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2.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334740

RESUMO

Myasthenia gravis (MG) is a rare and potentially dangerous autoimmune condition, which affects the acetylcholine receptors at the neuromuscular junction of skeletal muscle. MG's diverse symptomatology may readily masquerade as other neurological conditions, posing a diagnostic challenge to clinicians. We describe a 24-year old man who presented to the emergency department with a new onset internuclear ophthalmoplegia. After a series of investigations, we eventually arrived at a diagnosis of MG with pseudointernuclear ophthalmoplegia with an incidentally detected prolactinoma. We explore the literature regarding the pathophysiology of pseudointernuclear ophthalmoplegia, the link between prolactin and autoimmunity and the association between prolactinoma and MG.


Assuntos
Diplopia/etiologia , Miastenia Gravis/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Humanos , Achados Incidentais , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/imunologia , Transtornos da Motilidade Ocular/diagnóstico , Hipófise/diagnóstico por imagem , Hipófise/metabolismo , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Prolactina/sangue , Prolactina/metabolismo , Prolactinoma/sangue , Prolactinoma/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Psychiatr Danub ; 32(3-4): 367-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370734

RESUMO

BACKGROUND: The prevalence of hyperprolactinemia among psychiatric patients receiving antipsychotic medications was estimated to be between 30% and 70%. A review of the literature on prolactin and schizophrenia symptoms suggests that the correlation between them is complex and not limited to the adverse effects of antipsychotics. Relations with specific symptom dimensions have not been found consistently across studies. The association between increased prolactin and recurrent episodes of schizophrenia needs to be replicated in larger samples and in a population of female patients. The aim of this study was to find out whether elevated prolactin is related to specific symptoms or dimensions of schizophrenia, which is a heterogenic entity. SUBJECTS AND METHODS: The sample consisted of 119 consecutively acute admitted women, aged 18 to 45 years with recurrent schizophrenia diagnosed on bases of DSM-5 criteria. Assessment for all the enrolled subjects comprised a psychiatric evaluation and blood draw to determine the prolactin level. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS). Data were analyzed by regression analysis and the Independent Samples t Test. Values are given as means ±SD. RESULTS: Hyperprolactinemia was detected in 74.79% patients (n=89), whereas the group without hyperprolactinemia comprised 25.21% of the sample. When plasma prolactin levels and clinical features between groups were compared, there was a statistically significant difference in the negative subscale scores of the PANSS (p=0.0011), positive subscale scores of the PANNS (p=0.0043), general subscale scores of the PANSS (p=0.0226) and total scores of the PANNS (p=0.0003). CONCLUSION: There were statistically significant differences in the clinical symptoms between two compared groups in total score and in the positive, negative and general subscores.


Assuntos
Hiperprolactinemia/sangue , Prolactina/sangue , Esquizofrenia/sangue , Psicologia do Esquizofrênico , Adolescente , Adulto , Antipsicóticos/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Esquizofrenia/tratamento farmacológico , Adulto Jovem
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(8): 525-529, oct. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196885

RESUMO

INTRODUCTION: Hyperprolactinemia may be due to physiological or pathological causes, and may be asymptomatic or induce hypogonadism, infertility, and/or galactorrhea. It is important to take prolactin samples while avoiding stress, as this may increase prolactin levels. Therefore, our aim was to assess the value of prolactin serial sampling after brachial vein cannulation. PATIENTS AND METHODS: Sixty-six patients (34.9±11.8 years of age, 92.4% female) with an initial elevated random prolactin level were included. A prolactin sample was drawn at baseline and after a 30min rest. RESULTS: The median referral prolactin level was 37.4ng/ml (interquartile range [IQR* 23.3), the baseline prolactin level at serial sampling was 19.5ng/ml (IQR 8), and the value after a 30min rest was 17.1ng/ml (IQR 7.9). Hyperprolactinemia was not confirmed by serial sampling in 45 patients (68.2%). There were no statistically significant differences in referral prolactin levels between patients with and without confirmed hyperprolactinemia (41.2ng/ml and 36.7ng/ml respectively, p = 0.3). Galactorrhea was found in 13.6% of patients, amenorrhea or oligomenorrhea in 28.8%, infertility in 7.6%, erectile dysfunction in 4.6%, and gynecomastia in 3%, while 45.5% were asymptomatic. There were no statistical differences regarding the presence or absence of any of these symptoms and subsequent confirmed hyperprolactinemia. Fifty-seven patients (86.4%) were discharged after the results of the prolactin serial sampling were obtained. CONCLUSIONS: Prolactin serial sampling may be a useful test to detect artefactual hyperprolactinemias, thus avoiding unnecessary additional tests and treatments


