Amenorrhea-galactorrhea Syndrome Research Articles

Pituitary Adenoma Revealed by Optic Neuropathy: a Case Report and Literature Review

Pituitary adenoma, also known as pituitary adenoma, is a type of benign tumor of the pituitary gland, which is a gland located in the brain and which is responsible for controlling the production of hormones such as cortisol, prolactin, growth hormone and hormones that stimulate functioning of the ovaries and testes. This type of tumor is rare and, as it is benign, it is not life threatening, however it can cause symptoms that decrease quality of life such as infertility, decreased libido, milk production or neurological and ophthalmological symptoms such as headache or partial loss of vision. This is a 25-year-old student, with a pathological history of amenorrhea-galactorrhea syndrome. After about 5 years with amenorrhea and galactorrhea, she mentioned that she had consulted with general practitioners and gynecologists several times in her country of origin but they were unable to discover the cause for lack of diagnostic means, after 6 months of her arrival in the kingdom of Morocco, presented in our ophthalmology service of HMIMV-Rabat, at the ophthalmological examination, uncorrected visual acuity 2/10 in the right eye and 1/10 in the left eye, visual acuity with correction 4/10 in the right eye and 3/10 in the left eye with visual field loss, Fundus examination of the right and left eye showed pale papilla with pathological cupping. Papillary OCT vertical diameter with pathological cupping at 0.84 in the left eye and limit at 0.61 in the right eye (f-1); visual field revealed amputation in right and left eye and orbitocerebral MRI was favorable to pituitary macroadenoma with diameter of (18x15x15 mm), compresses optic chiasm, complementary exams: Elevated prolactin of: 23 135.00 µUI/ml, thyroid hormone dosage: T3, T4 and TSH are all normal. Finally, we requested consultation with an endocrinologist and a neurosurgeon, and the patient was transferred to the neurosurgery service for a better study and possible surgery.

The health status of children born to mothers with persistent galactorrhea syndrome - amenorrhea treated with parlodel

A dopamine agonist - bromo-a-ergocriptine (parlodel) is traditionally used in the treatment of persistent galactorrhea-amenorrhea syndrome (SGA) [11, 13, 19]. Parlodel reduces the frequency of mitoses and the number of secretory granules in the lactotrophs of the adenohypophysis [50], and is capable of slowing the growth of prolactin-secreting pituitary adenomas [1, 40].
 According to a number of authors [5, 11, 13, 56], the dosage and timing of the use of the drug depend on the form of LNG. According to most researchers [6, 17, 19, 24, 29], the effectiveness of its use correlates with the form of the disease. However, the effectiveness of parlodel therapy is apparently also influenced by the functioning of the dopaminergic system (DAS) of a particular patient [15].

The Thickening of the Pituitary Stalk: about 25 Cases

Summary This is a retrospective study of 25cases of thickening of pituitary stalk. All patients benefited from a clinical, biological (hormonal and non hormonal) and radiological exploration seeking etiology and scalability of their pathologies. Results A female predominance was found. The average is 42 years (4.5 to 60). Three children were observed in this series. Methods The most frequent reason for consultation was polyuria polydipsia syndrome (90%); It was associated with an amenorrhea galactorrhea syndrome in a little over two-thirds (63.2%) and epilepsy in one case. Questioning revealed the former existence of extra-pituitary sarcoidosis in five cases. The hormonal exploration showed a post pituitary insufficiency in all cases; A central diabetes insipidus (CDI) is observed in three pediatric cases. It was associated with hypopituitarism in 87,5% (n: 21/24) of cases: anterior pituitary Insufficiency (n: 10/24) thyreo-gonadotrope insufficiency (n: 11/24). Moderate hyperprolactinemia was observed in two thirds of cases (68, 4%). CDI is observed in three pediatric cases. The etiological exploration of the thickening of the pituitary stalk allowed to retain the following diagnoses: sarcoidosis 66,6% (n: 16/24)-lymphocytic hypophysitis 12,5% (n: 3/24 ) metastase cancer 12,5% (n: 3/24): vesicular thyroid carcinoma n: 1, breast cancer n: 2; cyst ratke 4.16% ( n: 1/24) « idiopathic » 8.3% (n: 2/24). The cyst of ratkes and idiopathic forms were found in children. The evolution was marked in a child by the appearance of an autoimmune thyroiditis suggest the possible diagnosis of an autoimmune origin to the thickening of the pituitary stalk. No cause has been identified in the other case after a decline of ten years.

