Normal Serum Prolactin Research Articles

8386 The Evolving Face of The Great Masquerader - Panhypopituitarism Associated with Neurosyphilis

Abstract Disclosure: M. Yabe: None. Z. Lin: None. F. Joseph: None. G. Philip: None. R. Silver: None. L. Callejas: None. J. Giunta: None. Untreated syphilis is on the rise in the United States. The CDC reported syphilis cases in newborns have increased 10-fold over a decade in November 2023, signifying the emergence of untreated infections. Pituitary involvement in syphilis is a very rare phenomenon, and endocrinological investigation is often overlooked. This will be the second reported case of neurosyphilis with pituitary involvement in a non-HIV infected patient. A 45-year-old female with no significant past medical history was admitted to the hospital with progressive neurological symptoms of intermittent left-side headache, hearing loss with tinnitus, and gait instability. Postcontrast MRI Brain revealed multifocal leptomeningeal enhancement involving supratentorial and infratentorial regions. Thickening of the enhanced pituitary infundibulum was also noted. Subsequent RPR titer showed 1:16 and lumbar puncture revealed CSF-VDRL titer 1:32, with pleocytosis 83 cells/uL, CSF-glucose 19 mg/dL, and CSF-protein 370 mg/dL. The patient completed Penicillin G 4 million/units intravenous every 4 hours for 14 days, with repeat MRI showing significant interval decrease in previously described extensive supratentorial and infratentorial leptomeningeal enhancement. However, there is no record of her sexual partner receiving treatment. The patient was readmitted one year later after a fall while displaying dysmetria. MRI Brain with contrast revealed a small subacute infarct along the right frontal corona radiata and pituitary gland measuring up to 1.2 cm in craniocaudal dimension compared to 0.4 cm on the prior exam. This prompted evaluation of pituitary hormones: FSH 0.8 IU/L, LH <0.3 IU/L, and ACTH 6.3 pg/mL, with normal serum growth hormone and prolactin levels. Further investigation revealed morning cortisol 2.5 ug/dL, thyrotropin < 0.2 uIU/mL, and free thyroxine 0.63 ng/dL. Radiological evidence is suspicious of inflammatory etiology of the pituitary gland. The patient was discharged with endocrinology follow-up and plan to perform a pituitary gland biopsy as an outpatient for confirmatory result. The association of neurosyphilis and hypophysitis leading to panhypopituitarism in a non-HIV infected patient was first reported in 2015. Since then, there remains limited research regarding their association due to rarity of pituitary involvement in neurosyphilis. With untreated syphilis on the rise and increased availability of MRI, clinicians should expect to encounter more cases of neurosyphilis with pituitary involvement in the future. Early detection of panhypopituitarism in those with positive CSF-VDRL titer could lead to better clinical outcomes. It is paramount that these cases are documented to emphasize pituitary involvement in neurosyphilis and encourage a low threshold to initiate endocrinological testing in the future. Presentation: 6/3/2024

Peripаrtal Cardiomyopathy

The purpose of the study is to describe a clinical case of peripartal cardiomyopathy (CM) and conduct literature analysis. Peripartal CM is defined as reduced ejection fraction of the left ventricle <45%, reduced fractional shortening <30%, as well as increased end-diastolic size of the left ventricle > 2.7 cm/m2. At the same time, there should be no detectable causes of heart failure, as well as development of heart failure in the last month of pregnancy or within 5 months after childbirth. The review presents data on possible causes of peripartal CM. Risk factors for peripartal CM are: age younger than 20 years and older than 30 years, preeclampsia, hypertension, multiple pregnancy, prolonged duration of viral infection, macro- and micronutrient insufficiency, etc. Prolactin and its 16 kDa fragment, as well as excessive activity of cathepsin D, play a leading role in pathogenesis of peripartal CM. A step-by-step algorithm for diagnosis of peripartal CM in real clinical conditions is described. Material and methods. The patient is K., 18 years old, in anamnesis: no prior history of cardiovascular diseases, according to the patient, she had pneumonia a year ago. The patient has not registered increased blood pressure. Physiological pregnancy proceeded satisfactorily; natural delivery was on time. On the 56th day after childbirth, the patient was admitted to the intensive care unit with complaints: shortness of breath, muscle weakness, palpitations, lower leg edema. From anamnesis: 1 month after childbirth, the next day after psychoemotional overstrain, the patient began to notice shortness of breath, lack of sleep, muscle weakness, decreased lactation. The examination revealed an increase in the sedimentation rate of erythrocytes, C-reactive blood protein, proteinuria, hematuria, as well as a decrease in the ejection fraction of the left ventricle. Results. Together with standard therapy, addition of prolactin secretion inhibitors and dopamine receptor stimulators led to significant improvement of the patient’s condition: proteinuria significantly decreased, edematous syndrome was gone, and LV contractile function significantly recovered. Conclusion. The clinical case demonstrates the development of a rare variant of peripartal CM, debuting with proteinuria and preserved kidney function, as well as normal serum prolactin levels. Apparently, there are different phenotypes of peripartal CM.