INTRODUCCIÓN: La hiperprolactinemia puede ser debida a causas fisiológicas o patológicas, y puede ser asintomática o inducir hipogonadismo, infertilidad y/o galactorrea. Es importante obtener las muestras de prolactina evitando situaciones de estrés, puesto que este puede incrementar sus niveles. Por tanto, nuestro objetivo era evaluar la utilidad de la realización de curvas de prolactina mediante canalización de la vena braquial. MATERIALES Y MÉTODOS: Se incluyeron 66 pacientes (edad: 34,9±11,8 años; 92,4% mujeres) con una prolactina aleatoria inicial elevada. Se obtuvieron una muestra de prolactina basal y otra tras un reposo de 30min. RESULTADOS: La prolactina mediana inicial fue 37,4ng/ml (IQR: 23,3), la prolactina basal de la curva 19,5ng/ml (IQR: 8), y tras 30min de reposo, 17,1ng/ml (IQR: 7,9). La curva descartó una hiperprolactinemia en 45 pacientes (68,2%) No hubo diferencias estadísticamente significativas en la prolactina de derivación entre aquellos pacientes en los que se confirmó una hiperprolactinemia y aquellos que no (41,2 vs. 36,7ng/ml; p = 0,3). Un 13,6% de los pacientes presentaron galactorrea, un 28,8% amenorrea u oligomenorrea, un 7,6% infertilidad, un 4,6% disfunción eréctil y un 3% ginecomastia. El 45,5% estaban asintomáticos. No hubo diferencias estadísticamente significativas entre la presencia o ausencia de ninguno de estos síntomas y una hiperprolactinemia confirmada posteriormente. Se pudo dar de alta a 57 pacientes (86,4%) tras la obtención de los resultados de la curva de prolactina. CONCLUSIONES: La curva de prolactina puede ser una prueba útil pata detectar falsas hiperprolactinemias, evitando la realización de pruebas complementarias y tratamientos adicionales innecesarios


Assuntos
Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Hiperprolactinemia/diagnóstico , Prolactina/análise , Prolactina/sangue , Estudos Retrospectivos , Imunoensaio/métodos , Estatísticas não Paramétricas , Modelos Lineares
6.
PLoS One ; 15(8): e0235806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756565

RESUMO

INTRODUCTION: Oxytocin is a key hormone in breastfeeding. No recent review on plasma levels of oxytocin in response to breastfeeding is available. MATERIALS AND METHODS: Systematic literature searches on breastfeeding induced oxytocin levels were conducted 2017 and 2019 in PubMed, Scopus, CINAHL, and PsycINFO. Data on oxytocin linked effects and effects of medical interventions were included if available. RESULTS: We found 29 articles that met the inclusion criteria. All studies had an exploratory design and included 601 women. Data were extracted from the articles and summarised in tables. Breastfeeding induced an immediate and short lasting (20 minutes) release of oxytocin. The release was pulsatile early postpartum (5 pulses/10 minutes) and coalesced into a more protracted rise as lactation proceeded. Oxytocin levels were higher in multiparous versus primiparous women. The number of oxytocin pulses during early breastfeeding was associated with greater milk yield and longer duration of lactation and was reduced by stress. Breastfeeding-induced oxytocin release was associated with elevated prolactin levels; lowered ACTH and cortisol (stress hormones) and somatostatin (a gastrointestinal hormone) levels; enhanced sociability; and reduced anxiety, suggesting that oxytocin induces physiological and psychological adaptations in the mother. Mechanical breast pumping, but not bottle-feeding was associated with oxytocin and prolactin release and decreased stress levels. Emergency caesarean section reduced oxytocin and prolactin release in response to breastfeeding and also maternal mental adaptations. Epidural analgesia reduced prolactin and mental adaptation, whereas infusions of synthetic oxytocin increased prolactin and mental adaptation. Oxytocin infusion also restored negative effects induced by caesarean section and epidural analgesia. CONCLUSIONS: Oxytocin is released in response to breastfeeding to cause milk ejection, and to induce physiological changes to promote milk production and psychological adaptations to facilitate motherhood. Stress and medical interventions during birth may influence these effects and thereby adversely affect the initiation of breastfeeding.


