These data show that incidental hemorrhage in prolactinoma is not uncommon. It is more likely to occur in macroprolactinoma, where 1 in 5 develop hemorrhage, and is particularly common in women with macroprolactinoma. The majority are asymptomatic and resolve spontaneously.

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Abstract-Maternal protein restriction in rats leads to endothelial dysfunction and decreased NO bioavailability in the offspring. Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) are recognized to have pleiotropic actions including increasing NO bioavailability and reducing inflammation and oxidative damage. This study assessed statin treatment on vascular function in a model of endothelial dysfunction, which is independent of dyslipidemia. Wistar rats were fed a control (18% casein) or protein-restricted (9% casein) diet throughout pregnancy. At weaning, a subset of the protein-restricted group was given atorvastatin (10 mg/kg per day) in the drinking water. At 145 days of age, offspring were euthanized by CO 2 inhalation. Plasma samples were collected for markers of inflammation, vascular reactivity of the thoracic aorta, and small mesenteric arteries were assessed on the wire myograph, and tissues were snap frozen for molecular biology analysis. Thoracic aorta endothelial-dependent vasodilatation was attenuated in the male offspring from both protein-restricted groups compared with controls (PϽ0.05) but was similar in females (P value not significant). Endothelial-dependent dilatation of mesenteric arteries was attenuated in male and female protein-restricted offspring (PϽ0.05) and was corrected by atorvastatin. Maternal protein restriction increased plasma inflammatory markers granulocyte chemotactic protein, lipocalin-2, and ␤ 2 -microglobulin in male and C-reactive protein in female offspring (PϽ0.05). Atorvastatin had no effect on inflammatory markers in the males but restored C-reactive protein to control levels in the females (PϽ0.05). Aortic and mesenteric artery mRNA levels of endothelial NO synthase, superoxide dismutase 1, and tumor necrosis factor-␣ were unchanged. These data suggest that atorvastatin can restore endothelial function in this model, but its effects are gender specific and dependent on the vascular bed. Key Words: statins (atorvastatin) Ⅲ experimental models Ⅲ fetal programming Ⅲ vascular biology Ⅲ endothelium Ⅲ nitric oxide Ⅲ inflammation T here is considerable evidence that the etiology of cardiovascular and metabolic diseases has origins partly in the developmental environment. 1 A widely used animal model to study this phenomenon is the rat, in which the restriction of dietary protein during pregnancy leads to raised blood pressure and endothelial dysfunction in the offspring. [2][3][4] Increasingly, evidence from this model points to a disruption to the NO pathway as a key component of the underlying pathophysiology. 4,5 The healthy vascular endothelium plays an important role in maintaining vascular tone through the release of factors including NO, prostacyclin, and endothelial-derived hyperpolarizing factor. 6 The importance of a healthy endothelium is seen in cardiovascular and metabolic diseases, where endothelial dysfunction is associated with atherosclerosis, hypertension, and the metabolic syndrome. 7-9 Important in the development of such endothelial ...

18 Background: We compared the role played by mental health comorbidities in the health care cost and utilization of non-elderly patients with breast and prostate cancer. Methods: The Military Health System affords its beneficiaries equal access to medical care. We performed a cross-sectional analysis using administrative data of all 9.5 million beneficiaries, ages 18-64, with direct care and a primary diagnosis of either invasive breast or prostate cancer during FY2007–FY2014. We used regression models to identify predictors of cost and utilization, including sociodemographic variables, system of care, treatment modalities, chronic disease comorbidities, and mental health comorbidities. Results: On average,annuallythere were 23,800 and 13,300 patients with breast or prostate cancer, respectively. More comorbid depression (16.8%) or anxiety (14.2%) occurred among breast cancer patients than prostate cancer patients (6.9%, 6.7%). Annual cost per patient (inc. pharmacy) was significantly higher for breast cancer ($16,287 vs. $11,069, p < 0.001). The strongest predictors of annual breast cancer costs were (in order from highest predictive value) chemotherapy, surgery, and mood or adjustment disorder (p < 0.0001); the strongest predictors for prostate costs were chemotherapy, radiation therapy, surgery, and mood or adjustment disorder (p < 0.0001). Mood and adjustment disorders were strong predictors of the annual number of ambulatory visits, hospital admissions, and bed days for both breast and prostate cancer (p < 0.0001). Conclusions: Mental health comorbidities play a significant role in health care costs and utilization of non-elderly adults who are breast and prostate cancer patients. An unexpected finding was that, although different in frequency, mental health comorbidities were important predictors of cost and utilization for both patients with breast and prostate cancer. For both breast and prostate cancer, routine screening and treatment for mental health disorders should be part of quality cancer care.