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1.
J Neuroimmunol ; 353: 577523, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33640717

RESUMO

OBJECTIVE: To report a unique case and literature review of post COVID-19 associated transverse myelitis and dysautonomia with abnormal MRI and CSF findings. BACKGROUND: Coronavirus disease have been reported to be associated with several neurological manifestations such as stroke, Guillain-Barré syndrome, meningoencephalitis amongst others. There are only few reported cases of transverse myelitis with the novel coronavirus (n-CoV-2) and only one reported case identifying dysautonomia in COVID-19 patient. Here, we identify a COVID-19 patient diagnosed with acute transverse myelitis in addition to dysautonomia following with complete resolution of symptoms. METHOD: A retrospective chart review of a patient diagnosed with post SARS-CoV-2 infection acute transverse myelitis and dysautonomia, and a review of literature of all the reported cases of transverse myelitis and COVID-19, from December 1st, 2019 till December 25th, 2020, was performed. CONCLUSION: To our knowledge, this is the first reported case of transverse myelitis and dysautonomia in a patient with SARS-CoV-2 infection, who responded to intravenous methyl prednisone and bromocriptine. Follow-up imaging of the spine showed complete resolution of the lesion. Further studies would be recommended to identify the underlying correlation between COVID-19 and transverse myelitis.


Assuntos
/complicações , Mielite Transversa/virologia , Disautonomias Primárias/virologia , Medula Espinal/patologia , Adulto , Anti-Inflamatórios/uso terapêutico , Bromocriptina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Humanos , Masculino , Metilprednisolona/uso terapêutico , Mielite Transversa/tratamento farmacológico , Mielite Transversa/patologia
2.
Cochrane Database Syst Rev ; 9: CD007667, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32880105

