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2.
Pediatr Hematol Oncol ; 37(5): 438-444, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32299275

RESUMO

Involvement of the pituitary gland by leukemic infiltration is exceedingly rare. Here, we describe a very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor and review the literature for previously reported cases. Our female patient presented 13 years after completion of therapy for B-ALL with headache, amenorrhea, galactorrhea and a pituitary mass. Subsequent studies revealed recurrence of her leukemia, and the pituitary lesion resolved after induction chemotherapy. Our case highlights the importance of considering leukemic infiltrate in the differential diagnosis of pituitary mass, particularly in a patient with a history of hematologic malignancy, sparing unnecessary surgical intervention and informing endocrine evaluation. In addition, the case also highlights difficulties with characterizing this recurrence as a very late relapse or clonal evolution of the original leukemia.


Assuntos
Infiltração Leucêmica/diagnóstico , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Diagnóstico Diferencial , Feminino , Galactorreia/diagnóstico , Humanos , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Prolactina/sangue , Recidiva , Tireotropina/sangue , Adulto Jovem
5.
J Med Case Rep ; 13(1): 334, 2019 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-31731892

RESUMO

BACKGROUND: Inflammation of the pituitary gland can occur in a variety of primary or secondary disorders. Idiopathic granulomatous hypophysitis is a rare inflammatory disease of the pituitary gland that can closely mimic a pituitary adenoma clinicoradiologically. Most authorities agree on minimally invasive transsphenoidal surgery as the mainstay in diagnosis and treatment of this disorder. There is still some controversy regarding pure medical management of idiopathic granulomatous hypophysitis in the literature. CASE PRESENTATION: A 47-year-old Iranian woman of Azeri ethnicity with a history of benign breast cysts with a chief complaint of galactorrhea presented to our endocrinology clinic. Her past medical history was negative for any menstrual irregularities, hirsutism, visual complaints, diplopia, polyuria and polydipsia or seizures. She was taking 100 mcg of levothyroxine daily. Her familial history and physical examination were unremarkable. Her initial laboratory work-up revealed hyperprolactinemia (82.4 ng/mL) with otherwise normal pituitary axes. Brain magnetic resonance imaging showed a pituitary macroadenoma for which she was treated with 0.5 mg of cabergoline weekly. Although her serum prolactin level dropped to 1.7 ng/mL and her galactorrhea was resolved, she continued to complain of headaches and nausea. Repeated imaging showed no decrease in size of the macroadenoma. Therefore, she underwent transsphenoidal surgery of the macroadenoma which was reported as chronic granulomatous hypophysitis by expert pathologists. Tuberculosis, sarcoidosis, Wegener's granulomatosis, Langerhans cell histiocytosis, and syphilis were ruled out by appropriate tests and she was diagnosed as having idiopathic granulomatous hypophysitis. Fortunately, her condition was not complicated by hypopituitarism and she was symptom free 9 months after transsphenoidal surgery. CONCLUSIONS: Idiopathic granulomatous hypophysitis, a rare inflammatory disease of the pituitary gland, is a diagnosis of exclusion for which both medical and surgical management are reported in the literature. We present a case of idiopathic granulomatous hypophysitis who was symptom free with no complications of hypopituitarism following its transsphenoidal resection after 9 months of follow-up.


Assuntos
Anti-Inflamatórios/uso terapêutico , Hipofisite Autoimune/diagnóstico , Imagem por Ressonância Magnética , Prednisolona/uso terapêutico , Tiroxina/uso terapêutico , Hipofisite Autoimune/fisiopatologia , Hipofisite Autoimune/terapia , Feminino , Galactorreia/etiologia , Cefaleia/etiologia , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Náusea/etiologia , Neuroimagem , Resultado do Tratamento
8.
Endocr Pract ; 25(10): 1067-1073, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31170360