Determinants of Infertility among Married Couples in a Tertiary Hospital in Bangladesh

Introduction: Infertility is a common issue among married couples in Bangladesh. Infertility is often caused by a combination of multiple factors, and that individual cases of infertility can be complex and difficult to diagnose. Objective: To assess the determinants of infertility among the infertile couples both male and female. Materials and Methods: This prospective observational study was conducted in the Infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period from 01.07.2018 to 30.31.12.2021. Five hundred infertile couples were recruited from the out-patient department of infertility unit who came to take treatment for their infertility problem. Results: Mean (± SD) age of the female patients was 27.1 ± 5.2 years ranged between 18-44 years. Mean (± SD) age of the husband of patients was 34.0 ± 5.9 years ranged between 22-55 years. Primary infertility was seen in 59.8% study subjects and secondary infertility was seen in 40.2% study subjects. In our study, most of the women (94%) had below normal (<3 U/L) serum FSH. Most of the women (96%) had below normal (< 2U/L) serum LH. Serum TSH was normal (0.2 – 4.5 mU/L) in 51.0% patients. Majority of the women (60.8%) had above normal (>21 pml/L) serum FT4 level. Most of the women 72.2% had normal serum prolactin level. In male patients, Testosterone level was above normal (>30 nmol/L) in majority of the patients (73.4%). In Hysterosalpigography (HSG), 0.40% had abnormal uterine cavity, 4.2% had septed uterus, 15.2% had bicornuate uterus, 1.0% had unicornuate uterus and 1.6% had endometrial polyp. Hysteroscopy found abnormal uterus in 1.2% of patients, abnormal uterine cavity in 11.4%, abnormal endometrial flakes in 12.4%, abnormal right ostium in 13.0% and abnormal left ostium in 12.6%. Intrauterine adhesion, polyp and submucus fibroid were found in 35.2%, 2.8% and 17.6% respectively. Laparoscopy found abnormal uterus in 3% patients, abnormal right fallopian tube in 33.2%, abnormal left fallopian tube in 34.2%. Also, abnormal right fallopian tube in 37.0% and abnormal left fallopian tube in 37.6%. Pouch of Douglas free was found in 63%. During dye test in laparoscopy, 57.6% patients were found positive. In quality, semen type was found poor (<4%) in majority (61%) of the husbands. Regarding semen count, above normal (>20 million/ml) level was found in majority of the patients (80.8%). Regarding semen quality, majority (96%) had oligospermia (<15 million/ml). In case of rapid linear (RL), normal (50-60%) level was seen in majority of the patients (81.6%). In case of slow linear (SL), below normal (<15%) was seen in majority (64.8%) of the patients. Regarding non-propagative (NP), normal (0-10%) level was seen in most of the (87.8%) patients. In case of morphology of sperms, above normal (>50 million/ml) level was seen in most of the patients (80.6%). Conclusion: This study shows that a significant percentage of both male and female are suffering from infertility. The major causes of male infertility are partly hormonal, structural abnormalities of male genitalia, infection of genital tract, and partly psychological. Causes of female infertility are mostly hormonal, structural abnormalities of the uterus, fallopian tubes, infection of the genital tract and partly psychological.

Metabolic Abnormalities, Inflammatory Markers and Endothelial Dysfunction in Hyperprolactinemia due to Prolactinoma before and after Normalization of Serum Prolactin: A Prospective Case Control Study.

