvic adhesions.

Our case report describes three conceptions after transperitoneal migration of the ovum in a woman with only one ovary, the contralateral oviduct, and extensive postoperative pelvic adhesions obliterating the Douglas cul-de-sac. This suggests that anatomic integrity of the pelvis is not always essential for ovum pick-up.

Vaginal cabergoline in the treatment of hyperprolactinemic patients intolerant to oral dopaminergics.

OBJECTIVE: To evaluate the effectiveness and tolerance of vaginal cabergoline in hyperprolactinemic patients intolerant to oral dopaminergics. DESIGN: Case reports. SETTING: University hospital endocrinological outpatient clinic. PATIENTS: A 35-year-old primipara woman with idiopathic hyperprolactinemia and a 22-year-old female with primary amenorrhea harboring macroprolactinoma. INTERVENTIONS: Treatment with vaginal cabergoline (0.5 mg two and five times a week). MAIN OUTCOME MEASURES: The serum PRL levels and side effects were assessed before and during treatment. RESULTS: A single vaginal dose of 0.5 mg cabergoline reduced serum PRL levels by approximately 50% to 85% of basal values over a period of 4 to 5 hours. In the patients with idiopathic hyperprolactinemia, serum PRL levels normalized during long-term treatment, whereas in the one with macroprolactinoma they remained above the normal values (79 ng/mL [conversion factor to SI unit, 3.180]) despite resumption of menses and marked tumor shrinkage (70% reduction). No side effects were reported. CONCLUSIONS: Vaginal cabergoline is a safe and effective method of therapy for hyperprolactinemia and it avoids the adverse events of oral administration.

Gonadotropin releasing hormone agonist treatment for severe menorrhagia in patients with contraindications to surgery.

Four patients with heavy menorrhagia, severe iron-deficiency anemia and contraindications to surgery were treated with a gonadotropin-releasing hormone agonist in a depot formulation. At 2 months of therapy they were all amenorrheic, and at 6 months the hematologic values had improved markedly. Gonadotropin-releasing hormone agonists may obviate emergency surgery in patients at high surgical risk or could constitute the first line of sequential therapeutic regimens, once general health conditions have improved.

Flutamide in the treatment of hirsutism.

Ten hirsute women were treated with flutamide (250 mg/day) for 6 months to evaluate its effect. Hair growth as assessed by the Ferriman and Gallwey hair score was significantly reduced in all patients (P less than 0.01). The only significant change in endocrine levels was an increase in serum androstenedione (P less than 0.01). Acne and seborrhea improved markedly. No side effects were noted during the treatment. Our data suggest that the antiandrogenic properties of flutamide render it a suitable single agent in the treatment of hirsutism.

Gestational aspects of uterus didelphys.

The reproductive history was analyzed of 13 women with a laparoscopic or laparotomy diagnosis of uterus didelphys and followed for two to six years. Two patients (15.4%) presented with primary infertility; the other 11 had a total of 27 pregnancies, the outcome of which was spontaneous abortion in 20 cases (74%), premature labor in 6 (22.2%) and term birth in 1 (3.7%), with a live birth rate of 18.5%. Metroplasty was performed in five cases, with live birth in three, spontaneous abortion in 1 and no postoperative conceptions in one. Cervical cerclage was performed in only one case and bilateral ovarian resection in one. The live birth rate, considering all pregnancies before and after treatment, was 35%. The compromised fertility of the uterus didelphys is probably attributable to congenital alterations in vascularization that may have a negative influence on developmental phases following implantation, particularly the structuralization of the fetomaternal relations that precede placentation.

Prevalence of urinary tract abnormalities in a large series of patients with uterovaginal atresia.

The morphology of the urinary tract was studied in 81 patients with uterovaginal atresia. Anomalies were found in 33 per cent of the cases. The most frequent abnormality was the presence of a solitary kidney either located normally or in the pelvis. These findings are discussed in light of the pertinent literature.

Radioimmunoassayable plasma luteinizing hormone in primary amenorrhea.

PIP: Plasma luteinizing hormone (LH) was detectable by radioimmunoassay in 35 patients, all with female external genitalia, who had never menstruated spontaneously. Patients were grouped as follows: 11 with hypogonadotropic hypogonadism (1 pituitary dwarf, all with normal sex chromatin) 16 with gonadal dysgenesis (5 XO, 5 XX, 2 XY, 3 mosaics), and 8 with uterovaginal atresia (normal karyotypes.) Radioimmunoassay was performed with rabbit anti-human chorionic gonadotropin labeled with iodine-125, by the polystyrene tube method, on plasma samples taken at 9-11 a.m. Hypogonadism patients had mean 9.1 mI.U. LH (range 0-18); gonadal dysgenesis patients had mean 61.5 (range 23-103); uterovaginal atresia patients had 11.9 (0-35). It was noteworthy that no overlap was observed between primary gonadal failure (gonadal dysgensis), and secondary (hypogonadism), and that LH values in 2 other patients with polycystic ovaries, LH was 16 and 34 mI.U. and FSH was not increased.^ieng

Growth hormone and ACTH secretory dynamics in Turner's syndrome.