RESUMO

Objective: Simonetta Vespucci, considered the most beautiful woman of the Renaissance, is the inspiration and face of one of the most famous paintings of all times, "The Birth of Venus," by Botticelli. She died in 1476 at the age of 23 years. We postulate she suffered from a pituitary-secreting tumor progressing to pituitary apoplexy. The goals of this study were 3-fold: (i) verify that the subject depicted by Botticelli in different paintings represents the same woman; (ii) identify the facial traits affected by the progression of a growth hormone- and prolactin-secreting tumor; and (iii) confirm that the observed changes of the face traits observed in the portraits of Simonetta Vespucci are compatible with the facial traits changes identified earlier. Methods: Comparison among face traits was based on the analysis of the face regions measured by means of fiducial points and their distances, and after pose compensation based on three-dimensional head modelling. Results: In favor of the hypothesis that Simonetta suffered from a pituitary growth hormone- and prolactin-secreting tumor stands changes of her lineaments, a feature which becomes evident over the years and particularly manifest in the Allegorical Lady, where galactorrhea is depicted. Conclusion: We conclude that sufficient evidence is presented to suggest that Simonetta Vespucci, the Venus depicted by Botticelli, suffered from pituitary adenoma secreting prolactin and growth hormon with parasellar expansion. The current interpretation of the Venus strabism should be revisited according to this finding. Abbreviation: GH = growth hormone.


Assuntos
Adenoma , Neoplasias Hipofisárias , Feminino , Galactorreia , Hormônio do Crescimento , Humanos , Gravidez , Prolactina
9.
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
10.
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
11.
J Affect Disord ; 250: 330-332, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30875676

RESUMO

BACKGROUND: It is well known that aripiprazole co-treatment effectively reduces antipsychotic-induced hyperprolactinemia. However, the effectiveness of aripiprazole to treat high prolactin levels induced by antidepressant drugs with serotoninergic activity, such as duloxetine, remains unknown. CASE PRESENTATION: An 18-year-old female diagnosed with major depressive disorder (MDD) was treated with 100 mg sertraline once daily. After two weeks, galactorrhoea was observed. Blood biochemical tests revealed an elevated serum prolactin level of 241 ng/mL. Physiological causes and additional potential pathological causes were ruled out. Therefore, sertraline was cross tapered with mirtazapine. Galactorrhoea ceased, but the side-effect of sedation prompted a switch to 40 mg duloxetine twice daily. After two weeks, the patient developed menstrual irregularities and milky discharge concomitant with a serum prolactin level of 205 ng/mL. As a result, duloxetine was decreased to 60 mg once daily, and aripiprazole was initiated at 2.5 mg daily and titrated to 5 mg daily. Two weeks after the initiation of dual therapy, galactorrhoea stopped, and prolactin levels decreased to 118 ng/mL. After eight weeks, prolactin levels decreased to 39 ng/mL, and menstruation returned to normal. After antidepressant therapy finished, prolactin levels normalized to 19 ng/mL. CONCLUSION: The case suggests that adjunctive aripiprazole may be useful as a treatment option for duloxetine-induced hyperprolactinemia in MDD.


Assuntos
Antipsicóticos/efeitos adversos , Aripiprazol/uso terapêutico , Cloridrato de Duloxetina/efeitos adversos , Hiperprolactinemia/tratamento farmacológico , Receptores de Dopamina D2/agonistas , Adolescente , Amenorreia , Transtorno Depressivo Maior/tratamento farmacológico , Quimioterapia Combinada , Feminino , Galactorreia , Humanos , Hiperprolactinemia/induzido quimicamente , Distúrbios Menstruais , Prolactina/sangue
12.
J Formos Med Assoc ; 118(10): 1430-1437, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30612883

