<b>Long‐term follow‐up of patients with hyperprolactinaemia</b>

Jeffcoate, W. J.; Pound, Nicholas; Sturrock, Nigel; Lambourne, Jonathon

doi:10.1046/j.1365-2265.1996.00824.x

Cited by 136 publications

(72 citation statements)

References 16 publications

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“…True pituitary adenomas often retain the capacity to respond to hypothalamic trophic stimuli. Furthermore, pituitary adenomas, especially prolactinomas, may resolve spontaneously, demonstrating the plasticity of adenomatous pituitary cell growth (6). Finally, the clear demonstration of pituitary tumor mass shrinkage in patients receiving somatostatin analogs for acromegaly or dopaminergic therapy for prolactinomas (34,35) supports the notion that some of the transformed pituitary cells retain a measure of hypothalamic control, with the capacity to reverse adenoma growth.…”

Section: Introductionmentioning

confidence: 53%

“…These adenomas grow slowly, and are discovered in up to 25% of unselected autopsy specimens. Although the natural history of pituitary microadenoma growth is difficult to ascertain because of the intrinsic inaccessibility of pituitary tissue for study, it is clear that microadenomas do not invariably progress to macroadenomas; furthermore, macroadenomas are stable or exhibit very slow growth, and may in fact resolve spontaneously (6). Oncogene mutations commonly encountered in nonendocrine neoplasms (e.g., ras and p53) are not generally present in pituitary adenomas, yet disturbed intrapituitary paracrine growth factor expression and action have been extensively documented (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms for pituitary tumorigenesis: the plastic pituitary

Melmed¹

2003

J. Clin. Invest.

119

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The anterior pituitary gland integrates the repertoire of hormonal signals controlling thyroid, adrenal, reproductive, and growth functions. The gland responds to complex central and peripheral signals by trophic hormone secretion and by undergoing reversible plastic changes in cell growth leading to hyperplasia, involution, or benign adenomas arising from functional pituitary cells. Discussed herein are the mechanisms underlying hereditary pituitary hypoplasia, reversible pituitary hyperplasia, excess hormone production, and tumor initiation and promotion associated with normal and abnormal pituitary differentiation in health and disease.

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Section: Introductionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Mechanisms for pituitary tumorigenesis: the plastic pituitary

Melmed¹

2003

J. Clin. Invest.

119

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“…We have not compared oestrogen treatment alone as fertility is an important issue for many of these patients, but this would usually be a cheaper option. There is also the possibility of remission in one-third of patients with hyperprolactinaemia following pregnancy (20). It is interesting to note that, despite these caveats, the two modalities of treatment do not differ significantly in terms of cost over 10 years.…”

Section: Discussionmentioning

confidence: 99%

Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?

Turner¹,

Adams²,

Wass³

1999

European Journal of Endocrinology

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Aims: Reported cure rates following trans-sphenoidal surgery for microprolactinoma are variable and recurrence rates in some series are high. We wished to examine the cure rate of trans-sphenoidal surgery for microprolactinoma, and to assess the long-term complications and recurrence rate. Design: A retrospective review of the outcome of trans-sphenoidal surgery for microprolactinoma, performed by a single neurosurgeon at a tertiary referral centre between 1976 and 1997. Patients: All thirty-two patients operated on for microprolactinoma were female, with a mean age of 31 years (range 16-49). Indications for surgery were intolerance of dopamine agonists in ten (31%), resistance in six (19%) and resistance and intolerance in four (12.5%). Two patients were from countries where dopamine agonists were unavailable. Results: The mean pre-operative prolactin level was 2933 mU/l (range 1125-6000). All but 1 had amenorrhoea or oligomenorrhoea, with galactorrhoea in 15 (46.9%). Twenty-five (78%) were cured by trans-sphenoidal surgery, as judged by a post-operative serum prolactin in the normal range. During a mean follow-up of 70 months (range 2 months to 16 years) there was one recurrence at 12 years. Post-operatively, one patient became LH deficient, two patients became cortisol deficient and two became TSH deficient. Out of 21 patients tested for post-operative growth hormone deficiency, 6 (28.6%) were deficient. Five patients developed post-operative diabetes insipidus which persisted for greater than 6 months. There were no other complications of surgery. The estimated cost of uncomplicated trans-sphenoidal surgery, and follow-up over 10 years, was similar to that of dopamine agonist therapy. Conclusion:In patients with hyperprolactinaemia due to a pituitary microprolactinoma, transsphenoidal surgery by an experienced pituitary surgeon should be considered as a potentially curative procedure. The cost of treatment over a 10 year period is similar in uncomplicated cases to long-term dopamine agonist therapy.