Hyperprolactinemia is associated with obesity, dyslipidemia, insulin resistance, and low-grade inflammation which may promote endothelial dysfunction (EnD). Limited work has been done on EnD in prolactinomas and we, therefore, studied serum markers of inflammation and EnD in patients with prolactinomas before and after treatment with dopamine agonists. Fifty-six treatment naïve patients with prolactinomas and fifty-three (apparently healthy age and sex-matched) controls were enrolled in the study and subjected to clinical assessment and laboratory investigations including blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urea, creatinine, uric acid, erythrocyte sedimentation rate (ESR), highly sensitive C-reactive protein (hsCRP) and markers of EnD i.e., intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). Patients were treated with a dopamine agonist (cabergoline) and parameters (like ESR, hsCRP, ICAM-1, and VCAM-1) were measured at 12 weeks. The majority of the patients (84%) were female, more than half (52%) had metabolic syndrome and over a third (36%) were obese. Blood glucose fasting, HbA1c, lipid fractions, ESR, hsCRP, ICAM-1, and VCAM-1 were significantly higher in patients than in controls. Median ICAM-1 was 1331.95 ng/ml (IQR 803.43-1825.99) in patients vs 753.04 ng/ml (IQR 402.04-871.55) in controls, P < 0.001 and median VCAM-1in patients was 971.35 ng/ml (IQR 695.03-1285.23) as against 634.56 ng/ml (IQR 177.49-946.50) in controls, p0.001. Serum ICAM-1 and VCAM-1 correlated positively with hsCRP. On multivariate regression analysis, serum hsCRP was the only significant predictor of change in ICAM-1 and VCAM-1. Normalization of serum PRL with CAB resulted in a significant decrease in metabolic parameters, ESR, hsCRP, ICAM-1, and VCAM-1. Hyperprolactinemia because of prolactinoma is associated with EnD secondary to systemic inflammation and metabolic abnormalities which improve after treatment with DA.

Improving pregnancy rate in infertile patients with polycystic ovarian syndrome receiving clomiphene citrate and cabergoline in euprolactinomic women in single cycle treatment.

To assess the therapeutic efficacy of cabergoline when given routinely with clomiphene citrate (CC) in infertile women with polycystic ovarian syndrome (PCOS) and normal serum prolactin in single cycle therapy. This prospective study included a total of 110 infertile women with polycystic ovaries and normal serum prolactin divided into two groups. The first group received only a single cycle clomiphene citrate 100 mg in two divided doses (50 mg × 2) from Day 2 to Day 6. The second group received the same regimen of clomiphene citrate along with cabergoline in two divided doses of 0.5 mg each week at Day 2 and Day 9, respectively. All patients were evaluated through full history and physical examination. Blood was extracted from all patients for hormonal assay and ultrasound for the assessment of ovulation. The success rate of ovulation induction was statistically significant. Biochemical pregnancy elevated to (36.0%, n = 18) with using combined drugs while it was 14.0%, n = 7, with the use of clomiphene citrate alone (p = 0.011). The clinical pregnancy rate in the study group was elevated to 32.0%, n = 16, which is statistically significant. No significant association was found between abortion and the type of treatment. There were no significant differences between the groups regarding drug side effect like ovarian hyper stimulation rate, multiple pregnancy rate as well as other adverse effects. Adding cabergoline in small doses together with clomiphene citrate in PCOS infertile women and normal serum prolactin increases the success rate of ovulation & significantly improves pregnancy rate with minimal drug side effects.

CLINICAL PROFILE AND EVALUATION OF SERUM PROLACTIN LEVEL IN CIRRHOSIS OF LIVER WITH SPECIAL REFERENCE TO CHILD PUGH SCORE

Clinical profile and evaluation of serum prolactin level in cirrhosis of liver with special reference to Child Pugh Score. Abstract Background: With the increasing incidence of liver cirrhosis the use of a biomarker such as prolactin, indicates the severity of the disease, its complications and serves as a tool for early intervention. Aim: To study the clinical profile and evaluation of serum Prolactin level in Cirrhosis of Liver with special reference to Child Pugh Score. Materials and Methods: A observational cross sectional study on 70 patients admitted under Department of Medicine, JMCH from July 2020 to June 2021. All the patients are subjected to the routine work up for chronic liver disease including serum prolactin level. Results: A total of 70 Patients analyzed in the study. The mean age is found to be 47 years with SD ±13 years, the male and female ratio is 4:1 with mean prolactin levels among the males, it is 36.9 ng/dl with SD ±15.3 ng/dl and in females it is 42.8 ng/dl with SD ±14.2 ng/dl . Of the 70 patients in this study, 59 (84.3%) of them had serum prolactin levels elevated above 19 ng/ml with various clinical profiles . The various clinical presentations noted in our study included ascites in 69 (98.5%) patients, portal hypertension in 63( 90 %) of the patients , oesophageal varices in 44 (62.85%) with upper GI bleed in 31 (44.3%) patients, hepatic encephalopathy (grades 1-4) in 50 (71.42%) patients. Out of 70 patients 55(78.5%) were of class C in child pugh score and the mean prolactin level is found to be 43.638 ng/ml while normal serum prolactin levels is seen in all patients with Class A of Child Pugh Class with p value &lt; 0.001 . The Spearmen coefficient value i.e. the r-value was 0.830 which is a strong positive correlation between the child pugh scoring system and serum prolactin level. Conclusion: Serum prolactin level correlated with the Child Pugh score in predicting the severity of the disease. Patients with a higher serum prolactin have a greater incidence of complications of cirrhosis like PHTN, HE and Esophageal varices.