Assuntos
Aleitamento Materno , Lactação/sangue , Ocitocina/sangue , Hormônio Adrenocorticotrópico/sangue , Ansiedade/sangue , Feminino , Humanos , Hidrocortisona/sangue , Lactação/fisiologia , Gravidez , Prolactina/sangue , Estresse Fisiológico
7.
Diabetes Res Clin Pract ; 166: 108247, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505717

RESUMO

AIM: To determine the pooled association between variations of prolactin serum levels within the physiological range and the risk of type 2 diabetes mellitus (T2D). METHODS: Pubmed, Scopus, Web of Science, and grey literature were searched for studies investigating the association between variations of prolactin serum levels in the normal range and the risk of T2D in adults. The risk of prevalent and incident T2D was summarized as the odds ratio or relative risk according to the quartile of prolactin serum concentration, using random-effects meta-analysis. RESULTS: Of 2,014 articles identified, 6 met the inclusion criteria. Data were pooled from cross-sectional studies including 6,670 subjects and longitudinal studies involving 13,203 subjects. Men with prolactin levels in the fourth quartile versus those in the first quartile had decreased risk of prevalent T2D (OR 0.52; 95%CI 0.35-077). The same association was seen in women (OR 0.46; 95%CI 0.30-0.73). Conversely, prolactin levels in the fourth versus first quartile were not associated with the risk of incident T2D in men (RR 1.21; 95%CI 0.79-1.87) or women (RR 0.77; 95%CI 0.48-1.22). CONCLUSION: Higher prolactin serum levels within the normal range were associated with reduced risk of prevalent but not incident T2D. Further studies are necessary to address whether this association is causal, but these findings raise the discussion regarding the optimal level of prolactin suppression in subjects undergoing therapy with dopaminergic agonists.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Prolactina/sangue , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Risco , Fatores de Risco
8.
Int J Sports Med ; 41(12): 846-857, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32599644

RESUMO

This study investigated the effect of performing prolonged mental exertion during submaximal cycling exercise on exercise tolerance and fatigue. Participants performed 5 experimental sessions. Session 1: determination of cycling peak power output. Sessions 2 and 3: cycling to exhaustion at 65% peak power output with mental exertion or watching a movie. Sessions 4 and 5: cycling for 45 min at 65% peak power output with mental exertion or while watching a movie. During sessions 2-5, rate of perceived exertion and heart rate were recorded while cycling and cortisol and prolactin concentrations, psychomotor vigilance task performance, and maximal voluntary contraction were measured pre-and post-sessions. During sessions 2 and 3, time to exhaustion was reduced (p<0.01) and rate of perceived exertion was increased (p<0.01) in session 2 compared to 3. Cortisol, prolactin and heart rate increased and psychomotor vigilance task and maximal voluntary contraction decreased from pre-to post-sessions with no difference between sessions. Cortisol, prolactin and rate of perceived exertion were higher (p<0.03) in session 4 than 5. Heart rate increased and maximal voluntary contraction decreased from pre-to post-sessions with no difference between sessions. Prolonged mental exertion during cycling exercise reduces exercise tolerance, which appears to be mediated psychologically rather than physiologically.