The secretory dynamics of GH and ACTH were studied in 14 patients with Turner's syndrome. The parameters investigated were plasma GH and cortisol responses to hypoglycemia, plasma cortisol circadian rhythm and suppressibility by dexamethasone, and response of urinary Porter-Silber chromogens to metyrapone. The results were mostly normal. These data do not support the hypothesis suggesting an abnormality of hypothalamic-pituitary function in Turner's syndrome.

Male pseudohermaphroditism due to 17-hydroxylase deficiency.

A 27-year-old phenotypic female presented with primary amenorrhea, severe hypertension, and hypokalemia. At the age of puberty sexual development had not occurred; in particular, sexual hair had not grown. Past history revealed an episode of subarachnoid hemorrhage and several episodes of ventricular tachyarrhythmia. Karyotype was 46, XY. The steroids requiring 17-hydroxylation (cortisol, testosterone, pregnanetriol, 17-ketosteroids, 17-hydroxycorticosteroids) were low, while those not requiring 17-hydroxylation (progesterone, deoxycorticosterone, corticosterone) were high, demonstrating 17-hydroxylase deficiency. The corticosterone/deoxycorticosterone ratio was relatively low, suggesting an associated partial deficiency of 11-hydroxylase.

Cabergoline versus bromocriptine in suppression of lactation after cesarean delivery.

We evaluated the efficacy of cabergoline, a new ergoline derivative, in blocking puerperal lactation in a group of women delivered by cesarean section. In a single-blind controlled trial 36 women were randomly allocated to treatment with cabergoline 1 mg in a single dose p.o. (n = 18) or bromocriptine 5 mg/day p.o. for 14 days (n = 18). Treatment was started about 50 h after delivery. Clinical assessment of breast signs and determination of serum prolactin were performed just before treatment and at 3, 5, 7 and 14 days. In the cabergoline-treated group milk secretion was inhibited in 17 women (94.4%). Maximum decrease of serum prolactin was -89.7% at 5 days, and the prolactin-lowering effect of cabergoline was still present at 14 days. In the bromocriptine group milk secretion was inhibited in 16 women (88.9%). Maximum prolactin decrease (-86.9%) was reached at 3 days. Persistent side effects were comparable in the two groups. This study demonstrates that a single oral dose of 1 mg cabergoline is as effective in suppressing puerperal lactation as a full treatment with bromocriptine, even in women delivered by cesarean section.

Gonads and genital ducts in a case of male pseudohermaphroditism.

We describe a patient with a 46,XY karyotype, ambiguous external genitalia and partial 17a-hydroxylase deficiency in whom we performed a light microscopic study of the gonads and genital ducts. The right and left testes and epididymides were hypoplastic whereas the right vas deferens was normal, the left one was atretic and a left infundibular remnant was also present, which could be due to a concomitant deficiency in testicular secretions in the early stages of embryonic development or to the possibility of receptor insensitivity for testicular hormones or to a concomitant gonadal dysgenesis.

X chromosomes attached by their short arm : presence of an inactive centromere influences the replication patterns.

A 19 years old girl with gonadal dysgenesis and short stature had one giant chromosome formed by two X-chromosomes attached by their short arms 46,X,i dic(X) (p223::p223) A 45,X cell line was present in 40% of cultured lymphocytes but only in 2% of fibroblasts cultured from the right gonad and absent in fibroblasts from the left gonad and skin. The abnormal chromosome had one Cd-positive, active centromere and one inactive centromere. A study of DNA replication with autoradiography and BrdU treatment revealed that the abnormal X was always the late replicating one. In a proportion of cells there was an asymmetric pattern of replication : the region with the inactive centromere had a tendency to replicate later than the portion with the functioning centromere. The Xg blood group segregation suggested that the attached X chromosomes were of paternal origin and therefore a true isodicentric formed after an isochromatid break followed by joining of the two sister chromatids.

Pregnancy following metergoline treatment in a patient with hyperprolactinaemia.

A 33-year-old woman who had had amenorrhoea and galactorrhoea for ten years and had hyperprolactinaemia was treated with metergoline, a serotonin antagonist. There was a marked decrease in plasma prolactin levels. After two months, ovulation and pregnancy occurred. This is the first such report.