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“…Entretanto, em algumas situações, nenhuma dessas causas é identificada, caracterizando o quadro de hiperprolactinemia idiopática (Piazza et al, 2005). O seguimento desses pacientes, por longo tempo, demonstra que em torno de 35% dos casos os valores de PRL normalizam, em 10% a 15% aumentam, em até 10% um microprolactinoma é diagnosticado e, nos demais, os valores permanecem inalterados (Jeffcoate et al, 1996;Sanfilippo, 1999).…”

Section: Causas De Hiperprolactinemiaunclassified

Estados hiperprolactinêmicos: inter-relações com o psiquismo

Nahás

Nahás-Neto

Pontes

et al. 2006

Rev. psiquiatr. clín.

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ResumoA hiperprolactinemia é o distúrbio endócrino mais freqüente do eixo hipotálamo-hipofisário, observado em mulheres na idade reprodutiva. Caracteriza-se pela elevação consistente dos valores plasmáticos de prolactina. A regulação da produção da prolactina dá-se por meio da ação inibitória de um neurotransmissor, a dopamina. As manifestações clínicas são distúrbios do ciclo menstrual, amenorréia, galactorréia, infertilidade e diminuição da libido. Entretanto, sintomas psicológicos, especialmente ansiedade e depressão, têm sido associados à hiperprolactinemia. Contudo, há poucos estudos clínicos publicados sobre o tema. O papel da prolactina na patogênese dos distúrbios psiquiátricos pode refletir ação direta sobre o sistema nervoso central, efeito indireto por meio dos hormônios gonadais ou constituir fatores independentes, resultantes da depleção de dopamina. Assim, detectada a prevalência de distúrbios psiquiátricos em pacientes com hiperprolactinemia, conclui-se pela necessidade de maior número de pesquisas que investiguem as bases da possível inter-relação entre os estados hiperprolactinêmicos e o psiquismo.Palavras-chaves: Hiperprolactinemia, psiquismo, dopamina. AbstractHyperprolactinemia is the most frequent endocrine disorder of the hypothalamus-hypophysis axis observed in women of reproductive age. It is characterized by elevated serum prolactin levels. Prolactin production is regulated by the inhibitory action of a neurotransmitter, dopamine. Clinical manifestations include irregular menstrual cycle, amenorrhea, galactorrhea, infertility and libido decrease, but psychological symptoms, especially anxiety and depression, have also been associated with hyperprolactinemia. Nonetheless, few studies about this condition are available. In the pathogenesis of psychiatric disorders, prolactin may have either a direct action on the central nerve system or an indirect effect via gonadal hormones or function as independent factors as a result of dopamine depletion. Thus, since the prevalence of psychiatric disorders in patients with hyperprolactinemia was detected, it was concluded that further studies are necessary to investigate the basis of a potential relationship between both hyperprolactinemic and psychiatric conditions.

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Long‐term follow‐up of patients with hyperprolactinaemia

Abstract: These data confirm the findings of others that hyperprolactinaemia will prove self-limiting in up to one-third of women, and that pregnancy may be one factor which triggers a return to normal function.

Cited by 136 publications

References 16 publications

Mechanisms for pituitary tumorigenesis: the plastic pituitary

Mechanisms for pituitary tumorigenesis: the plastic pituitary

Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?

Estados hiperprolactinêmicos: inter-relações com o psiquismo

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