Assuntos
Ciclismo/fisiologia , Ciclismo/psicologia , Tolerância ao Exercício , Fadiga Mental/fisiopatologia , Fadiga Mental/psicologia , Frequência Cardíaca , Humanos , Hidrocortisona/sangue , Masculino , Contração Muscular/fisiologia , Percepção , Esforço Físico/fisiologia , Prolactina/sangue , Análise e Desempenho de Tarefas , Fatores de Tempo , Adulto Jovem
9.
Eur J Endocrinol ; 183(3): 307-316, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32570208

RESUMO

Objective: Low circulating prolactin is a potential marker of metabolic risk during pregnancy. We aimed to investigate associations between prolactin and glucose status in pregnant women with and without gestational diabetes mellitus (GDM) or polycystic ovary syndrome (PCOS). Design: Prospective observational cohort study. From the Odense Child Cohort, 1497 pregnant women were included. Methods: Blood samples were assessed during first, second (prolactin, hemoglobin A1c (HbA1c)) and third trimester (fasting prolactin, testosterone, HbA1c, insulin, glucose). Oral glucose tolerance test (OGTT) was performed around gestation week 28 in 350 women with risk factors for GDM and in 272 randomly included women. GDM was defined by 2-h plasma glucose ≥9.0 mmol/L. Results: The median (IQR) prolactin increased from 633 (451-829) mIU/L in first-second trimester to 5223 (4151-6127) mIU/L at third trimester. Prolactin was inversely associated with HbA1c in first (r = -0.19, P < 0.001) and third trimester (r = -0.07, P = 0.014). In third trimester, women with GDM (n = 37; 6.0%) had lower prolactin compared to women without GDM (4269 vs 5072 mIU/L, P = 0.004). Third trimester prolactin multiple of the median (MoM) was inversely associated with risk of GDM in multivariate regression analysis (OR 0.30, P = 0.034). PCOS was diagnosed in 10.0% (n = 146). Early pregnancy prolactin MoM was positively associated to PCOS diagnosis (OR 1.38, P = 0.051). Conclusions: Low prolactin levels during pregnancy were associated with higher HbA1c and risk of GDM. A diagnosis of PCOS was associated with higher early pregnancy prolactin levels.


Assuntos
Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/metabolismo , Prolactina/sangue , Glicemia/metabolismo , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/metabolismo , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/metabolismo , Resistência à Insulina/fisiologia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos
10.
Eur J Endocrinol ; 181(3): 95-105, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32530258

RESUMO

CONTEXT: Association of central diabetes insipidus (CDI) and pituitary stalk thickening (PST) may have several etiologies (including malignancies) and differential diagnosis remains often difficult. OBJECTIVE: The purpose of this study was to identify which clinical, biochemical or radiological features could help clinicians to make an etiological diagnosis, especially distinguishing neoplastic from non-neoplastic pituitary stalk lesions. DESIGNS AND METHODS: We retrospectively analyzed clinical, biochemical, radiological and histological data of 38 adult patients diagnosed with CDI and PST of proven etiology. RESULTS: Of the 38 pituitary stalk lesions included, 11 (29%) were neoplastic. A histopathological diagnosis was obtained in 22/38 (58%) patients. The three most frequently observed etiologies of PST were neuroinfundibulitis (34%), germinoma (21%) and histiocytosis (18%). Pituitary stalk thickness was larger for neoplastic lesions, particularly germinomas. Male gender and a very young age were statistically associated with a risk of germinoma. At least one anterior pituitary deficit was observed in nearly 60% of patients. Patients with neoplastic PST were more affected by multiple anterior pituitary dysfunction than patients with benign PST. A high serum prolactin level was individually the best predictor of a neoplastic origin (90% sensitivity and 60% specificity for a serum prolactin level 1.27-fold above the normal upper limit (ULN)). CONCLUSION: We confirm a relatively high risk of malignancy in adult patients presenting with the association of CDI and PST. Young age, male gender, a very large thickening of the stalk, multiple anterior pituitary deficits and prolactin above 1.3× ULN increase the likelihood of a neoplastic origin.