RESUMO

BACKGROUND: Antisocial personality disorder (AsPD) is associated with rule-breaking, criminality, substance use, unemployment, relationship difficulties, and premature death. Certain types of medication (drugs) may help people with AsPD. This review updates a previous Cochrane review, published in 2010. OBJECTIVES: To assess the benefits and adverse effects of pharmacological interventions for adults with AsPD. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also checked reference lists and contacted study authors to identify studies. SELECTION CRITERIA: Randomised controlled trials in which adults (age 18 years and over) with a diagnosis of AsPD or dissocial personality disorder were allocated to a pharmacological intervention or placebo control condition. DATA COLLECTION AND ANALYSIS: Four authors independently selected studies and extracted data. We assessed risk of bias and created 'Summary of findings tables' and assessed the certainty of the evidence using the GRADE framework. The primary outcomes were: aggression; reconviction; global state/global functioning; social functioning; and adverse events. MAIN RESULTS: We included 11 studies (three new to this update), involving 416 participants with AsPD. Most studies (10/11) were conducted in North America. Seven studies were conducted exclusively in an outpatient setting, one in an inpatient setting, and one in prison; two studies used multiple settings. The average age of participants ranged from 28.6 years to 45.1 years (overall mean age 39.6 years). Participants were predominantly (90%) male. Study duration ranged from 6 to 24 weeks, with no follow-up period. Data were available from only four studies involving 274 participants with AsPD. All the available data came from unreplicated, single reports, and did not allow independent statistical analysis to be conducted. Many review findings were limited to descriptive summaries based on analyses carried out and reported by the trial investigators. No study set out to recruit participants on the basis of having AsPD; many participants presented primarily with substance abuse problems. The studies reported on four primary outcomes and six secondary outcomes. Primary outcomes were aggression (six studies) global/state functioning (three studies), social functioning (one study), and adverse events (seven studies). Secondary outcomes were leaving the study early (eight studies), substance misuse (five studies), employment status (one study), impulsivity (one study), anger (three studies), and mental state (three studies). No study reported data on the primary outcome of reconviction or the secondary outcomes of quality of life, engagement with services, satisfaction with treatment, housing/accommodation status, economic outcomes or prison/service outcomes.   Eleven different drugs were compared with placebo, but data for AsPD participants were only available for five comparisons. Three classes of drug were represented: antiepileptic; antidepressant; and dopamine agonist (anti-Parkinsonian) drugs. We considered selection bias to be unclear in 8/11 studies, attrition bias to be high in 7/11 studies, and performance bias to be low in 7/11 studies. Using GRADE, we rated the certainty of evidence for each outcome in this review as very low, meaning that we have very little confidence in the effect estimates reported. Phenytoin (antiepileptic) versus placebo One study (60 participants) reported very low-certainty evidence that phenytoin (300 mg/day), compared to placebo, may reduce the mean frequency of aggressive acts per week (phenytoin mean = 0.33, no standard deviation (SD) reported; placebo mean = 0.51, no SD reported) in male prisoners with aggression (skewed data) at endpoint (six weeks). The same study (60 participants) reported no evidence of difference between phenytoin and placebo in the number of participants reporting the adverse event of nausea during week one (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.06 to 16.76; very low-certainty evidence). The study authors also reported that no important side effects were detectable via blood cell counts or liver enzyme tests (very low-certainty evidence). The study did not measure reconviction, global/state functioning or social functioning. Desipramine (antidepressant) versus placebo One study (29 participants) reported no evidence of a difference between desipramine (250 to 300 mg/day) and placebo on mean social functioning scores (desipramine = 0.19; placebo = 0.21), assessed with the family-social domain of the Addiction Severity Index (scores range from zero to one, with higher values indicating worse social functioning), at endpoint (12 weeks) (very low-certainty evidence). Neither of the studies included in this comparison measured the other primary outcomes: aggression; reconviction; global/state functioning; or adverse events. Nortriptyline (antidepressant) versus placebo One study (20 participants) reported no evidence of a difference between nortriptyline (25 to 75 mg/day) and placebo on mean global state/functioning scores (nortriptyline = 0.3; placebo = 0.7), assessed with the Symptom Check List-90 (SCL-90) Global Severity Index (GSI; mean of subscale scores, ranging from zero to four, with higher scores indicating greater severity of symptoms), at endpoint (six months) in men with alcohol dependency (very low-certainty evidence). The study measured side effects but did not report data on adverse events for the AsPD subgroup. The study did not measure aggression, reconviction or social functioning. Bromocriptine (dopamine agonist) versus placebo One study (18 participants) reported no evidence of difference between bromocriptine (15 mg/day) and placebo on mean global state/functioning scores (bromocriptine = 0.4; placebo = 0.7), measured with the GSI of the SCL-90 at endpoint (six months) (very low-certainty evidence). The study did not provide data on adverse effects, but reported that 12 patients randomised to the bromocriptine group experienced severe side effects, five of whom dropped out of the study in the first two days due to nausea and severe flu-like symptoms (very low-certainty evidence). The study did not measure aggression, reconviction and social functioning. Amantadine (dopamine agonist) versus placebo The study in this comparison did not measure any of the primary outcomes. AUTHORS' CONCLUSIONS: The evidence summarised in this review is insufficient to draw any conclusion about the use of pharmacological interventions in the treatment of antisocial personality disorder. The evidence comes from single, unreplicated studies of mostly older medications. The studies also have methodological issues that severely limit the confidence we can draw from their results. Future studies should recruit participants on the basis of having AsPD, and use relevant outcome measures, including reconviction.


Assuntos
Transtorno da Personalidade Antissocial/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adulto , Agressão/efeitos dos fármacos , Transtornos Relacionados ao Uso de Álcool/tratamento farmacológico , Amantadina/uso terapêutico , Ansiedade/tratamento farmacológico , Bromocriptina/uso terapêutico , Desipramina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nortriptilina/uso terapêutico , Fenitoína/uso terapêutico , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Kardiologiia ; 60(6): 984, 2020 Jul 07.
Artigo em Russo | MEDLINE | ID: mdl-32720617