Effect of liver cirrhosis on erectile function in rats: A study combining bioinformatics analysis and experimental research.

To explore the mechanism through which liver cirrhosis (LC) causes erectile dysfunction (ED). Bioinformatic analysis was used to predict the potential signalling pathways in LC-induced ED, and N-nitrosodiethylamine was used to establish a rat model of LC. H&E staining, Western blotting and RT-qPCR were used to detect pathological tissue damage and changes in mRNA and protein expression levels. In addition, the expression levels of sex hormones such as estradiol (E2), prolactin (PRL) and testosterone (T) were measured. The hypoxia-inducible factor (HIF) pathway was an important pathway in our bioinformatics prediction. Pathological damages were detected in the liver and penile tissues of the model rats. Compared with the normal group's serum hormone levels, E2 and PRL were increased in LC rats, while T was decreased (p<0.01). The mRNA and protein expression results from penis tissues showed that endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) were both downregulated, and HIF-1α was upregulated in the model group compared to the normal group (p<0.01). These data suggest that LC hinders erectile function and causes histopathological changes in the penis by affecting the expression of HIF-1α, eNOS, iNOS, E2, PRL and T.

The Expression of Prolactin Receptors in Benign Breast Tumors Is Not Associated with Serum Prolactin Level.

The role of prolactin (PRL) and its receptors in the initiation and development of benign breast tumors (BBT) has not been sufficiently studied. An imbalance in the system of hormone homeostasis is crucial in the development of BBT. In particular, an association between elevated prolactin levels and the development of BBT has been reported. Our study showed no significant differences between PRL receptor (PRL-R) expression in BBT tissue under normal and elevated serum PRL levels. There was also no significant correlation between age, PRL-R expression in BBT tissue, intact tissue, and PRL level in the serum. There was a strong significant correlation (p < 0.01; r = 0.92) between PRL-R expression in BBT samples and intact breast tissue, which did not depend on the serum PRL level. There was also no significant difference in the expression of the proliferative marker Ki-67 in BBT tissues from women with normal and elevated levels of serum PRL (p > 0.05). No signs of PRL and its receptors were detected in the BBT cystic fluid women with elevated serum PRL levels. In summary, our prospective study showed that the expression of PRL-R in the tissue of BBT and physiological breast tissue does not depend on the level of serum PRL.

Prolactinoma Outcome After Pregnancy and Lactation: A Cohort Study.

Context:Prolactinoma is the most frequent pituitary tumor among women of childbearing age. Fewer studies have addressed the outcome of prolactinomas after gestation.Objective:The aim was to study the spontaneous remission rate and change in tumor size after pregnancy and/or lactation in women with prolactinomas.Patients and Methods:Retrospective study conducted at a tertiary care center of north India. Records of 25 women with 31 pregnancies (20 microprolactinomas and 11 macroprolactinomas), who conceived on dopamine agonist (cabergoline) were studied. Cabergoline was stopped at conception in 24 pregnancies and continued in 7. Serum prolactin was noted 3 months after delivery and/or lactation. Magnetic resonance imaging available at last visit after delivery and/or lactation was also noted. Remission was defined as normal serum prolactin after pregnancy and/or lactation without use of cabergoline.Results:Among patients in whom cabergoline was stopped during pregnancy (n = 24), 41.6% (n = 10) had prolactin in normal range (achieved remission) after pregnancy and/or lactation. In 25% (n = 6) of women, adenoma size decreased by more than 50%, in 33%(n = 8), there was no change in adenoma size, and in 42% (n = 10), decrease in adenoma size was less than 50% after pregnancy and/or lactation. The median duration of cabergoline treatment before pregnancy among patients who achieved remission was 60 months against 24 months in those who did not achieve remission. The median pre-pregnancy adenoma size was 5.5 mm in women with remission against 8 mm in women who did not achieve remission.Conclusion:Pregnancy-induced remission of hyperprolactinemia was seen in 41.6% prolactinomas. Longer duration of dopamine agonist treatment before pregnancy, small pre-pregnancy adenoma size, and lower baseline prolactin were associated with high likelihood of remission, though not statistically significant.