Assuntos
Diabetes Insípido Neurogênico/patologia , Doenças da Hipófise/patologia , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Adulto , Fatores Etários , Idoso , Diabetes Insípido Neurogênico/diagnóstico por imagem , Feminino , Germinoma/complicações , Germinoma/patologia , Histiocitose/complicações , Histiocitose/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico por imagem , Hipófise/diagnóstico por imagem , Adeno-Hipófise/diagnóstico por imagem , Adeno-Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais
11.
Eur J Endocrinol ; 183(2): 221-231, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32583656

RESUMO

Context: In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective: Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design: This was a multicenter (France and Belgium) retrospective study. Patients: Eighteen patients treated with antipsychotics were included. Results: Under DA, median PRL levels decreased from 1247 (117-81 132) to 42 (4-573) ng/mL (P = 0.008), from 3850 (449-38 000) to 141 (60-6000) ng/mL (P = 0.037) and from 1664 (94-9400) to 1215 (48-5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0-57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusions: Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.


Assuntos
Antipsicóticos/uso terapêutico , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Bélgica , Interações Medicamentosas , Feminino , França , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/psicologia , Prolactina/sangue , Prolactinoma/patologia , Prolactinoma/psicologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Recidiva , Estudos Retrospectivos
12.
Arch Gynecol Obstet ; 302(1): 265-271, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32409924

RESUMO

INTRODUCTION: Estrogen and prolactin affect vitamin D metabolism. In conditions such as pregnancy and lactation, their interaction in regulating vitamin D metabolism and circulating FGF23 is not clearly defined. The aim of this study is to investigate this interaction in female rats. METHOD: This study was performed on 50 female adult rats, which were divided into five groups of Sham, ovariectomized rats (O), and three groups of ovariectomized rats were indicated with prolactin alone (OP), estradiol alone (OE), and a combination of estradiol and prolactin (OEP). Serum levels of 25(OH)D, 1,25(OH)2D3, FGF23, PTH, vitamin D-binding protein, calcium, and phosphorous were evaluated. RESULTS: Serum 1,25(OH)2D3 and PTH in OE were higher than the O group (P < 0.001 and P = 0.003, respectively). Serum FGF23 in the OE group was lower than the O group (P = 0.016). Serum 1,25(OH)2D3 increased in OP compared to the O group (P < 0.001) and OE group (P < 0.001). Serum FGF23 in OP was lower than the O group (P = 0.04). Furthermore, combining estradiol and prolactin showed no extra effect on increasing serum 1,25(OH)2D3. Serum 1,25(OH)2D3 was positively correlated with serum prolactin levels (r = 0.318, P = 0.017) in all five groups. CONCLUSION: It is suggested that estradiol could increase 1,25(OH)2D3 by elevating PTH and decreasing serum FGF23; however, prolactin was able to increase 1,25(OH)2D3 by lowering serum FGF23. Moreover, prolactin was shown to be more potent in augmenting serum 1,25(OH)2D3 than estrogen itself, which is important in maternal and fetal calcium supply during late pregnancy and lactation.


Assuntos
Estrogênios/uso terapêutico , Fatores de Crescimento de Fibroblastos/efeitos dos fármacos , Prolactina/uso terapêutico , Vitamina D/sangue , Animais , Estrogênios/sangue , Estrogênios/farmacologia , Feminino , Prolactina/sangue , Prolactina/farmacologia , Ratos , Ratos Wistar
13.
Tunis Med ; 98(2): 138-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32395803