RESUMO

Aim      To evaluate the effect of bromocriptine on clinical hemodynamic and functional indexes and to analyze life prognosis for patients with periportal cardiomyopathy divided into two groups: group 1, bromocriptine treatment (n=21) and group 2, standard treatment without bromocriptine (n=22). History was taken, examination and standard clinical evaluation were performed, the Clinical Condition Scale (CCS with V.Yu. Mareev, 2000, modification) was administered, and 6-min walk test (6MWT) was performed. Quality of life was determined with the Minnesota questionnaire. Standard 12-lead electrocardiography, echocardiography, and blood biochemistry with measuring C-reactive protein (CRP) and prolactin, were performed. Follow-up duration was one year.Results Heart rate was significantly decreased in group 1 (22.7%) compared to group 2 (18%); the 6-min distance was increased (61 and 50 %, respectively), the total CCS score was decreased (66 and 55 %, respectively, and the quality of life Minnesota questionnaire score was improved (from 68.4±12.4 to 26.4±12.4 and from 63.4±10.9 to 36.4±15.1, respectively). Also, left ventricular (LV) end-diastolic dimension was reduced from 66.82±7.07 to 60.67±3.79 mm (9.2 %) in group 1 and from 61.92±4.41 to 58.91±4.68 mm (5 %) in group 2, which was associated with increases in LV ejection fraction by 18.3 and 14.5 %, respectively. In both groups, CRP concentration was decreased from 8.3±4.1 to 4.3±1.2 mg/l and from 8.5±3.5 to 6.3±1.5 mg/l, respectively. The bromocriptine treatment was associated with a significant decrease in prolactin level (62 %). The LV function completely recovered in 66.6% of patients in group 1 and in 27% of patients in group 2.Conclusion      The bromocriptine treatment of periportal cardiomyopathy in combination with an optimal drug therapy was associated with an additional beneficial effect on the clinical functional status, intracardiac hemodynamics, blood concentration of CRP, and a potentiality for complete recovery of the LV function.


Assuntos
Bromocriptina/uso terapêutico , Cardiomiopatias , Cardiomiopatias/tratamento farmacológico , Humanos , Período Periparto , Qualidade de Vida , Resultado do Tratamento
4.
Clin Exp Hypertens ; 42(7): 675-679, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-32478610

RESUMO

BACKGROUND: Bromocriptine, a dopamine agonist, used for the treatment of hyperprolactinemia, type 2 diabetes, ovarian hyper-stimulation syndrome, has also effects on the cardiac remodeling process, but the mechanism of action is unknown. The aim of this work was to determinate the effect during hypertrophic process through molecular mechanisms that include prolactin receptor (Prlr) and receptor of dopamine 2 (D2 r) expression. METHODS: We used a model of cardiac hypertrophy induced by an aortocaval fistula (ACF) surgery in rats. Protein concentrations of D2 r and Prlr were determined by western blotting. The treatment consisted in water (control), captopril (50 mg/kg/day), bromocriptine (3 mg/kg/day), and ACF group (n = 6 per group). RESULTS: Our results showed that bromocriptine treatment decreases the hypertrophy index. Treatment with bromocriptine increases the protein expression of Prlr and D2 r in the cardiac tissue of rats with cardiac hypertrophy. CONCLUSIONS: We concluded that bromocriptine has a protective effect on cardiac hypertrophy, and due to this effect, it may modulate the expression of Prlr and D2 r, which are involved in the development of cardiac hypertrophy.


Assuntos
Bromocriptina/farmacologia , Cardiomegalia/metabolismo , Agonistas de Dopamina/farmacologia , Miocárdio/metabolismo , Receptores de Dopamina D2/metabolismo , Receptores da Prolactina/metabolismo , Animais , Bromocriptina/metabolismo , Bromocriptina/uso terapêutico , Cardiomegalia/prevenção & controle , Masculino , Ratos , Receptores de Dopamina D2/agonistas
6.
Pituitary ; 23(1): 65-69, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31792668

RESUMO

Prolactinomas are the most common pituitary tumors and pathological hyperprolactinemia. Therefore, women harboring prolactinomas frequently present infertility due to the gonadal axis impairment. The gold-standard treatment is dopamine agonist (DA) which can reverse hyperprolactinemia and hypogonadism, and promote tumor shrinkage in the majority of cases. Therefore, reports of pregnancy in such cohort become more common. In this scenario, bromocriptine is still the DA of choice due to its shorter half-life and larger experience as compared to cabergoline. In DA resistant cases, transsphenoidal pituitary surgery is indicated. However, potential risks of DA-induced pregnancies include fetal exposition and symptomatic tumor growth. Dopamine agonist should be discontinued as soon as pregnancy is confirmed in microprolactinomas and intrasellar macroprolactinomas (MAC). Concerning expansive/invasive MAC, DA maintenance should be considered. Periodically clinical evaluation should be performed during pregnancy, being sellar imaging indicated if tumor symptomatic growth is suspected. In such cases, if DA treatment fails, neurosurgery is indicated.