PIP: A case study of a 33-year-old hyperprolactinemic woman becoming pregnant after treatment with metergoline is reported. The patient had also had amenorrhea and galactorrhea for 10 years. Treatment twice a day with 4 mg metergoline, a serotonin antagonist, markedly decreased plasma prolactin levels. 2 months later the patient became pregnant and delivered a normal, healthy boy. This is the 1st report of ovulation induction by metergoline.

Increased forearm bone mineral content after bromocriptine treatment in hyperprolactinemia.

We studied 15 hyperprolactinemic women to evaluate possible modifications of bone mineral content after pharmacological treatment. Patients received a dopamine agonist (bromocriptine) for six months after which there was a significant decrease of prolactin plasma levels (P less than 0.01) and a significant increase of bone mineral content (P less than 0.05).

Cabergoline in the long-term therapy of hyperprolactinemic disorders.

The efficacy and safety of the new long-acting dopamine agonist cabergoline were evaluated in 127 hyperprolactinemic patients (124F and 3M; 71 with microprolactinoma, 14 with macroprolactinoma, 5 with operated macroprolactinoma and 37 with idiopathic disorder) who were treated with the drug for from 3 to 52 months (median, 14 months). Cabergoline was administered orally at dose levels ranging between 0.2 and 3.5 mg per week, given once weekly in 92 patients, twice weekly in 22, thrice weekly in 9 and daily in 4. Serum prolactin and progesterone levels, hematology, blood chemistry and electrocardiograms were frequently evaluated throughout treatment. CT or MR imaging of the pituitary was repeated during treatment in patients with macroprolactinoma and in 38 with microprolactinoma. After drug discontinuation, serum prolactin and gonadal function were evaluated monthly for three months in 65 patients and for up to two years in 12. Serum prolactin levels were normalized in 114 patients (90%). Of 56 women with amenorrhea, 52 resumed menses (with presumptive evidence of ovulation in 49); 17 women became pregnant; and sexual potency was restored in the 3 men. Evidence of tumor shrinkage was obtained in 13 of the 14 patients with macroprolactinoma and in 28 of 38 with microprolactinoma; complete disappearance of the tumor image was achieved in 2 macro and 14 microprolactinomas. A total of 48 adverse events was reported by 29 patients (23%), almost all typical of the pharmacological class and mild to moderate; no patient withdrew from treatment due to adverse events. Safety parameters did not change. Following cabergoline discontinuation, prolactin levels increased slowly, being still markedly lower than pretreatment values after three months; 10 patients out of 32 had persistently normal prolactin levels during one year of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiserotonin treatment of hyperprolactinemic amenorrhea: long-term follow-up with metergoline, methysergide, and cyproheptadine.

Twenty patients affected by hyperprolactinemic amenorrhea-galactorrhea have been treated with one or more of the following serotonin antagonists: metergoline, methysergide, and cyproheptadine. Among the 11 patients without evidence of pituitary tumor resumption of menses was observed in five, two of whom had ovulatory cycles; one patient became pregnant; ovulations occurred only during treatment with metergoline. In the group of nine patients with enlarged sellae, three experienced isolated episodes of bleeding, while two had three and four menses each, respectively; all cycles were anovulatory. Plasma prolactin levels and galactorrhea were favorably affected by treatment only in a minority of amenorrhea-galactorrhea patients with and without tumors.

Maternal thyroid function in early and late pregnancy.

Thyroid function was investigated during and after pregnancy in 12 healthy euthyroid women. During pregnancy, serum total T4 (TT4) levels were significantly elevated and nearly stable, while thyroxine-binding globulin (TBG) levels progressively increased till the 7th month. A slight elevation, though not significant, of free T4 (fT4) was recorded in early pregnancy. In the following months, fT4, free T3 (fT3) and the T4/TBG ratio progressively diminished, reaching a plateau at the 7th month. Serum TSH levels, measured by an ultrasensitive immunofluorometric assay, were comparable to postpartum values during the first trimester and showed a moderate upward trend with the progression of pregnancy. The evaluation of 24-hour TSH profiles was performed in 5 women during the first trimester of pregnancy. In all women, the circadian rhythm of TSH was present with a normal nocturnal surge, though anticipated in 1 case. In summary (1) during the first trimester of pregnancy, the increased thyroid activity does not seem to be only sustained by pituitary TSH which remains unmodified; the negative correlation between TSH and hCG levels might suggest that hCG also stimulates the gland to increase thyroid hormone output, and the presence of a normal TSH circadian rhythm indicates that the central mechanism of neuroregulation of the pituitary-thyroid axis is preserved in early pregnancy, and (2) in late pregnancy, a marked decrease in free thyroid hormone fractions is accompanied by serum TSH levels still in the normal range, indicating a modification of thyroid homeostasis which might recognize various etiological factors.