Hypothyroidism: Clinical Features

Hypothyroidism: Clinical Features

Clinical value of melatonin in the development of central mechanism disorders of reproductive function regulation

The excretion of melatonin in central mechanism disorders of reproductive function regulation is studied. It is stated that thyroid gland calcification is a physiological process and calcification process inhibition is a manifestation of hormonal homeostasis disorder in patients with neuroendocrinic pathology. The treatment of patients with sterility in the galactorrhea-amenorrhea syndrome and scleropolycystosis of ovaries of central genesis is to be performed differentially taking into account pineal gland state.

O-11-168 - New Boron neutron capture therapy system and its clinical application in patients with malignant

One hundred and seventy patients with endocrine abnormalities, 29 males and 141 females, were studied by computerized tomography (CT) scanning of the pituitary and by pituitary hormone assays including basal and stimulated hormone concentrations in the blood. Pituitary macroadenoma was observed in 40 of the 170 patients, microadenoma in 49, primary empty sella in 46, secondary empty sella in 25, including 20 of the 40 patients with macroadenoma after surgical removal or radiation therapy of the tumor. Suprasellar tumor was present in four patients. In 23 women with menstrual abnormalities and 3 men with impotence and hyperprolactinemia, the results of CT scanning were normal. Of the 40 patients with macroadenoma, 24 presented with a hyperfunctioning syndrome (acromegaly or hyperprolactinemia). Among the 49 patients with microadenomas, 46 had the amenorrhea-galactorrhea syndrome, one male presented with acromegaly and one with Cushing's disease, and one female also had Cushing's disease. Primary empty sella was associated with the amenorrhea-galactorrhea syndrome in females and impotence in males. Only four female patients demonstrating an empty sella were asymptomatic. Distinctive biochemical findings were identified in certain groups of patients with different pituitary pathologic features. CT scanning was found very useful in the assessment of the size of the tumor, its suprasellar or parasellar extension and response to therapy, and in differential diagnosis of tumor and empty sella. Disappointing results were obtained in patients with endocrine abnormalities and normal results of CT scanning, and in patients following surgical treatment for a pituitary tumor, when the identification of recurrent tumor was impossible from a single examination. It is concluded that CT scanning is the most advanced technique in the diagnosis of anatomic pituitary abnormalities, and it should replace the traditional invasive diagnostic procedures.

Radiologic and laboratory diagnosis of the pineal gland state in some neuroendocrinal syndromes in women

Radiologic and functional examinations of the pineal gland state and changes of bones of the vault and base of the skull are performed in 114 women (galactorrhea-amenorrhea syndrome is revealed in 32 women, syndrome of sclcropolycystosis of ovaries in 61 women, control group consists of 21 women). The data on melatonin excretion, calcification frequency of the pineal gland in different syndromes, signs of endocrinopathy, cndocraniosis, intracranial hypertension in the observed persons of all groups are given. It is suggested that the retardation of calcification of the pineal gland is connected with humoral and hormonal status disorder.

In the light of a petroleum lamp the operation could begin. Richard Frommel (1854-1912): pioneer in treatment of ruptured extrauterine pregnancy

Richard Frommel (1854-1912) can be called an outstanding German gynaecologist during the late 19th century. This article is intended to give a picture of his life, work, and personality. Frommel was director of the department of obstetrics and gynaecology at the university of Erlangen from 1887 to 1901. Science owes to him, amongst other contributions, an important impulse for changing the therapy of ruptured ectopic pregnancy. Up to the present day Frommel's name together with that of Johann Chiari (1817-1854), serve as eponyms for a special form of the amenorrhoea-galactorrhoea syndrome, namely, the persistent one-post partum. It remains puzzling why Frommel resigned office, when he was just 46 years old, giving up gynaecology completely only a short time later.