Assuntos
Agonistas de Dopamina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Bromocriptina/uso terapêutico , Feminino , Humanos , Gravidez
7.
Eur Heart J Acute Cardiovasc Care ; 9(2): 173-182, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29792513

RESUMO

INTRODUCTION: Acute peripartum cardiomyopathy complicated by cardiogenic shock is a rare but life-threatening disease. A prolactin fragment is considered causal for the pathogenesis of peripartum cardiomyopathy. This analysis sought to investigate the role of early percutaneous mechanical circulatory support with micro-axial flow-pumps and/or veno-arterial extracorporeal membrane oxygenation in combination with the prolactin inhibitor bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy. METHODS AND RESULTS: In this single-centre analysis, five peripartum cardiomyopathy patients with refractory cardiogenic shock received mechanical circulatory support with either Impella CP microaxial pump only (n=2) or in combination with veno-arterial extracorporeal membrane oxygenation (n=3) in the setting of biventricular failure. All patients were mechanically ventilated. In all cases mechanical circulatory support was combined with bromocriptine therapy and early administration of levosimendan. All patients survived the acute phase of refractory cardiogenic shock. Mechanical circulatory support using a micro-axial pump allowed to significantly reduce catecholamine dosage. Remarkably, early left ventricular support with micro-axial flow-pumps resulted in myocardial recovery whereas delayed Impella (mechanical circulatory support) implantation was associated with poor left ventricular recovery. CONCLUSION: Mechanical circulatory support in patients with refractory cardiogenic shock complicating peripartum cardiomyopathy was associated with a 30-day survival of 100% and a favourable outcome. Notably, early left ventricular unloading combined with bromocriptine therapy was associated with left ventricular recovery. Therefore, an immediate transfer to a tertiary hospital experienced in mechanical circulatory support in combination with bromocriptine treatment seems indispensable for successful treatment of peripartum cardiomyopathy complicated by cardiogenic shock.


Assuntos
Cardiomiopatias/etiologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Bromocriptina/uso terapêutico , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Terapia Combinada , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Insuficiência Cardíaca/terapia , Antagonistas de Hormônios/uso terapêutico , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Estudos Prospectivos , Choque Cardiogênico/mortalidade , Volume Sistólico/fisiologia , Taxa de Sobrevida , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
8.
Iran Biomed J ; 24(1): 24-9, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31454860

RESUMO

Background: In recent years, nanotechnology with modern advances in the macromolecular design of nano-carriers has proved to be helpful in the development of drugs delivery systems. This research represents a novel co-administration of nano-vehicles, known as liposomes. Liposomes efficiently encapsulate curcumin and bromocriptine (BR) in a polymer structure, which results in enhanced aqueous solubility of the mentioned hydrophobic agents and higher bioavailability of the drugs. Methods: Preparation of curcumin and BR liposomes were carried out by the thin film method, and the amounts of purified drug and its release were analyzed. After dose determination, the human lung cancer cells (QU-DB) were exposed to BR and curcumin liposomes for 12, 24, and 48 h. Then the viability and apoptosis assays were carried out by using tetrazolium dye and flow cytometry technique, respectively. Results: In this research, in vitro anti-cancer effects of former nano-formulations on lung cancer cells was confirmed, and no cytotoxicity effects of these nano-preparations were observed in the normal cells (HFLF-PI5). Discussion: Our findings suggest the nano-liposomal drugs as effective anti-cancer agents; however, additional clinical examinations are required.


Assuntos
Apoptose , Bromocriptina/administração & dosagem , Bromocriptina/uso terapêutico , Curcumina/administração & dosagem , Curcumina/uso terapêutico , Sistemas de Liberação de Medicamentos , Neoplasias Pulmonares/tratamento farmacológico , Nanopartículas/química , Apoptose/efeitos dos fármacos , Bromocriptina/farmacologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Curcumina/farmacologia , Liberação Controlada de Fármacos , Humanos , Lipossomos , Neoplasias Pulmonares/patologia , Tamanho da Partícula
10.
Pituitary ; 22(6): 581-593, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31522359