RESUMO

AIM: To determine the prevalence and the risk factors of hypogonadism in men with chronic renal failure (CRF). METHODS: We conducted a cross sectional analysis in 48 men with CRF. Total testosterone, prolactin, and gonadotropins were measured in all patients. Hypogonadism was defined by a low level (<10 nmol/l) or a low normal level (10-14 nmol/l) of total testosterone. RESULTS: The mean age was 53.31±10.22 years. Renal impairment was mild, moderate, severe and at end stage in 9,14,4 and 21 patients, respectively. Nineteen patients had been undergoing extra-renal purification. The average of total testosterone was 13.44±6.17 nmol/L. It was lower in patients with diabetic nephropathy (p=0.004). Hypogonadism was diagnosed in 22 patients (46 %). In this group, gonadotropins were normal in 21 cases and elevated in only one case. Hyperprolactinemia was retained in six patients. Type 2 diabetes (OR: 3.96; p=0.02) and diabetic nephropathy (OR=4.26; p=0.01) were the only risk factors of hypogonadism in our patients. CONCLUSION: Our results had demonstrated a high prevalence of hypogonadism in males with chronic renal failure. This hormone disorder was associated with type 2 diabetes and diabetic nephropathy.


Assuntos
Hipogonadismo/epidemiologia , Hipogonadismo/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Gonadotropinas/sangue , Humanos , Hipogonadismo/sangue , Hipogonadismo/diagnóstico , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Prolactina/sangue , Fatores de Risco , Testosterona/sangue
15.
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
16.
Horm Metab Res ; 52(4): 228-235, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32268424

RESUMO

Prolactin is known to have immune modulatory effects acting through the prolactin receptor, which is present on a variety of immune cells. Certain chemokines contribute to form the type of T helper (Th) preponderance in the immune response. The objective of this work was to assess if hyperprolactinemia not related to pregnancy is associated with changes in circulating levels of chemokines and other immunological markers. In this cross sectional study, 35 patients with hyperprolactinemia (5 men), and 102 healthy blood donors (19 men) were included. Serum levels of Th1- Th2- and Th17-associated chemokines, C-reactive protein, immunoglobulins, and the B cell attracting chemokine CXCL13 were assessed. The hyperprolactinemic group had significantly higher levels of Th2 associated CCL22 (p=0.022), Th17 associated CXCL1 (p=0.001), B cell attracting CXCL13 (p=0.003), and C-reactive protein (p<0.001) compared to controls, and these proteins were also positively correlated with prolactin levels. While differences in CCL22, CXCL1, CXCL13, and C-reactive protein were present in patients with low or moderate hyperprolactinemia, no differences were observed at high (>3600 mU/l) prolactin levels. To evaluate a possible dose-associated response to prolactin, an in vitro model was used, showing prolactin-induced increase in T-helper cell activation at moderate levels, while activation decreased at higher levels. Hyperprolactinemia seems to have several immunomodulatory effects and was associated with increased levels of chemokines associated with Th2 and Th17 responses and B cell attraction. However, patients with greatly increased prolactin had normal levels of chemokines, and in vitro, high levels of prolactin decreased T-helper cell activation.


Assuntos
Quimiocinas/metabolismo , Hiperprolactinemia/sangue , Hiperprolactinemia/imunologia , Imunomodulação/fisiologia , Prolactina/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Quimiocina CXCL13/metabolismo , Feminino , Humanos , Imunoglobulinas/análise , Imunoglobulinas/sangue , Ativação Linfocitária/fisiologia , Masculino , Pessoa de Meia-Idade , Células Th1/metabolismo , Células Th17/metabolismo , Células Th2/metabolismo
17.
J Zoo Wildl Med ; 51(1): 13-24, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32212542