Cure and Hormonal Control After Prolactinoma Resection: Case Series and Systematic Review.

ContextSurgical management of prolactinomas is an important treatment for patients intolerant of dopamine agonist therapy. However, predictors of postoperative outcomes remain unclear.ObjectWhile transsphenoidal surgical resection (TSSR) is important second-line therapy in prolactinoma patients, predictors of surgical cure and biochemical remission following TSSR remain sparse.MethodsA retrospective review of prolactinoma patients undergoing TSSR at the USC Pituitary Center from 1995 to 2020 was conducted. Participants were categorized as surgical cure (normalization of serum prolactin without medical treatment), surgical noncure, biochemical control (prolactin normalization with or without adjuvant therapy), and nonbiochemical control. A systematic review of the outcomes of surgically managed prolactinomas was performed.ResultsThe 40 female and 16 male participants had an average age of 35.6 years. Prior treatment included transsphenoidal resection (6, 11%) and dopamine agonist treatment (47, 84%). The 40 macroadenomas and 15 microadenomas exhibited suprasellar extension (24, 43%) and parasellar invasion (20, 36%). Fifteen (27%) were purely intrasellar. Gross total resection was achieved in 25 patients (45%) and subtotal in 26 (46%). Surgical cure was achieved in 25 patients (46%) and biochemical control in 35 (64%). Surgical cure was more likely in smaller, noninvasive tumors, those that were fully resected, and patients with lower preoperative (< 1000 ng/mL) and immediately postoperative (< 7.6 ng/mL) prolactin levels. Ten of 26 patients (38%) undergoing adjuvant therapy achieved biochemical control, which was less likely in men and those with higher preoperative prolactin or invasive tumors.ConclusionSurgical resection of prolactinomas is a safe procedure that, when offered judiciously, can achieve symptom and/or biochemical control in a majority of patients. A variety of predictors may be useful in advising patients on likelihood of postoperative remission.

SUN-909 A Unique Presentation of Multiple Endocrine Neoplasia (MEN) Type 1 Mosaicism Caused by a Novel c.124G&amp;gt;A Variant in the MEN1 Gene

The MEN1 gene is positioned on the long arm of chromosome 11 (11q13) and results in the production of menin. A classical tumour suppressor gene; the spectrum of reported germline MEN1 mutations occur throughout the gene with no strong genotype/phenotype relationship. Mosaicism is extremely rare, a recent report citing only 2 mosaic cases by next generation sequencing1. We describe a 43-year-old female with MEN1 mosaicism associated with parathyroid adenoma and probable gastrinoma.Our patient initially presented with nephrolithiasis and nephrocalcinosis alongside biochemistry of primary hyperparathyroidism. Imaging confirmed a right lower pole parathyroid adenoma and the lesion was removed, pathology confirming the diagnosis (July 2018). Post operatively she remained hypercalcaemic. Repeat imaging suggested a further right sided culprit lesion.One year previously (August 2017) she was admitted with a perforated duodenal ulcer within the first part of the duodenum (D1), ascribed to ibuprofen use, requiring surgical repair. Whilst awaiting repeat parathyroid surgery she represented with a further duodenal ulcer and perforation (February 2019) this time in the second part of the duodenum(D2). A second parathyroidectomy was performed and genetic investigations were instigated, given the presence of classical MEN1 phenotype. Again, pathology was consistent with a parathyroid adenoma (March 2019).DNA was extracted for next generation sequencing which revealed mosaicism with a c.124 G>A variant detected in the MEN1 gene at a level of approximately 15%.Further investigations have shown normal serum prolactin and pituitary and pancreatic MRI imaging. With no other family members testing positive (parents and 2/3 children) this mutation appears to be a de novo index case. Adjusted Calcium is normal 2.53 mmol/L (2.2-2.6 mmol/L) but serum Chromogranin A is elevated (2620 µg/L (ref range <95 µg/L)).The c.124 G>A variant predicts an amino acid substitution p.(Gly42Ser) in menin structure, an amino acid change previously associated with MEN12. Given the paucity of MEN1 mosaicism reported within the literature with the presence of the two cell lines and only 15% mosaicism close monitoring will be crucial to determine the genotype/phenotype relationship in our patient. 1 Choppin et al 2019 Eur J Endocrinol 1; 180(2):L1-L3 2 Itoh et al 2017 Clin Pediatr Endocrinol 26;25-28