RESUMO

BACKGROUND/PURPOSE: The objectives of this study were to describe epidemiological data, treatment outcomes, and quality of life (QOL) of patients with acromegaly in Taiwan. METHODS: From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. After enrollment, each patient was kept on observation for 1 year. RESULTS: The analyzed cohort included 272 acromegalic subjects (117 males, 155 females) with a mean age of 51.4 ± 12.9 years. Their mean age at diagnosis was 41.8 ± 12.1 years. About 83.8% patients presented symptoms of facial changes. Galactorrhea was noted at the earliest age of 32.7 ± 9.1 years. The duration between the onset of symptoms/signs and diagnosis was 6.9 ± 8.1 years. Around 70.3% patients harbored a macroadenoma. At enrollment, percentages of patients ever received surgical intervention, radiotherapy, somatostatin analogs, and dopamine agonists were 94.8%, 27.9%, 64%, and 30%, respectively. At the final following-up visit, the random growth hormone (GH), nadir GH after oral glucose tolerance test, and the insulin-like growth factor 1 levels were 2.7 ± 4.9 µg/L, 2.4 ± 6.1 µg/L, and 291.5 ± 162.4 ng/mL, respectively. The remission rate assessed by random GH level (≦2 µg/L) was 63.8%. The mean AcroQoL scores for the total 22 items were 64.0 ± 19.7. About 42.8% patients never sensed or felt discomfort about their changes in appearance. CONCLUSION: This study described the profiles of acromegaly in Taiwan. It is important to enhance early diagnosis and timely commencement of treatment to prevent serious complications of acromegaly.


Assuntos
Acromegalia/diagnóstico , Acromegalia/terapia , Adenoma/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Qualidade de Vida , Acromegalia/sangue , Acromegalia/epidemiologia , Adenoma/complicações , Adenoma/terapia , Adulto , Glicemia/metabolismo , Feminino , Seguimentos , Galactorreia/etiologia , Hormônio do Crescimento/sangue , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Taiwan/epidemiologia , Adulto Jovem
13.
Clin Neurol Neurosurg ; 176: 53-60, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30529652

RESUMO

Pituitary prolactinomas in women often lead to amenorrhea, galactorrhea, or infertility. The purpose of this study was to evaluate the effectiveness of transsphenoidal surgery (TSS) in restoring fertility in women with proloactinomas. A systematic search of the literature was conducted in accordance with PRISMA guidelines through 6/13/2017. PubMed, Embase, and Cochrane databases were utilized to select studies reporting on patients with pituitary prolactinomas removed via TSS. Outcomes extracted included pre- and post-operative rates of menses, lactation, and fertility. Pooled effect estimates were calculated using random-effects. After removal of duplicates, 900 articles remained, of which 14 were meta-analyzed. The mean difference between pre- and post-operative prolactin level was 186.9 (95% CI = 133.7, 240.1; I2 = 69.9%; P-heterogeneity<0.01; 7 studies). The pooled prevalence of pre-operative amenorrhea was 96% (95% CI = 92%, 98%; I2 = 45.8%; P-heterogeneity = 0.09; 11 studies) and significantly larger than post-operative amenorrhea of 40% (95% CI = 27%, 55%; P- I2 = 85%; heterogeneity<0.01; 11 studies); (P-interaction comparing the 2 groups <0.01). The pooled prevalence of pre-operative galactorrhea was 84% (95% CI = 74%, 90%; I2 = 66.9%; P-heterogeneity<0.01; 10 studies) and significantly larger than post-operative galactorrhea of 29% (95% CI = 17%, 44%; I2 = 76.5%; P-heterogeneity<0.01; 7 studies) (P-interaction<0.01). Univariate meta-regression on age, continent, publication year, study design, quality, duration, or timing revealed these covariates were not effect modifiers for any of the 3 outcomes (all P > 0.05). No evidence of publication bias was seen using Begg's and Egger's tests (all P > 0.05). Transsphenoidal surgery appeared to improve fertility measures in women with pituitary prolactinomas.


Assuntos
Fertilidade/fisiologia , Neoplasias Hipofisárias/cirurgia , Prolactinoma/complicações , Prolactinoma/cirurgia , Amenorreia/cirurgia , Feminino , Galactorreia/cirurgia , Humanos , Neoplasias Hipofisárias/complicações , Gravidez , Prolactina/sangue
14.
Aesthetic Plast Surg ; 43(2): 366-369, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30456639