RESUMO

Perturbations in serum prolactin secretion, both over- and underproduction, are observed in zoo African elephants (Loxodonta africana) that exhibit abnormal ovarian cycles. Similar prolactin problems are associated with infertility in other species. Pituitary prolactin is held under constant inhibition by a hypothalamic-derived neurotransmitter, dopamine; thus, regulation by exogenous treatment with agonists or antagonists may be capable of reinitiating normal ovarian cycles. This study tested the efficacy of oral administration of cabergoline (agonist) and domperidone (antagonist) as possible treatments for hyperprolactinemia or chronic low prolactin, respectively. Hyperprolactinemic (overall mean prolactin, >30 ng/ml), acyclic elephants were administered oral cabergoline (2 mg, n = 4) or placebo (dextrose capsule, n = 4) twice weekly. Overall mean prolactin concentration decreased in treated females compared with controls (32.22 ± 14.75 vs 77.53 ± 0.96 ng/ml; P = 0.01). Interestingly, overall mean progestagen concentrations also increased slightly (P < 0.05) in treated females (0.15 ± 0.01 ng/ml) compared with controls (0.07 ± 0.01 ng/ml), but no reinitation of normal cyclic patterns was observed. Chronic low prolactin (overall mean prolactin, <10 ng/ml), acyclic females were orally administered domperidone (2 g/day, n = 4) or placebo (dextrose capsule, n = 4) for 4 wk, followed by 8 wk of no treatment (four cycles) to simulate the prolactin pattern observed in normal cycling elephants. Overall mean prolactin concentrations increased (P = 0.005) during domperidone treatment (21.77 ± 3.69 ng/ml) compared with controls (5.77 ± 0.46 ng/ml), but progestagen concentrations were unaltered. Prolactin regulation by dopamine was confirmed by expected responses to dopamine agonist and antagonist treatment. Although prolactin concentrations were successfully reduced by cabergoline, and domperidone initiated the expected cyclic prolactin pattern, neither treatment induced normal ovarian activity.


Assuntos
Cabergolina/uso terapêutico , Domperidona/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Antagonistas de Dopamina/uso terapêutico , Ciclo Estral/efeitos dos fármacos , Hiperprolactinemia/veterinária , Prolactina/sangue , Animais , Elefantes , Feminino , Hiperprolactinemia/tratamento farmacológico
18.
PLoS One ; 15(2): e0228648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017792

RESUMO

BACKGROUND: Antipsychotic medication, stress, gender, and age are factors that influence prolactin levels in patients with psychosis. The aim of the study was to investigate the level of prolactin response to antipsychotic treatment in acute patients, taking into account the total duration of psychosis. METHODS AND FINDINGS: The study was conducted on 170 acute patients with schizophrenia spectrum disorders and bipolar disorder. Subjects were divided into three subgroups according to the duration of the psychosis (less than 5 years, between 5 and 10 years and more than 10 years of disorder duration). The initial prolactin response under antipsychotic treatment was measured, while the severity of the psychiatric symptoms was assessed with the BPRS (Brief Psychiatric Rating Scale). Hyperprolactinemia was found in 120 (70.6%) patients, amongst which 80 (66.7%) were females and 40 (33.3%) were males. The average increase in prolactinemia was 2.46 times the maximum value in women, and 1.59 times in men. Gender (ß = 0.27, p<0.0001), type of antipsychotic medication according to potency of inducing hyperprolactinemia (ß = -0.23, p<0.003), and the duration of psychosis over 10 years (ß = -0.15, p = 0.04) significantly predicted prolactin levels, when age, diagnosis, antipsychotic category (conventional/atypical/combinations of antipsychotics), and BPRS total scores were controlled for. CONCLUSIONS AND RELEVANCE: Prolactin levels in patients treated with antipsychotic medication appeared to depend on patients' gender, on the type of antipsychotic medication according to potency of inducing hyperprolactinemia, and on the duration of the psychosis. An increase in prolactin levels was associated with female gender, while the use of prolactin sparing antipsychotics and a duration of psychosis over 10 years were associated with lower prolactin levels.


Assuntos
Antipsicóticos/farmacologia , Hiperprolactinemia/etiologia , Prolactina/efeitos dos fármacos , Transtornos Psicóticos/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Hiperprolactinemia/diagnóstico , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Olanzapina/efeitos adversos , Olanzapina/uso terapêutico , Prolactina/sangue , Transtornos Psicóticos/complicações , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Fatores Sexuais , Fatores de Tempo
19.
Artigo em Inglês | MEDLINE | ID: mdl-32012981