THE FREQUENCY OF ELEVATED PROLACTIN LEVEL IN POLYCYSTIC OVARY SYNDROME WOMEN (PCOS) AND ITS' EFFECT ON PREGNANCY RATE

Introduction: Prolactin is a hormone secreted from anterior pituitary gland which has different functions throughout the body of the fertile females. Women with polycystic ovary syndrome (PCOS) may exhibit a mild elevation of serum prolactin level. High prolactin level can affect the fertility potential causing ovulatory dysfunction. Even those with normal ovulation, failure of producing a sufficient amount of progesterone after ovulation may occur which resulted in a deficient endometrium; less liable for embryo implantation( luteal phase defect). Thus, this research is aimed to study the frequency of elevated prolactin in women with PCOS and to evaluate its' effect on pregnancy rate. Methods: Fifty-three infertile females were included. They divided in to two major groups: Group I: females with PCOS and Group II: females with no PCOS. Both groups sub-divided in to two subgroups: Group A with serum prolactin more than 20 ng/dl and Group B with normal serum prolactin 2-20 ng/dl. All females were included in ICSI program followed by assessment of pregnancy rate in both groups. Results: The study was showed that 69.44% of women who suffered from PCOS had an elevated serum prolactin level with a mean of 31.17±10.24. Pregnancy rate was lower in the females with high serum prolactin level in both PCOS and non-PCOS women. Conclusion: Hyperprolactinemia is more frequent in the females with PCOS than normal ovulatory females. Elevated serum prolactin level negatively affects implantation and decreases the chance of getting a pregnancy following ICSI.

Clinical Outcome of Invasive Pituitary Prolactinomas Treated with Cabergoline

Background: Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome.&#x0D; Aims of the study: In this study we evaluate the results of cabergoline administration as initial treatment during 4 years follow up period.&#x0D; Methods: We prospectively categorized 36 patients into four groups according to the results of 3 months of cabergoline treatment: group 1, tumor volume reduction (TVR) ˃25% with normalized serum prolactin (NP) (n = 24); group 2, TVR˃25% without NP (n = 4); group 3, TVR ˂25% with NP (n = 5); and group 4, TVR ˂25% without NP (n = 3).&#x0D; Results: During follow-up, 22 patients (91.7%) in group 1 achieved TVR˃50% with NP. Three patients (75%) in group 2 achieved TVR˃50% with NP after treatment for 8 months. In group 3, four patients (80.0%) continued medication because of improvement of symptoms and achieved additional TVR(18.8–46.4%). Surgery was performed on five patients (one in group 2, one in group 3, and three in group 4), and complete resection was achieved in four (80.0%). Overall, 25 (69.4%) of the 36 patients treated with cabergoline had complete response and 6 (16.7%) had partial response but did not require surgery. Thus, the overall response rate was 86%,with only five patients (14%) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor.&#x0D; Conclusion: Patients who achieve TVR˃25%with NP with 3 months of cabergoline administration had a high possibility of showing good long term response (TVR˃50% with NP) to cabergoline. A higher dose of dopamine agonist (DA) should be considered for patients who achieve TVR˃25% without NP.

Autoimmune thyroid diseases are more common in patients with prolactinomas: a retrospective case-control study in an Italian cohort.

Prolactin may exert immunological effects. Over the years, a higher prevalence of autoimmune thyroid diseases (ATD) has been reported in patients with prolactinomas (PRLs) in areas with sufficient iodine intake. The aim of our study was to evaluate the prevalence of ATD [Graves' disease (GD) and chronic autoimmune thyroiditis (AIT)] in a retrospective cohort of Italian patients with PRLs compared to a sex-matched control group, represented by subjects with non-functioning pituitary adenoma (NFPA) or empty sella (ES). We enrolled 149 patients (108 F/41M) with PRLs (110 micro/39 macro) and 143 subjects (100 F/43M) with NFPA (n = 96, 56 micro/40 macro) or ES (n = 47), with normal serum prolactin. Neck ultrasound and thyroid function tests (anti-thyroid antibodies, TSH, FT3 and FT4) were performed in all patients. In PRLs, median serum prolactin was significantly higher (98.3 vs. 8.9ng/ml, p ≤ 0.0001), while age was lower (34 vs. 46years, p ≤ 0.001) compared to controls. The prevalence of ATD was 13.4% (20/149) in PRLs (1 GD and 19 AIT) compared to 6.3% (9/143) in the controls (p = 0.042). At the multivariate analysis, serum prolactin was the only independent factor predicting ATD. Thyroid volume (12.5 ± 5.9ml vs. 12.8 ± 10ml, p = 0.47) and the presence of uni- or multinodular goiter (29.5% vs. 35%, p = 0.35) did not differ between PRLs and control groups. Our data in an area with mild iodine deficiency confirm a higher prevalence of ATD in patients with prolactinomas.