RESUMO

PURPOSE: Somatostatin analogs (SSAs) represent a mainstay of medical treatment for acromegaly, currently available as either intramuscular or deep subcutaneous injections. Patient-reported outcomes (PROs) are increasingly common as relevant outcomes in studies of acromegaly and its treatment, but there are no validated PRO measures available that focus on the disease burden and the impact of treatment, specifically designed for use in patients with acromegaly. We sought to develop a new and unique PRO measure, the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ). METHODS: Concept elicitation (CE) interviews were conducted with acromegaly patients in the United States receiving SSA injections at a stable dose for ≥ 6 months. A questionnaire was drafted based on these interviews; combined CE and cognitive debriefing (CE/CD) interviews were then conducted to confirm the content, clarity, and relevance of the questionnaire. RESULTS: Nineteen subjects completed interviews [n = 9 CE, n = 10 CE/CD; n = 15 Lanreotide Depot/Autogel (Somatuline), n = 4 Octreotide LAR (Sandostatin LAR)]. Most subjects responded positively when asked about the effectiveness of their current treatment; however, breakthrough symptoms, injection site reactions, and side effects were commonly reported and had negative impacts on social and emotional well-being and daily activities. All 10 subjects involved in debriefing interviews found the questionnaire to be relevant, easy to complete, and found the response options to be clear. The resulting 26-item Acro-TSQ covers symptoms and symptom control, gastrointestinal side effects and their impact on daily activities, the emotional impact of treatment, convenience and ease of use, and overall satisfaction. CONCLUSIONS: The Acro-TSQ is a novel PRO, focused on both disease burden and impact of treatment; it was found to be comprehensive, clear, and relevant for patients with acromegaly receiving injectable SSA treatment.


Assuntos
Acromegalia/tratamento farmacológico , Adulto , Bromocriptina/uso terapêutico , Cabergolina/uso terapêutico , Feminino , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Peptídeos Cíclicos/uso terapêutico , Satisfação Pessoal , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Inquéritos e Questionários
11.
Rehabilitación (Madr., Ed. impr.) ; 53(3): 155-161, jul.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185552

RESUMO

Introducción: el objetivo de este trabajo es evaluar los resultados y efectos secundarios de la administración de bromocriptina en pacientes con traumatismo craneoencefálico (TCE) en estado de síndrome vigilia sin respuesta (SVSR) o estado de mínima conciencia (EMC). Métodos: revisión retrospectiva de 10 casos clínicos: 6 TCE-SVSR y 4 TCE-EMC. Todos los pacientes recibieron bromocriptina con dosis iniciales de 2,5mg 2 veces al día. Esta fue incrementada progresivamente hasta 7,5 o 12,5mg 2 veces al día según respuesta y mantenida durante al menos 4 semanas. Se emplearon diversas escalas de valoración en los siguientes estadios: previo a la administración de bromocriptina, a las 4 semanas de inicio del tratamiento y previo al alta hospitaria. Las escalas de valoración que se emplearon fueron: Coma Recovery Scale-Revised, Disability Rating Scale, Glasgow Coma Scale, Barthel Scale y Marshall Scale. Resultados: de los 10 pacientes 4 en EMC y 4 en SVSR consiguieron al alta 23 puntos en escala CRS-R, emergiendo por tanto de dichos estados y alcanzando un estado de fuera de mínima conciencia. Dos de los 10 pacientes mejoraron, pero de manera más discreta pasando de SVSR a EMC (8 a 11 y de 5 a 10 puntos en CRS-R). Conclusiones: considerando el mal pronóstico de recuperación de estos pacientes el beneficio-riesgo es positivo con bromocriptina a dosis como mínimo de 7,5mg 2 veces al día durante 4 semanas


Introduction: the aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). Methods: we conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale. Results: of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R). Conclusions: considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Bromocriptina/uso terapêutico , Transtornos da Consciência/tratamento farmacológico , Lesões Encefálicas Traumáticas/complicações , Estudos Retrospectivos , Dano Encefálico Crônico/terapia , Resultado do Tratamento , Agonistas de Dopamina/uso terapêutico
12.
Am J Audiol ; 28(3): 548-552, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31430172

RESUMO

Objective Current recommendations for cochlear hydrops treatment include systemic glucocorticoids and diuretics. Cochlear cells express dopamine receptors, although their role is unknown in the pathophysiology of cochlear hydrops. Case Description We report the case of remission of recurrent right-sided cochlear hydrops in a young male patient treated with bromocriptine due to pituitary macroprolactinoma. Transient improvement was observed after oral steroid and diuretic treatment, but cochlear hydrops recurred until the dose of bromocriptine was increased to 10 mg daily. Conclusion Bromocriptine may stimulate dopamine receptors in cochlear cells with potential therapeutic role in patients with cochlear hydrops. There are no widely accepted and effective treatments for endolymphatic hydrops, and identifying potential new and efficacious therapeutics is of high relevance.