Primary amenorrhea-galactorrhea with hyperprolactinemia and huge pituitary enlargment in juvenile primary hypothyroidism

We report a girl with juvenile primary hypothyroidism revealed by growth retardation and a syndrome of primary amenorrhea-galactorrhea with hyperprolactinemia and suprasellar pituitary enlargement. Resolution of the pituitary enlargement and the amenorrhea-galactorrhea syndrome occurred after thyroid hormone replacement. No similar observation has been reported earlier in juvenile hypothyroidism.

Clinical Characteristics in Multiple Endocrine Neoplasia Type 1 in Japan: A review of 106 patients

A review of 106 patients with multiple endocrine neoplasia (MEN) type 1 reported between 1966-1989 in Japan was conducted in order to clarify the natural history of this disease. Sporadic MEN 1 was found in 61 patients, and familial MEN 1 was found in 45 patients from 15 families. The mean ages at diagnosis of the two groups were 46.2 and 41.3 years, respectively, and the male to female ratio was 3:4. With regards to the involvement of the pituitary, parathyroid and endocrine pancreas, the combination of three endocrine glands was 31%, and that of two was 48%, in which the pituitary, parathyroid and endocrine pancreas had tumorous lesions in 60%, 88% and 63%, respectively. The first clinical manifestations of MEN 1 were the symptoms of hyperparathyroidism (32%), pituitary tumors (26%), peptic ulcer (28%) and hypoglycemia (13%). These symptoms appeared between 6 and 57 years of age (mean 34 years). The main clinical symptoms of the pituitary tumors were acromegaly and gigantism (37%), galactorrhea-amenorrhea syndrome (20%), Cushing's disease (10%) and visual disturbance due to compression of the tumor (20%). The clinical manifestations of hyperparathyroidism were mainly asymptomatic hypercalcemia (41%), nephrolithiasis (42%) and osteitis fibrosa (5%). In the patients with pancreatic tumor, Zollinger-Ellison syndrome (52%) and hypoglycemic symptoms (42%) were found. Tumors in the adrenal cortex, thyroid, carcinoid and lipoma were detected in association with MEN 1 in the frequencies of 28%, 21%, 9% and 5%, respectively. Death was reported in 37 patients between 9 and 86 years of age (mean 50.0 years). The cause of death was gastrointestinal bleeding and perforation (45%), surgery (24%) and disseminated carcinomatosis (18%). Recently, the gene predisposing to this syndrome has been assigned to chromosome 11 (11q13) in non-Japanese cases but not yet in Japanese MEN 1 patients.

Hyperprolactinemia with prolonged amenorrhea reversed with bromocriptine in a menopausal woman

Bromocriptine treatment of the amenorrhea-galactorrhea syndrome with elevated prolactin levels is well recognized. The return of menses after 30 years in a menopausal woman with this syndrome is described. Lowering of both prolactin and follicle-stimulating hormone levels was found to occur after bromocriptine therapy.

Study on galactorrhea-amenorrhea syndrome (GAS) with special reference to normoprolactinemic GAS

In order to clarify the mechanism(s) which causes galactorrhea and amenorrhea in patients with Galactorrhea-Amenorrhea Syndrome (GAS) (Group A, n = 20), composed of Chiari-Frommel Syndrome (CFS) (Subgroup I, n = 3), Argonz-del Castillo Syndrome (ADCS) (Subgroup II, n = 5) and Drug-induced Galactorrhea-Amenorrhea (DIG) (Subgroup III, n = 12), we analysed basal plasma prolactin (PRL) and gonadotropin levels and their responsiveness to TRH and LH-RH, respectively in GAS patients. In addition, another group of galactorrhea patients without amenorrhea (Group B, n = 29) was selected, and further divided into three subgroups; subgroup I (n = 7) with persisting postpartum lactation, subgroup II (n = 7) of idiopathic galactorrhea, and subgroup III (n = 15) induced by drug administration. There were found unexpectedly high frequencies of normoprolactinemic patients (less than 23.7 ng/ml) in 40% of GAS (66.7% in CFS, 40% in ADCS, and 33.3% in DIG). The PRL responsiveness to TRH, evaluated by % delta PRL (peak PRL - basal PRL/basal PRL X 100), tended to be high in ADCS and DIG (group after discontinuation of drugs) compared with those of normal subjects (n = 12) and patients with primary hypothyroidism (n = 21). PRL response was almost normal in CFS or DIG (group during drug administration). Basal level of plasma gonadotropin in GAS was comparable to that of normal subjects. However, responsiveness of gonadotropin to LH-RH in GAS tended to be high compared with that of normal subjects. The patients in group B (subgroup I-III) demonstrated almost parallel responses of PRL and gonadotropin, respectively, to those of corresponded subgroups in group A. From the present results, we concluded that; 1) It seems likely that frequency of normoprolactinemic patients in GAS (Group A) is surprisingly high. 2) A still unclarified mechanism(s) for the occurrence of galactorrhea, not explained solely by plasma radioimmunoassayable PRL level and/or hyperresponsiveness of PRL to stimuli, may operate on a considerably large number of group A patients. 3) Decreased gonadotropin secretion at pituitary level seems not to be a main cause of menstrual abnormality in group A patients. 4) The same mechanism(s) as in group A patients may cause galactorrhea in group B patients.

Hyperprolactinemia with prolonged amenorrhea reversed with bromocriptine in a menopausal woman

Bromocriptine treatment of the amenorrhea-galactorrhea syndrome with elevated prolactin levels is well recognized. The return of menses after 30 years in a menopausal woman with this syndrome is described. Lowering of both prolactin and follicle-stimulating hormone levels was found to occur after bromocriptine therapy.

Rathke??s cleft cyst

We report a case of pituitary adenoma with two compartments, i.e. a part within the sella turcica and a part infiltrating the sphenoid bone beneath the sella, producing growth hormone (GH) and prolactin. The patient had the amenorrhea-galactorrhea syndrome, but not acromegalic symptoms. Although the two compartments were united through a small dural perforation, immunohistochemical studies demonstrated that GH and prolactin were separately secreted from the intrasellar and extrasellar components, respectively. Somatotropic adenomas frequently produce prolactin, but it is unusual for these hormones to be secreted from distinctly different parts of the same lesion. (Neurosurgery 21:56-59, 1987)

Amenorrhea-galactorrhea syndrome in the prolactin-secreting pituitary tumor: nursing implications.

The amenorrhea-galactorrhea syndrome in prolactin-secreting pituitary tumors is described. The role of prolactin in the development of amenorrhea and galactorrhea is discussed along with the other endocrine abnormalities that overproduction of prolactin may cause. The diagnostic tests that are commonly performed to identify this disease entity are presented with reference to the nurse's role in preparing patients for the diagnostic work-up. Recent advances in transsphenoidal surgery, radiotherapy, and the use of Bromocriptine as therapeutic modalities for this disorder are described. Nursing guidelines that accompany planning care for patients undergoing these treatment regimes are provided.

Chronic dihydroergotoxine treatment affects the number of dopamine recognition sites in rat striatum

Ergot derivatives have been proposed to have ameliorative effects in various pathological conditions where dopaminergic transmission is believed to be impaired, namely Parkinson's disease, amenorrhea-galactorrhea syndrome, and in the treatment of behavioural disturbances of the elderly. To get more insight into a possible involvement of a direct action of ergot derivatives on dopamine receptors we studied the effect of acute and chronic dihydroergotoxine (DHT) treatment on 3H-Spiroperidol and 3H-N-Propylnorapomorphine (3H-NPA) binding to rat striatal membrane preparations. The results are in favor of an interaction of ergot derivatives with dopamine recognition sites both after acute and chronic treatment.

Arachnoid cyst as a cause of the amenorrhea-galactorrhea syndrome

A 28-year-old primigravid woman undergoing an apparently uncomplicated pregnancy noted decreased fetal movement at 33 weeks' gestational age. On admission to her local hospital, a contraction stress test showed non repetitive late decelerations and was nonreactive. An ultrasound examination showed severe oligohydramnios. Earlier in the pregnancy, an ultrasound examination performed at 14 weeks' gestational age showed a normal amount of amniotic fluid. On transfer to our institution, the suspicious nonreactive fetal heart monitor tracing was confirmed. Ultrasound examination revealed oligohydramnios, a biparietal diameter of 7.6 em, and an estimated weight of 1800 gm. One and possibly both kidneys were noted to be present. The next morning the mother was given 20 mg of furosemide intravenously. Filling of the fetal bladder was not observed over 4 hours. The examination, repeated the next day, yielded the same result. That afternoon, electronic monitoring revealed spontaneous contractions with repeated late fetal heart rate decelerations. Since the cervix was closed, rupture of the membranes and internal monitoring were not feasible. After extensive discussions with the parents, a low-transverse cesarean section was performed, and a 1860 gm, meconium-stained, male infant, with Apgar scores of 9 and 9, was delivered. There was no amniotic fluid. The placenta weighed 680 gm and was normal in appearance. The infant had a normal physical examination and had no evidence of respiratory distress. An ultrasound examination showed normal-sized kidneys bilaterally. The infant had no urine output, and within 24 hours the serum creatinine level rose from 0.8 to 2.1 mg/dl. A renal scan performed at 24 hours of age showed minimal renal function with no radioactivity demonstrable over the bladder. Because of rising serum creatinine levels and continued anuria, peritoneal dialysis was initiated. The infant remained anuric until the fifth postnatal day, when 2 ml of urine was produced. Over the next 4 days, the volume of urine gradually increased in quantity to 30 ml in 24 hours. The serum creatinine level fell to 0.8 mg/dl. Dialysis was discontinued and the serum creatinine level remained stable. Unfortunately, the infant developed staphylococcal peritonitis and, despite vigorous antibiotic therapy, died at 3 weeks of age. At autopsy, the infant had normal kidneys, ureters, bladder, and renal arteries and veins. The

Variation of serum prolactin-releasing activity in women with the galactorrhea-amenorrhea syndrome after bromocriptine treatment

Serum methanol extracts were obtained from nine women with the galactorrhea-amenorrhea syndrome, 24 pregnant women in the third trimester, and 18 normal men and women. The serum extract released prolactin (PRL) in significant amounts from rat anterior pituitary in vitro. The extracts from patients with galactorrhea-amenorrhea released PRL in large quantities. A significant positive correlation was observed between the PRL-releasing activity and serum PRL levels in individual samples from the pregnant women and normal subjects but not from the patients with galactorrhea-amenorrhea. Bromocriptine therapy suppressed serum PRL levels of five patients without tumors but increased the PRL-releasing activity in three out of five patients after treatment for 1 or 2 months. Apparently hypothalamic regulation of PRL secretion was disrupted in these three patients after bromocriptine therapy.

Excretion of Technetium in Human Milk

The radioisotope technetium-99m(99mTc) is widely used in nuclear medicine for a variety of scanning procedures. On occasion, it may be necessary to perform such studies on a nursing mother, and it is important to know what dose of radioactive material a nursing infant might receive and how soon after the isotope administration the mother may resume breast-feeding. Technetium is one of the halide elements and is handled, biologically, much like iodine.1 Like iodide,2,3 the pertechnetate ion (99mTcO4-) is concentrated in the thyroid gland1,4 and stomach5,6 and in the breast milk of nursing mothers4-6 and women with the amenorrhea-galactorrhea syndrome.7 In this report we present studies on 99mTcO4- in breast milk, including its binding to milk protein, biologic half-life, and calculations of radioactivity that might be ingested by a nursing infant.

The Effects of Pyridoxine on Pituitary Hormone Secretion in Amenorrhea-Galactorrhea Syndromes

Pyridoxine (vitamin B6) is metabolized in vivo to pyri-doxal-5′-phosphate, which serves as a cofactor for dopa decarboxylase. This enzyme converts dopa to dopamine, for which reason it has been thought that pyridoxine might function as a dopaminergic agent. The data concerning the effects of pyridoxine on pituitary hormones in normal subjects and in patients with hyperprolactine-mia have been conflicting. The present study was undertaken because of the lack of information concerning the effects of pyridoxine on gonadotropins and because of unexplained reports of the amelioration of galactorrhea by pyridoxine. The study was designed in an attempt to determine if acute or chronic pyridoxine administration could be shown to have any dopamine-like effect on the pituitary function in patients with amenorrhea and galactorrhea. The major emphasis, however, was to evaluate the effect of pyridoxine on prolactin and gonadotropins. Six patients (ages 22 to 37 years) with amenorrhea were studied, five of whom also had galactorrhea and elevated serum prolactin levels. Four provocative or suppressive tests were performed on alternate days after an overnight fast: TRH (500 mg) was injected as an intravenous bolus; L-dopa (500 mg) was given orally; chlorpromazine (25 mg) was injected intramuscularly (four patients); and a 300-mg intravenous bolus of pyridoxine was given. Blood samples were taken at intervals after each test. They were assayed for LH, FSH, and prolactin after L-dopa and chlorpromazine, and for these plus hGH and TSH after pyridoxine and TRH. The patients were then placed on 600 mg of pyridoxine per day orally (in three divided doses) and were readmitted 21 days later for a repeat of the above protocol on pyridoxine. They remained on 600 mg of pyridoxine per day orally for 3 to 4 months, with monthly clinical evaluations and basal serum prolactin, LH, and FSH measurements. The patients were similarly followed for 3 months after discontinuing pyridoxine. There were no significant responses of prolactin, LH, FSH, hGH, or TSH to pyridoxine under either basal or treatment conditions. TRH induced similar responses in plasma TSH before and during administration of pyridoxine. Before therapy, prolactin rose after TRH in four of the six patients. On pyridoxine, prolactin increased after TRH in two patients who had not responded initially. One of these women resumed menses while on pyridoxine. There was, however, no significant difference in mean prolactin reponse to TRH before or during pyridoxine therapy, whether comparison is made of maximum levels or increments of prolactin. The administration of 25 mg of chlorpromazine did not change the basal prolactin, LH, or FSH concentrations in any patient significantly. L-dopa caused a decrease in the basal prolactin concentration in all patients before pyridoxine treatment. The degree of suppression was unchanged after 3 weeks of pyridoxine therapy. Gonad-otropin levels did not change after L-dopa in either the pre- or post-therapy test. The L-dopa-induced rise in GH was unchanged before and after pyridoxine. Within individual tests, both before and after pyridoxine, prolactin increased after TRH and decreased after L-dopa, and hGH increased after L-dopa similarly. The means for each sampling time within tests were, however, significantly different (P < 0.05) for the TSH response to TRH. The mean basal prolactin, LH, and FSH (97.1 ± 14.8 ng/ml, 23.6 mlU/ml, and 18.8 ± 1.9 mlU/ml, respectively) during chronic pyridoxine treatment were not significantly different from pretreatment levels or from those 3 months after cessation of therapy. In addition, the mean basal prolactin of all tests after 21 days of pyridoxine (96.1 ± 10.3 ng/ml) was unchanged. Nevertheless, two of the six patients resumed regular menses during the chronic pyridoxine therapy. These patients had the lowest basal prolactin levels but could not be distinguished from the group on the basis of responses to the provocative tests nor on the basis of hormone levels after chronic therapy. One of these patients continued to have monthly menstrual periods during the 3 months after discontinuing pyridoxine, whereas the other had only two periods with light bleeding. Pretreatment levels of pyridoxal-5′-phosphate and hemolysate pyridoxal kinase were similar among the four patients in whom they were measured. After 3 to 4 months of pyridoxine treatment, the pyridoxal-5′-phosphate concentrations were also similar in the two patients who began menses (3 and 427 ng/1010 red blood cells; 89 and 156 ng/ml of plasma) and two of the patients whose menses did not begin (437 and 153 ng/1010 red blood cells; 126 and 67 ng/ml of plasma). The hemolysate pyridoxal kinase activity was likewise similar in the two pairs. No adverse effects were noted during pyridoxine therapy.