RESUMO

BACKGROUND: Breast augmentation is one of the most frequently performed esthetic operations. Galactorrhea and galactocele formation are both very rare complications. The real cause still remains unknown, but various risk factors have been well reported in the literature. This report concerns a case of postoperative galactocele following bilateral breast augmentation via the inframammary approach with dual-plane insertion of implants, which is usually considered a protective approach in terms of risk factors for induction of postoperative galactorrhea. METHODS: The patient had no significant surgical, gynecological or medical history, including galactorrhea or hyperprolactinemia, and did not present any chest wall abnormalities. There has been no use of oral contraceptives or any other drugs. After the surgical procedure, the patient presented with infection-like symptoms, for which galactorrhea or galactocele was initially not considered, mainly for the absence of specific risk factors. RESULTS: After antibiotic and bromocriptine therapy, her breast returned to normal, with no pain, inflammation, enlargement or esthetic alterations. After 6 months of follow-up, the patient did not present any abnormality and she was satisfied with the result. CONCLUSION: With our report, we want to underline that galactorrhea and galactocele cannot be ruled out, even in patients with no risk factors and with procedures considered as "protective." With a fast diagnosis and a specific therapy, implants and final result can be rescued. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Amenorreia/etiologia , Cisto Mamário/etiologia , Implantes de Mama/efeitos adversos , Galactorreia/etiologia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Géis de Silicone , Amenorreia/diagnóstico , Cisto Mamário/diagnóstico , Feminino , Galactorreia/diagnóstico , Humanos , Complicações Pós-Operatórias/diagnóstico , Adulto Jovem
15.
J Clin Psychopharmacol ; 38(4): 317-326, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29912799

RESUMO

PURPOSE/BACKGROUND: Prolactin-related adverse effects contribute to nonadherence and adverse health consequences, particularly in women with severe mental illness. Treating these adverse effects may improve treatment acceptability, adherence, and long-term outcomes. METHODS/PROCEDURES: Premenopausal women with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder were recruited for a randomized, double-blind, placebo-controlled 16-week trial of adjunct aripiprazole (5-15 mg/d). Participants had elevated prolactin (>24 ng/mL) and were experiencing galactorrhea, amenorrhea, oligomenorrhea, or sexual dysfunction on a prolactin-elevating antipsychotic. Participants were evaluated biweekly for prolactin elevation and galactorrhea and completed a menstrual diary review. Psychiatric symptoms and adverse effects were closely monitored. FINDINGS/RESULTS: Forty-six women were randomized (n = 25 aripiprazole, n = 21 placebo). Thirty-seven completed at least 8 weeks of the study (n = 20 [80%] aripiprazole and n = 17 [81%] placebo). Aripiprazole (mean dose, 11.7 ± 2.4 mg/d) was effective for lowering prolactin relative to placebo (P = 0.04). In addition, 45% (9/20) of the aripiprazole group had a normalized prolactin (<24 mg/mL) compared with 12% (2/17) of the placebo group (P = 0.028). Galactorrhea resolved in 77% (10/13) of the aripiprazole-treated participants compared with 33% (4/12) in the placebo group (P = 0.028). Normalization of sexual function (<16 on the Arizona Sexual Experience Scale) occurred in 50% on aripiprazole (7/14) versus 9% (1/11) on placebo (P = 0.030). No differences between groups in symptoms or adverse effects were noted. Overall, women rated a mean score of 4.6 ± 0.6 on a 5-point Likert scale for sexual function improvement, suggesting their particular satisfaction with improvement in this domain. IMPLICATIONS/CONCLUSIONS: Building upon prior studies, this rigorous evaluation confirms the utility of adjunctive aripiprazole as a strategy for improving prolactin and managing prolactin-related adverse effects in premenopausal women with psychosis.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Quimioterapia Combinada/métodos , Pré-Menopausa/efeitos dos fármacos , Prolactina/sangue , Transtornos Psicóticos/tratamento farmacológico , Adulto , Amenorreia/induzido quimicamente , Amenorreia/prevenção & controle , Antipsicóticos/efeitos adversos , Aripiprazol/administração & dosagem , Método Duplo-Cego , Feminino , Galactorreia/induzido quimicamente , Galactorreia/prevenção & controle , Humanos , Adesão à Medicação , Oligomenorreia/induzido quimicamente , Oligomenorreia/prevenção & controle , Qualidade de Vida
16.
BMJ Case Rep ; 20182018 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-29627777

RESUMO

The clinical presentation of a young woman with galactorrhoea is described in detail including the history and clinical examination findings. While the patient and her family members feared a serious medical condition which had so far been an obscurity despite a number of investigations, we tried to diagnose the patient starting from the basics, which after a proper history revealed a levosulpiride-induced galactorrhoea. This again lays emphasis on the old adage in medical field that 'a proper history and examination are the key to diagnosis'. There are few reports pertaining to levosulpiride-induced galactorrhoea making it a rare side effect of this drug. We further try to discuss the different causes of galactorrhoea in a young non-pregnant woman which can be encountered in clinical practice.