Assuntos
Bromocriptina/uso terapêutico , Doenças Cocleares/tratamento farmacológico , Perda Auditiva Neurossensorial/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Audiometria de Tons Puros , Doenças Cocleares/complicações , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Prolactinoma/patologia , Recidiva
13.
Rehabilitacion (Madr) ; 53(3): 155-161, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31370942

RESUMO

INTRODUCTION: The aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). METHODS: We conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale. RESULTS: Of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R). CONCLUSIONS: Considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Bromocriptina/uso terapêutico , Fármacos do Sistema Nervoso Central/uso terapêutico , Transtornos da Consciência/tratamento farmacológico , Adolescente , Adulto , Bromocriptina/administração & dosagem , Fármacos do Sistema Nervoso Central/administração & dosagem , Coma Pós-Traumatismo da Cabeça/tratamento farmacológico , Esquema de Medicação , Humanos , Pessoa de Meia-Idade , Estado Vegetativo Persistente/tratamento farmacológico , Estudos Retrospectivos , Medição de Risco , Índices de Gravidade do Trauma , Adulto Jovem
14.
World Neurosurg ; 129: e686-e694, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181361

RESUMO

OBJECTIVE: First-line treatment for prolactin-producing pituitary adenomas is dopamine agonist (DA) therapy. This is the first study to analyze the rate of radiographic and hormonal regression of prolactinomas in response to DA therapy to better understand what time frame we consider DA treatment failure. METHODS: We searched the electronic medical records of 3 tertiary care medical institutions for patients with prolactinomas. The primary outcome was tumor volume and prolactin (PRL) levels at various time points. The secondary outcome was indicators of treatment failure. Modeling by both linear and exponential models was tested to determine potential predictors of response magnitude and treatment failure by multivariate and regression analyses respectively. RESULTS: There were 99 patients (53% male) included in this analysis. The mean patient age was 42.7 years ± 14.5, and mean width/volume of tumor at diagnosis was 12.3 mm and 1.3 cm3, respectively. The mean PRL level at diagnosis was 593.2 ng/mL (79-7913). Modeling indicated a plateau at 68.2% initial volume (95% confidence interval 61.7-73.5) by 12.6 months and a PRL plateau of 21.4 ng/mL (95% confidence interval 0-92.5) by 3.3 months. Multivariate analyses revealed male sex (odds ratio 0.168; P = 0.036) to be a predictor of faster PRL response to DA therapy. CONCLUSIONS: Prolactinomas plateau in PRL levels and the rate of size regression within the first year of DA treatment. Prolactinomas with lack of size regression and failure to reach normalization of PRL levels by 12 months may be considered for other management strategies.


Assuntos
Bromocriptina/uso terapêutico , Cabergolina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactina/sangue , Prolactinoma/tratamento farmacológico , Adulto , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Prolactinoma/sangue , Prolactinoma/diagnóstico por imagem , Prolactinoma/patologia , Fatores Sexuais , Falha de Tratamento , Carga Tumoral
15.
Breast J ; 25(5): 974-976, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31165510

RESUMO

Lactating adenomas are painful, benign breast lesions, typically presenting during pregnancy and treated with surgery. Here we present a case of a 25-year-old pregnant woman who developed multiple, bilateral lactating adenomas and was successfully treated during her third trimester with bromocriptine alone. Bromocriptine, a dopamine agonist, may be used in pregnancy to effectively treat lactating adenomas in lieu of surgery.