RESUMO

BACKGROUND: Breast cancer rates in Asia are much lower than in Europe and North America. Within Asia, rates are lower in Mongolia than in neighboring countries. Variation in pregnancy exposure to endogenous hormone concentrations may explain the differences, but data are lacking. METHODS: We measured maternal serum progesterone, prolactin, estradiol and estrone concentrations in the second half of pregnancy in a cross-sectional study of urban (n = 143-194 depending on the analyte) and rural (n = 150-193) Mongolian women, and U.S. women from Boston (n = 66-204). Medical records provided information on maternal and perinatal factors. Geometric mean hormones were estimated from standard linear models with the log-hormone as the dependent variable and country as the independent variable adjusted for maternal and gestational age at blood draw. RESULTS: Mean concentrations of prolactin (5722 vs. 4648 uIU/mL; p < 0.0001) and estradiol (17.7 vs. 13.6 ng/mL; p < 0.0001) were greater in Mongolian than U.S. women, while progesterone (147 vs. 201 ng/mL; p < 0.0001) was lower. Mean hormone concentrations were similar in rural and urban Mongolian women. Results were generally similar, with additional adjustment for gravidity, parity, height, body mass index at blood draw, education and alcohol use during pregnancy, and when stratified by offspring sex or parity. CONCLUSIONS: Mongolian women had greater concentrations of prolactin and estrogen and lower concentrations of progesterone than U.S. women, while hormone concentrations were similar in rural and urban Mongolian pregnancies. IMPACT: These data do not support the hypothesis that estrogen concentrations in pregnant women are lower in Mongolian compared with Caucasian women.


Assuntos
Neoplasias da Mama/epidemiologia , Estradiol/sangue , Estrona/sangue , Gravidez/sangue , Progesterona/sangue , Prolactina/sangue , Adulto , Boston/epidemiologia , Estudos Transversais , Feminino , Humanos , Mongólia/epidemiologia , Adulto Jovem
20.
Gen Comp Endocrinol ; 291: 113420, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32032604

RESUMO

Incubating eggs represents a trade-off for parent birds between spending enough time fasting to take care of the clutch and to get enough nutrients for self-maintenance. It is believed that the pituitary hormone prolactin plays an important role in such allocation processes. Incubation does not solely imply the active warming of the eggs but also the active egg-turning to facilitate absorption of albumen by the embryo, reduce malposition and prevent the embryo from adhering to the inner shell membrane. However, how prolactin secretion is related to egg-turning behaviors is presently poorly addressed. In addition, several environmental contaminants can affect parental care behaviors through their endocrine disrupting properties but the effects of such contaminants on egg-turning behaviors remain so far unexplored. Using artificial eggs equipped with miniaturized data loggers, we investigated the relationships between egg-turning behaviors, prolactin secretion and contaminants burden in Arctic black-legged kittiwakes (Rissa tridactyla). Specifically, we examined the relationships between blood concentrations of poly- and perfluoroalkyl substances (PFASs), organochlorines (OCs), mercury (Hg), plasma prolactin levels and both egg-turning frequency and angular change. We also incorporated baseline corticosterone levels since this glucocorticoid is known to affect parental care. Plasma prolactin levels were positively related to angular change in female kittiwakes while corticosterone was not related to egg-turning behaviors in either sex. Hg was not related to egg-turning behaviors in either sex. We found contrasting associations between OCs and PFASs, since polychlorinated biphenyls (PCBs) were negatively associated with angular change in females, contrary to linear perfluorooctanesulfonate (PFOSlin) and perfluoroalkyl carboxylic acids (PFCAs) which were positively related to egg-turning frequency and angular change in both sexes. Additionally, PFASs concentrations were positively related to prolactin levels in female kittiwake. The possible stimulation of prolactin secretion by PFASs could therefore make adult kittiwakes to allocate more time taking care of their eggs, and thus possibly modify the trade-off between spending enough time caring for the clutch and obtaining enough nutrients at sea.


Assuntos
Ácidos Alcanossulfônicos/sangue , Charadriiformes/sangue , Poluentes Ambientais/sangue , Fluorcarbonetos/sangue , Hidrocarbonetos Clorados/sangue , Óvulo/fisiologia , Prolactina/sangue , Animais , Regiões Árticas , Corticosterona/sangue , Poluição Ambiental , Feminino , Geografia , Masculino
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