Are Prolactin Serum Levels and Coronary Artery Atherosclerosis Correlated in Postmenopausal Women? A Cross-sectional Study

Prolactin is correlated with some conditions that predispose individuals to atherosclerosis. Prolactin receptors have been found in atherosclerotic plaques. However, the correlation between the serum prolactin level and the extension and severity of coronary artery atherosclerosis has yet to be studied. In total, 414 postmenopausal women candidated for selective coronary angiography with normal serum prolactin levels were enrolled. The patients' lipid profile and levels of serum prolactin, thyroid-stimulating hormone, C-reactive protein, urea, creatinine, and fasting blood sugar were measured. The Gensini score for each patient was calculated. The study population was divided into 3 groups according to the tertile of the serum prolactin level. There was no statistically significant difference in terms of the Gensini score between the 3 groups in the univariate analysis (P = 0.075). The multivariable analysis showed that the serum prolactin level was not an independent determinant of the Gensini score (P = 0.430), whereas age, hypertension, diabetes and dyslipidemia were the independent determinants of the Gensini score. There was no statistically significant correlation between the serum prolactin level and coronary artery atherosclerosis expressed as the Gensini score in our sample of postmenopausal women.

Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle.

To assess whether endometrial injury in the cycle preceding controlled ovarian hyperstimulation during intracytoplasmic sperm injection (ICSI) improves the implantation and pregnancy rates. Between January 1, 2016, and March 31, 2017, a randomized controlled trial was conducted at a center in Egypt among 300 women who met inclusion criteria (first ICSI cycle, aged <40years, day-3 follicle-stimulating hormone <10IU/L, normal serum prolactin, no uterine cavity abnormality). The women were randomly allocated using a web-based system to undergo endometrial scratch in the cycle preceding controlled ovarian hyperstimulation (n=150) or to a control group (n=150). Only data analysts were masked to group assignment. The primary outcomes were the implantation and clinical pregnancy rates at 14days and 4weeks after embryo transfer, respectively. Analyses were by intention to treat. The implantation rate was significantly higher in the endometrial scratch group (41.3% [90/218]) than in the control group (30.0% [63/210]; P<0.001). The clinical pregnancy rate was also significantly higher in the endometrial scratch group (44.2% [61/138]) than in the control group (30.4% [41/135]; P<0.001). Endometrial injury in the cycle preceding the stimulation cycle improved implantation and pregnancy rates during ICSI. CLINICALTRIALS.GOV: NCT02660125.

Area under the curve of temporal estrogen and progesterone measurements during assisted reproductive technology: Which hormone is the main determinant of cycle outcome?

Is there any relationship between estrogen and progesterone concentrations during assisted reproductive technology (ART)? Which hormone is the main determinant of impaired endometrial receptivity? This study was conducted from July to December 2016 at the in vitro Fertilization/Intracytoplasmic Sperm Injection unit at Zeynep Kamil Women and Children's Health Training and Research Hospital. A total of 289 women who underwent ART were prospectively screened and areas under the curve of temporal estrogen (AUCEM) and progesterone measurements (AUCPM) were calculated for each participant. Women were included if they had regular menstrual cycles, normal serum prolactin levels and had not received hormone treatment within three months. ART was indicated in all patients for unexplained infertility. Patients were divided into two groups: with (n = 90) and without (n = 199) embryo implantation. The relationship between the two AUCs and ART success was assessed in terms of embryo implantation and clinical pregnancy. Implantation was successful in 90 (31.1%) women, and a fetal heart rate was detected in 83 (28.7%) cases. There was a significant correlation between AUCEM and AUCPM (r = 0.525, P < 0.001). Multivariate regression analysis showed significant associations between failure of implantation, lack of clinical pregnancy and AUCEM (beta coefficient = 0.311, P < 0.001; beta coefficient = 0.297, P < 0.001, respectively) after adjusting for AUCPM. Our data showed that the degree of endometrial estrogen exposure is the main factor functioning as a detrimental effect of ovarian stimulation on endometrial receptivity.