Assuntos
Adenoma/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Bromocriptina/uso terapêutico , Antagonistas de Hormônios/uso terapêutico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Adulto , Feminino , Humanos , Dor/tratamento farmacológico , Gravidez , Terceiro Trimestre da Gravidez
16.
Intern Med ; 58(21): 3125-3128, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243214

RESUMO

A 22-year-old Japanese woman consulted an endocrinologist due to persistent galactorrhea for the past 10 months. She had hyperprolacinemia and had previously been diagnosed with type 2 diabetes mellitus based on her glycohemoglobin level of 11.6%. After two months, she was admitted to our hospital and finally diagnosed with prolactinoma. For the treatment of prolactinoma, bromocriptine 2.5 mg/day was started. After seven days, her post-prandial blood glucose levels, homeostasis model assessment of insulin resistance and plasma C-peptide levels were significantly improved. These results indicate that traditional bromocriptine can be an effective therapeutic alternative in patients with prolactinoma complicated with type 2 diabetes.


Assuntos
Bromocriptina/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Amenorreia , Diabetes Mellitus Tipo 2/complicações , Feminino , Galactorreia/tratamento farmacológico , Galactorreia/etiologia , Humanos , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Adulto Jovem
17.
BMJ Case Rep ; 12(6)2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31213433

RESUMO

While neuroleptic malignant syndrome (NMS) is typically characterised by delirium, motor rigidity, fever and dysautonomia, the syndrome is not pathognomonic, and NMS remains a diagnosis of exclusion. Here, we describe the case of a 44-year-old woman, with no relevant psychiatric history, admitted to a nephrology unit due to acute renal failure. After administration of antipsychotics, she presented with mental status alteration, generalised tremor, rigidity and autonomic nervous system dysfunction. Fever and rhabdomyolysis, however, were not prominent, and NMS was not considered initially in the differential diagnosis. The resulting delay in diagnosis, with continued administration of antipsychotics, led to progressive clinical deterioration. Once NMS was considered, however, antipsychotics were withdrawn and the patient was treated with electroconvulsive therapy (ECT), followed by administration of a dopamine receptor agonist, with close to full remission of all symptoms. Importantly, during outpatient follow-up, sustained mild and asymmetric tremor and rigidity was noted, leading to a diagnosis of Parkinson's disease. While this raises questions regarding differential diagnosis between NMS in Parkinson's disease, versus worsening of Parkinson's disease due to antipsychotic treatment, the former is supported by the acute and rapidly progressive onset of exuberant autonomic dysfunction and clouded conscience, after administration of a neuroleptic. Ultimately, a definitive distinction between these two alternatives for diagnosis of the inaugural neurological presentation in this patient is not possible. Nevertheless, we believe this case illustrates that NMS can be easily missed, particularly in atypical cases, delaying appropriate treatment, and that a flexible multimodal treatment approach, involving ECT, should be considered for complex clinical cases. Furthermore, it also underlines the importance of post-NMS follow-up, to investigate underlying neurological or medical disorders, particularly in those patients who do not have a full recovery.


Assuntos
Lesão Renal Aguda/terapia , Anticonvulsivantes/uso terapêutico , Antipsicóticos/uso terapêutico , Bromocriptina/uso terapêutico , Lorazepam/uso terapêutico , Síndrome Maligna Neuroléptica/diagnóstico , Lesão Renal Aguda/fisiopatologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Síndrome Maligna Neuroléptica/tratamento farmacológico , Síndrome Maligna Neuroléptica/fisiopatologia , Diálise Renal , Resultado do Tratamento
18.
Georgian Med News ; (287): 26-29, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30958283

RESUMO

Currently, lots of young couples are facing infertility. One of the relatively rare causes of female infertility is prolactinoma - hormonally active pituitary tumor that secretes excessive quantity of prolactin. Excessive prolactin production is leading to anovulation and women infertility. We propose for your attention a case report management of patient with prolactinoma. Long and adequate administration of inhibitors of prolactin secretion leads to regression of the tumor size up to its complete disappearance, which allows patients with prolactinoma not only to get pregnant, but also to nurse and give birth to healthy children.