Assuntos
Dispepsia/tratamento farmacológico , Galactorreia/induzido quimicamente , Infecções por Helicobacter/tratamento farmacológico , Hipófise/fisiopatologia , Inibidores da Bomba de Prótons/efeitos adversos , Sulpirida/análogos & derivados , Depressão/etiologia , Feminino , Galactorreia/diagnóstico , Galactorreia/psicologia , Infecções por Helicobacter/complicações , Humanos , Hipófise/efeitos dos fármacos , Inibidores da Bomba de Prótons/uso terapêutico , Sulpirida/efeitos adversos , Sulpirida/uso terapêutico , Resultado do Tratamento , Adulto Jovem
18.
J Coll Physicians Surg Pak ; 28(2): 93-97, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29394965

RESUMO

OBJECTIVE: To determine the frequency of Macroprolactin (MaPRL) in patients with increased total prolactin and its clinical and financial impact. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from March to May 2015. METHODOLOGY: Patients with high total prolactin were screened by polyethylene glycol (PEG) precipitation for determination of MaPRL. Clinical history, imaging work-ups, and cost incurred in further investigations were collected by telephonic interview after verbal consent. Patients were stratified into true hyperprolactinemia and macroprolactinemia after PEG treatment, based on monomeric prolactin levels. Medical records of cases registered with AKUH were reviewed to confirm the diagnosis. RESULTS: Two hundred and thirty-nine patients were identified with high prolactin levels. Macroprolactinemia was identified in 145 (60.7%) and true hyperprolactinemia in 94 (39.3%) patients. Galactorrhea was significantly more in true hyperprolactinemic females (p=0.022), followed by visual disturbances (p=0.01) and headache (p=0.006). Moreover, as majority of population were females, the clinical features in the macroprolactinemia group as compared to true hyperprolactinemic group were mostly related to non-pituitary causes like drug intake [42.5% (54) vs. 37% (30)], heat intolerance due to thyroidal illness [41.7% (53) vs. 38.3% (31)] and surgery [26.8% (34) vs 22.2% (18)] in females. Further radiological workup (MRI, CT) were conducted in 35 (37.2%) patients with true hyperprolactinemia. Twenty-one (60%) of the patients were confirmed to have pituitary adenomas. In eight (5.5%) patients with MaPRL, only one had pituitary microadenoma on radiological workup. Total cost impact on the basis of investigations, was significantly higher in the group undergone imaging, despite 7 out of 8 individuals found to have normal imaging results. The median total cost in true hyperprolactinemic group undergone imaging was Rs. 4370 (IQR=2412.5, 22850) as compared to macroprolactinemic groups; Rs. 3,250 (IQR=2150, 4278). There was significant difference in the cost burden of both the groups (p <0.001). CONCLUSION: High frequency of MaPRL was identified in patients with hyperprolactinemia. Screening with PEG precipitation in hyperprolactinemic sera is simple and cost-effective.


Assuntos
Adenoma/diagnóstico por imagem , Amenorreia/epidemiologia , Efeitos Psicossociais da Doença , Galactorreia/epidemiologia , Hiperprolactinemia/epidemiologia , Hiperprolactinemia/etiologia , Imagem por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Adenoma/complicações , Adenoma/epidemiologia , Adulto , Amenorreia/sangue , Estudos Transversais , Feminino , Galactorreia/sangue , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Humanos , Hiperprolactinemia/sangue , Hiperprolactinemia/complicações , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/métodos , Masculino , Paquistão/epidemiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/epidemiologia , Polietilenoglicóis , Estudos Retrospectivos , Tomógrafos Computadorizados
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