Human prolactin (hPRL) is the most recent anterior pituitary hormone in human endocrinology, whose structure has been elucidated in 1977. The possibility to measure hPRL in serum has led to a rapid increase of our knowledge of prolactin-physiology and -pathophysiology in men. hPRL is the only anterior pituitary hormone which is under predominantly inhibitory hypothalamic control. The effects of prolactin in the various species differ considerably, whereas in men it acts mainly upon the mammary gland and the gonadal system. Hyperprolactinemia leads typically to hypogonadism, amenorrhea and frequently galactorrhea. The hyperprolactinemia-hypogonadism-syndrome has been identified as a separate entity in recent years. Because of the relative frequency of this disease prolactin measurements have become of great importance in the diagnosis of sterility. Depending on the cause of hyperprolactinemia a neurosurgical, radiotherapeutical or medical treatment is indicated.
Two patients with hyperprolactinemic secondary amenorrhoea were treated with gonadotropin releasing hormone (GnRH). Both desired children and had an incompatibility to treatment with Dopamin agonists (Zyklomat). Both patients ovulated and had regular follicular maturation in spite of rising prolactin levels. The pregnancies occurred in the first treatment cycles. The pulsatile intravenous administration of GnRH is apparently a viable alternative plan of management in patients with a moderate hyperprolactinemia and incompatibility to Dopamine agonists to the treatment with gonadotropins which was in use up to now.
Little is known about the influence of hydramnios on the alphafetoprotein (AFP)-concentration in the amniotic fluid. We therefore investigated in 19 patients with hydramnios the diagnostic value of the sonographic evidence and the AFP-concentration in the amniotic fluid in relation to prenatal diagnosis of fetal malformations in two independent series. An anlysis of the AFP-concentration in the amniotic fluid can corroborate the diagnosis of a malformation made by sonography and influence decisions concerning the management of pregnancy and delivery. If ultra-sonic tests show no anomalies, significantly increased AFP-concentrations in the amniotic fluid of patients with hydramnions can merely confirm a suspicious of an existing malformation and influence decisions on further diagnostic steps.
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