Assuntos
Galactorreia/etiologia , Infertilidade Feminina/etiologia , Neoplasias Hipofisárias/diagnóstico , Prolactina/sangue , Prolactina/metabolismo , Prolactinoma/diagnóstico , Bromocriptina/uso terapêutico , Antagonistas de Dopamina/uso terapêutico , Feminino , Humanos , Infertilidade Feminina/sangue , Distúrbios Menstruais/etiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológico , Gravidez , Resultado da Gravidez , Prolactinoma/complicações , Prolactinoma/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
19.
Cell Death Dis ; 10(5): 335, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-31000722

RESUMO

The treatment of hyperprolactinemia is based on the use of dopamine agonists, mainly bromocriptine (BRC) and cabergoline (CAB). They reduce tumour size effectively and restore gonadal function. However, there is a difference in drug sensitivity between CAB and BRC in patients with prolactinoma, although the underlying mechanisms are still unknown. Thus, we investigated whether there are differences in tumour sensitivity to CAB and BRC and their possible differential mechanisms in two prolactinoma cell lines. In our study, we found that GH3 cells are more sensitive to BRC and that MMQ cells are more sensitive to CAB. Moreover, BRC and CAB elicited cell death via different pathways; BRC induced prolactinoma cell death mainly through the apoptosis pathway, and CAB induced pituitary prolactinoma cell death mainly via the autophagic cell death pathway. Using gene microarray analysis, we found that BRC induces the apoptosis of prolactinoma cells through the ERK/EGR1 signalling pathway, whereas CAB induces autophagic death by inhibiting the AKT/mTOR signalling pathway. Our study showed the difference in tumour sensitivity and differential mechanisms in BRC- and CAB-treated prolactinoma cells, which provides a theoretical basis for the accurate treatment of prolactinoma.


Assuntos
Apoptose/efeitos dos fármacos , Bromocriptina/farmacologia , Cabergolina/farmacologia , Transdução de Sinais/efeitos dos fármacos , Clorometilcetonas de Aminoácidos/farmacologia , Animais , Bromocriptina/uso terapêutico , Cabergolina/uso terapêutico , Linhagem Celular Tumoral , Proteína 1 de Resposta de Crescimento Precoce/antagonistas & inibidores , Proteína 1 de Resposta de Crescimento Precoce/genética , Proteína 1 de Resposta de Crescimento Precoce/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Feminino , Camundongos , Camundongos Nus , Proteínas Associadas aos Microtúbulos/metabolismo , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia , Prolactinoma/tratamento farmacológico , Prolactinoma/metabolismo , Prolactinoma/patologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Interferência de RNA , RNA Interferente Pequeno/metabolismo , Ratos , Serina-Treonina Quinases TOR/metabolismo
20.
Clin Rheumatol ; 38(5): 1263-1270, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30635855

RESUMO

The sexual dimorphic prevalence of autoimmunity represents one of the most alluring observations among the mosaic of autoimmunity. Sex hormones are believed to be a mainstay of this asymmetry. The greater prevalence of autoimmunity among fertile women, disease onset/relapses during pregnancy, and postpartum are some of the points that support this theory. Undeniably, motherhood represents one of the most remarkable challenges for the immune system that not only has to allow for the conceptus but also deal with extraordinary hormonal alterations. Prolactin has a recognized immune-stimulatory effect, mainly inhibiting the negative selection of autoreactive B lymphocytes. In accordance, hyperprolactinemia has been associated with several autoimmune diseases, interfering with its pathogenesis and activity. During the pregnancy and lactation period, assorted autoimmune patients experience relapses, suggesting an active interference from increased levels of prolactin. This association was found to be significant in systemic lupus erythematosus, rheumatoid arthritis, and peripartum cardiomyopathy. Furthermore, treatment with bromocriptine has shown beneficial effects specially among systemic lupus erythematosus patients. In this review, we attempt to provide a critical overview of the link between prolactin, autoimmune diseases, and motherhood, emphasizing whether breastfeeding should be avoided among women, both with diagnosed disease or high risk for its development.


Assuntos
Autoimunidade , Aleitamento Materno/efeitos adversos , Hiperprolactinemia/etiologia , Prolactina/metabolismo , Artrite Reumatoide/imunologia , Bromocriptina/uso terapêutico , Feminino , Humanos , Hiperprolactinemia/tratamento farmacológico , Lactente , Saúde do Lactente , Recém-Nascido , Lúpus Eritematoso Sistêmico/imunologia , Leite Humano/imunologia , Escleroderma Sistêmico/imunologia
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