Time Course of Resolution of Hyperprolactinemia After Transsphenoidal Surgery Among Patients Presenting with Pituitary Stalk Compression

Primary lactotroph disinhibition, or stalk effect, occurs when mechanical compression of the pituitary stalk disrupts the tonic inhibition by dopamine released by the hypothalamus. The resolution of pituitary stalk effect-related hyperprolactinemia postoperatively has not been studied in a large cohort of patients. We performed a retrospective review to investigate the time course of recovery of lactotroph disinhibition after transsphenoidal surgery. Medical records were retrospectively reviewed for all patients undergoing transsphenoidal surgery with the senior author from April 2008 to November2014. Of 556 pituitary adenomas, 289 (52.0%) were eliminated: 77 (13.9%) had an immunohistochemically confirmed prolactinoma, 119 (21.4%) patients had previous surgery, 93 (16.7%) had incomplete medical records, leaving 267 patients (48.0%) for final analysis. Of these patients, 72 (27.0%) had increased serum prolactin levels (≥23.3 ng/mL), suggestive of pituitary stalk effect (maximum prolactin level= 148.0 ng/mL). Patients with stalk effect were more likely than those with normal serum prolactin levels to present with menstrual dysfunction (29.7% vs. 19.4%; P < 0.01) and galactorrhea (11.1% vs. 2.1%; P < 0.01). Patients with lactotroph disinhibition were more likely to harbor macroadenomas than were patients who did not show lactotroph disinhibition (81.9% vs. 70.2%; P= 0.06). Among patients with increased preoperative prolactin, 77.8% experienced normalization of serum prolactin postoperatively, galactorrhea improved in 100%, sexual dysfunction resolved in 66.6%, and menstrual dysfunction among premenopausal females normalized in 73.3% at last follow-up (mean, 5.35years; range, 0.1-10 years). Transsphenoidal surgery can provide durable normalization of serum prolactin levels and related symptoms caused by pituitary stalk compression-related lactotroph disinhibition.

Differential diagnosis and management of abnormal uterine bleeding due to hyperprolactinemia

Abstract Abnormal uterine bleeding may be acute or chronic accounting for up to 30% of outpatient visits to gynecologists. Hyperprolactinemia is one of the most common endocrine disorders associated with ovulatory dysfunction that results in menstrual irregularities. Prior to initiating treatment, the various causes (physiologic, pathologic, pharmacologic, or idiopathic) of hyperprolactinemia must be elucidated. Prolactin is a stress hormone that increases in response to stressful conditions; therefore, while collecting samples it is necessary to reduce venipuncture stress. A thorough patient history and physical examination will help to identify the cause and to direct therapy. Imaging results must always be assessed along with a patient’s clinical history and biochemical parameters when a pituitary tumor is suspected. Magnetic resonance imaging is the method of choice for the diagnosis of microprolactinomas and macroprolactinomas in both initial assessment and follow-up. Several drugs may cause a significant increase in serum prolactin concentration. If clinically feasible, the drug should be discontinued; if this is not possible, it should be substituted with a drug of similar action that does not cause hyperprolactinemia. Prolactinomas are the most common cause of pituitary adenomas affecting women of fertile age leading to significant elevations in prolactin that warrant treatment. Idiopathic hyperprolactinemia may be observed in the presence of elevated serum prolactin levels and in the absence of any other recognized cause of increased prolactin secretion. Dopamine agonists are the mainstay of therapy in prolactinomas and symptomatic idiopathic hyperprolactinemia because they normalize serum prolactin, effectively shrink prolactinomas and normalize gonadal function (i.e. menstruation).

Cabergoline in the Treatment of Male Orgasmic Disorder-A Retrospective Pilot Analysis.

IntroductionMale orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve orgasmic dysfunction.AimsTo determine whether cabergoline increases the potential for orgasm in men with orgasmic disorder.MethodsA retrospective chart review of men treated in a single andrology clinic for delayed orgasm or anorgasmia in a pilot study using cabergoline 0.5 mg twice weekly was performed. Duration of treatment and response were noted. Medical records were examined for other factors including history of prostatectomy and concomitant androgen supplementation.Main Outcome MeasuresSubjective improvement in orgasmic function resulting from cabergoline treatment.ResultsOf 131 men treated with cabergoline for orgasmic disorder, 87 (66.4%) reported subjective improvement in orgasm and 44 (33.6%) reported no change in orgasm. Duration of therapy (P = .03) and concomitant testosterone therapy (P = .02) were associated with a significant positive response to cabergoline treatment. No differences were found between injectable and non-injectable testosterone formulations (P = .90), and neither age (P = .90) nor prior prostatectomy (P = .41) influenced the outcome of cabergoline treatment. Serum testosterone levels before (P = .26) and after (P = .81) treatment were not significantly different in responders vs non-responders.ConclusionCabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder.