ergoline and Headache

Meningitis is an uncommon complication of an untreated pituitary macroadenoma. Meningitis may occur in patients with macroadenomas who have undergone transsphenoidal surgery and radiotherapy and is usually associated with rhinorrhea. Less commonly, cerebrospinal fluid rhinorrhea has been reported as a complication of treatment of prolactinomas by dopamine agonists. Cerebrospinal fluid rhinorrhea in cases of untreated pituitary macroadenoma is reported only in isolated cases. Acute bacterial meningitis without rhinorrhea in patients with an untreated pituitary macroadenoma is an exceptional finding with only three previously reported cases.. A 31-year-old male was urgently admitted for headache, fever and visual loss. Neuroimaging disclosed an invasive pituitary lesion. Cerebrospinal fluid leakage was not clinically detected. Lumbar puncture showed acute meningitis. Blood tests revealed increased inflammatory markers, a serum prolactin of 9000 ng/ml (2.5-11 ng/ml) and panhypopituitarism. Intravenous antibiotics and hydrocortisone replacement therapy were initiated, leading to a favorable clinical outcome. An endoscopic transsphenoidal debulking procedure was performed, it showed that the sphenoid floor was destroyed and the sinus occluded by a massive tumor.. Meningitis should be ruled out in patients with a pituitary mass who present with headache and increased inflammatory tests, even in the absence of rhinorrhea.

Topics: Adult; Anti-Bacterial Agents; Blindness; Cabergoline; Combined Modality Therapy; Ergolines; Fever; Headache; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypophysectomy; Hypopituitarism; Male; Meningitis, Aseptic; Neoplasm Invasiveness; Pituitary Neoplasms; Prolactinoma; Sella Turcica; Third Ventricle; Thyroxine

To review medication-induced headache (MIH) through a systematic evaluation of the literature regarding the pharmacologic management of this condition.. To identify and evaluate all pharmacologic interventions for MIH, we conducted a qualitative systematic review of the English-language literature from 1966 to June 1998 using MEDLINE. The following search terms were used: chronic daily headache, transformed migraine, analgesic withdrawal headache, analgesic rebound headache, drug-associated headache, medication-induced headache, detoxification, and dihydroergotamine. In addition, a review of the references from relevant literature was also conducted to collect reports not identified in the MEDLINE search.. Numerous therapies for acute management of MIH have been evaluated, although no rigorously conducted clinical trials were identified. Therapies evaluated include abrupt withdrawal of analgesics, initiation of dihydroergotamine, nonsteroidal antiinflammatory agents, methylergonovine, dihydroergotamine, sumatriptan, amitriptyline, dexamethasone, piracetam, prothipendyl, and valproate. Epidemiology, diagnosis, clinical features, pathophysiology, and long-term prognosis of therapy are discussed and therapeutic guidelines are offered.. MIH is an underrecognized and difficult condition affecting headache-prone patients. The published literature concerning treatment of patients with MIH is scant and of poor quality, making it difficult for clinicians to decide on appropriate therapy. Recognition and treatment of MIH may lead to a long-term improvement in headache relief for many patients. It appears that complete withdrawal of the medications being overused is required for favorable long-term results.

Topics: Amitriptyline; Analgesics; Anti-Inflammatory Agents; Chronic Disease; Ergolines; Headache; Humans; MEDLINE; Piracetam; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome; Sumatriptan; Thiazines; Valproic Acid

Topics: Aged; Aged, 80 and over; Amnesia, Retrograde; Antineoplastic Agents; Cabergoline; Chordoma; Cranial Fossa, Posterior; Diagnosis, Differential; Dopamine Agonists; Ergolines; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Headache; Humans; Hyperprolactinemia; Luteinizing Hormone; Magnetic Resonance Imaging; Prolactinoma; Skull Base Neoplasms

Topics: Animals; Blood Pressure; Clinical Trials as Topic; Cycloheptanes; Cyproheptadine; Dogs; Ergolines; Guinea Pigs; Haplorhini; Headache; Histamine H1 Antagonists; Humans; Hypnotics and Sedatives; Lethal Dose 50; Methysergide; Mice; Migraine Disorders; Phenothiazines; Piperidines; Rabbits; Rats; Serotonin Antagonists; Thiophenes; Vascular Headaches

Fibrocystic breast disease is one of the most frequent conditions of the breast among women from 30 to 49 years, with a frequency of about 60%, hence the interest in studying and treating it with the most advanced and effective resources.. To compare the efficacy and adverse events of alpha dihydroergocryptine with cabergoline in patients with fibrocystic breast disease.. A prospective, longitudinal, open, comparative study between alpha-dihydroergocryptine and cabergoline, made in the service of Gynecology and Obstetrics at the Dr. Miguel Silva General Hospital in Morelia, Michoacán. 171 patients diagnosed with fibrocystic breast disease were randomly assigned to the alpha-dihydroergocryptine or the cabergoline group. Assessments were made at baseline and every month subsequently. The following symptoms were evaluated: breast tenderness, breast pain, lumps and nipple discharge. The concentrations of prolactin were determined and an ultrasound was performed at baseline and at 3 and 6 months, patients were questioned about adverse events.. 171 patients were included (81treated with alpha-dihydroergocryptine and 90 with cabergoline); 156 completed the study. The age limits were 18 and 51 years. The evolution time prior to study entry was 17.71 +/- 18.3 months for the alpha-dihydroergocryptine group and 18.57 +/- 20.35 for the cabergoline group. 15 patients discontinued treatment due to adverse events (8 of the alpha-dihydroergocryptine group and 7 of the cabergoline group). The most common adverse event was headache.. In this study alpha-dihydroergocryptine was better tolerated and had better clinical response compared with cabergoline; breast pain and breast tenderness disappeared within the first month of treatment. Adverse events were similar for both treatments.

Topics: Adolescent; Adult; Cabergoline; Dihydroergocryptine; Ergolines; Female; Fibrocystic Breast Disease; Galactorrhea; Gastrointestinal Diseases; Headache; Humans; Mastodynia; Middle Aged; Prolactin; Prospective Studies; Treatment Outcome; Young Adult

Topics: Adult; Aged; Arteriosclerosis; Attention; Clinical Trials as Topic; Drug Evaluation; Ergolines; Female; Headache; Humans; Intracranial Arteriosclerosis; Male; Middle Aged; Nicotinic Acids; Pain; Raynaud Disease

Topics: Animals; Blood Pressure; Clinical Trials as Topic; Cycloheptanes; Cyproheptadine; Dogs; Ergolines; Guinea Pigs; Haplorhini; Headache; Histamine H1 Antagonists; Humans; Hypnotics and Sedatives; Lethal Dose 50; Methysergide; Mice; Migraine Disorders; Phenothiazines; Piperidines; Rabbits; Rats; Serotonin Antagonists; Thiophenes; Vascular Headaches

Topics: Aged; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Bromocriptine; Cabergoline; Combined Modality Therapy; Dacarbazine; Drug Substitution; Ergolines; Fatal Outcome; Headache; Humans; Hyperprolactinemia; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Pituitary Neoplasms; Prolactin; Prolactinoma; Proton Therapy; Temozolomide

Topics: Adult; Brain; Cabergoline; Dopamine Agonists; Erectile Dysfunction; Ergolines; Headache; Humans; Magnetic Resonance Imaging; Male; Nipple Discharge; Pituitary Neoplasms; Prolactinoma

Prolactin (PRL)-secreting macroadenomas usually measure between 10 and 40 mm. Giant (adenoma size ≥40 mm) PRL-tumors are not common, and larger prolactinomas (maximal diameter ≥60 mm) are rare, and their management outcomes have not been well characterized.. We have identified 18 subjects (16 men, 2 females) with giant PRL-adenomas (size ≥60 mm; PRL > 1000 ng/ml) and summarized their characteristics and response to treatment.. Mean age was 36.3 ± 13.5 years (range 12-59 years). Mean adenoma size was 71.8 ± 10.2 mm (60-92 mm). Complaints at presentation included headaches in 11 patients, visual deterioration in 9, sexual dysfunction in 9 males, and behavioral changes in two. Fourteen (78 %) had visual field defects. Mean PRL at presentation was 28,465 ng/ml (range 1300-270,000). All patients were treated with cabergoline (3.9 ± 2.0 mg/week), except for one who received bromocriptine. Treatment achieved PRL normalization in 11/18 patients within a median interval of 20 months. Visual improvement occurred in 12/14 patients with pre-treatment visual abnormalities. Nine patients underwent surgery (transsphenoidal, 7; transcranial, 2). None of the seven patients with elevated PRL before surgery achieved remission post-operatively. After a follow-up of 7.8 ± 5.1 years, 15/18 patients had significant adenoma shrinkage. Eleven patients are normoprolactinemic, 3 are partially controlled (PRL < 3 × ULN), and 4 remain with significantly elevated PRL. Most patients reported disappearance or improvement of their complaints.. These enormous PRL-adenomas are invasive but respond fairly well to medical treatment. Long-term therapy with high dose cabergoline together with a pituitary surgery in some patients was the key for their successful management, achieving biochemical and clinical remission in most patients.

Topics: Adolescent; Adult; Antineoplastic Agents; Bromocriptine; Cabergoline; Child; Ergolines; Female; Galactorrhea; Headache; Hormone Antagonists; Humans; Male; Middle Aged; Neurosurgical Procedures; Pituitary Neoplasms; Prolactinoma; Sexual Dysfunction, Physiological; Treatment Outcome; Tumor Burden; Vision Disorders; Young Adult

Topics: Adult; Bromocriptine; Cabergoline; Combined Modality Therapy; Contraindications; Dopamine Agonists; Drug Substitution; Ergolines; Female; Headache; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypophysectomy; Infant, Newborn; Male; Pituitary Apoplexy; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Complications, Neoplastic; Prolactinoma; Thyroxine; Vision Disorders

Giant prolactinomas are rare pituitary tumours of which management can be a challenge. A 28-year-old man presented with headaches, visual impairment and behavioural changes. Clinically, the patient was found to have hypogonadism and bitemporal hemianopsia. A MRI demonstrated a pituitary tumour 76 mm in diameter and blood tests revealed a serum prolactin of 158,700 µU/mL (reference range 58-254). Initially, a craniotomy was performed. Immunohistochemistry of the tumour identified a prolactinoma with a high proliferative index and the patient was started on treatment with a dopamine agonist. A year later, neurological symptoms worsened due to regrowth of the lesion's cystic component, and so further surgery was performed. After 10 years of treatment with dopamine agonists, the prolactin levels decreased by 96.8%, there was an effective reduction in tumour size, and the neurological signs and symptoms resolved.

Topics: Adult; Craniotomy; Dopamine Agonists; Ergolines; Follow-Up Studies; Headache; Hemianopsia; Humans; Hypogonadism; Immunohistochemistry; Magnetic Resonance Imaging; Male; Pituitary Gland; Pituitary Neoplasms; Prolactin; Prolactinoma; Vision, Low

The aim of this article is to investigate the phenotype and etiology of prolactinoma-associated headache as well as present and discuss the plausible pain-relieving effect of dopamine agonist treatment.. In this case-based audit we included 11 patients with prolactinomas and one patient with idiopathic hyperprolactinemia presenting with headache that subsequently improved or resolved after dopamine agonist treatment.. A significant ipsilateral location of tumor mass and reported headache symptoms was observed (p = 0.018). After dopamine agonist treatment seven out of 12 patients became pain free within 2.5 months; after one year of treatment 11 out of 12 reported headache improvement or resolution. Average tumor volume reduction after treatment was 47 ± 22% during 9.5 ± 8.4 months of follow-up. There was no significant association between headache relief and tumor shrinkage (p = 0.43) or normalization of serum prolactin (p = 1.00), respectively.. 1) The significant association between lateralization of tumor and headache suggests a mechanical origin of the headache, 2) headache responded to dopamine agonist treatment in most patients, and 3) our observations encourage future prospective controlled trials to investigate the role of hyperprolactinemia in the pathogenesis of headache as well as the therapeutic effects of dopamine agonists.

Topics: Adult; Aminoquinolines; Cabergoline; Case-Control Studies; Dopamine Agonists; Ergolines; Female; Headache; Humans; Hyperprolactinemia; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Neoplasms; Prolactinoma; Recurrence; Substance Withdrawal Syndrome

Treatment with dopamine agonists in patients with prolactin (PRL) adenomas and Parkinson's disease is associated with central side effects. Central side effects may depend on a substance's ability to pass the blood-brain barrier, which can be actively controlled by transporter molecules such as the P-glycoprotein (P-gp) encoded by the ABCB1 gene.. We aimed to determine whether cabergoline is transported by the P-gp and whether polymorphisms of its encoding ABCB1 gene predict central side effects of cabergoline therapy in patients with PRL adenomas. i) In an experimental mouse model lacking the homologues of the human ABCB1 gene (Abcb1ab double knockout mouse model), we examined whether cabergoline is a substrate of the P-gp using eight mutant and eight wild-type mice. ii) In a human case-control study including 79 patients with PRL adenomas treated with cabergoline at the Max Planck Institute of Psychiatry in Munich, we investigated the association of four selected ABCB1 gene single nucleotide polymorphisms (SNPs) (rs1045642, rs2032582, rs2032583 and rs2235015), with the occurrence of central side effects under cabergoline therapy.. i) In the experimental mouse model, we observed that brain concentrations of cabergoline were tenfold higher in the mutant mice compared with their wild-type littermates, implying that cabergoline is indeed a substrate of the transporter P-gp at the blood-brain barrier level. ii) In the human study, we observed significant negative associations under cabergoline for the C-carriers and heterozygous CT individuals of SNP rs1045642 with two central side effects (frequency of fatigue and sleep disorders) and for the G-carriers of SNP rs2032582 with the enhancement of dizziness. For the SNPs rs2235015 and rs2032583, no associations with central side effects under cabergoline were found.. This is the first study demonstrating that individual ABCB1 gene polymorphisms, reflecting a different expression and function of the P-gp, could predict the occurrence of central side effects under cabergoline. Our findings can be viewed as a step into personalised therapy in PRL adenoma patients.

Topics: Adult; Aged; Animals; Antineoplastic Agents; ATP Binding Cassette Transporter, Subfamily D, Member 1; ATP-Binding Cassette Transporters; Cabergoline; Case-Control Studies; Ergolines; Fatigue; Female; Headache; Humans; Male; Mice; Mice, Knockout; Middle Aged; Pituitary Neoplasms; Polymorphism, Single Nucleotide; Predictive Value of Tests; Prolactinoma; Treatment Outcome

Juvenile cystinosis was diagnosed in a patient who presented with severe headache attacks and photophobia. Treatment with oral cysteamine and topical cysteamine eye drops was started. One-and-a-half years later, he developed unilateral gynecomastia and elevated prolactin and growth hormone levels. A pituitary macroprolactinoma was discovered and successfully treated with the dopamine agonist cabergoline. Increased serum growth hormone levels were attributed to enhanced growth hormone production by the prolactinoma and somatostatin inhibition by cysteamine. Although the occurrence of prolactinoma in this patient could be a simple coincidence, it might also be a rare yet unrecognised complication of cystinosis.

Topics: Administration, Oral; Administration, Topical; Body Height; Cabergoline; Child; Cysteamine; Cystinosis; Dopamine Agonists; Ergolines; Headache; Human Growth Hormone; Humans; Male; Ophthalmic Solutions; Pituitary Neoplasms; Prolactinoma; Radiation-Protective Agents; Treatment Outcome

We present the first case of successful non-surgical treatment of an internal carotid aneurysm, embedded within a macroprolactinoma. A 53 year old male, with a previous history of Non-Hodgkin's Lymphoma (NHL), presented with severe right sided frontal headache, decreased visual acuity, and ophthalmolplegia due to a third nerve palsy. A CT scan showed a 4.6 by 4.8 cm mass in the pituitary fossa with bony erosion. Initially, it was thought to be a cerebral recurrence of the Non-Hodgkin's disease. Direct questioning revealed a long history of erectile dysfunction with loss of libido. Prolactin at presentation was 537, 200 mU/l and a diagnosis of macroprolactinoma, with apoplexy was made. A subsequent MRI brain confirmed a large macroadenoma with an intra cavernous aneurysm encased by the tumour. A therapeutic dilemma ensued due to the need for urgent decompression of the visual pathways, preferably by surgery. However, in the presence of an intrasellar aneurysm, surgery would have been extremely hazardous. The patient was therefore commenced on cabergoline and rapidly titrated up to 4 mg per week. The aneurysm was treated by endovascular occlusion of the right carotid artery under radiological control. The combination of these therapies, without conventional surgical intervention, resulted in resolution of the third nerve palsy and recovery of visual acuity in the left eye. The diagnosis and management of this condition was challenging and the final outcome, with non-surgical treatment and carotid artery occlusion was satisfactory.

Topics: Angiography, Digital Subtraction; Antineoplastic Agents; Balloon Occlusion; Cabergoline; Carotid Artery, Internal; Dopamine Agonists; Ergolines; Headache; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Ophthalmoplegia; Pituitary Apoplexy; Pituitary Neoplasms; Prolactinoma; Treatment Outcome; Vision Disorders

Limited data are available on clinical presentation and treatment strategy in patients with GH-secreting adenomas with onset in adolescence.. To report results of diagnosis and treatment in adolescents with GH and IGF-I excess.. Analytical, observational, retrospective.. Thirteen patients (five females and eight males, age 15-20 years) all with macroadenoma (two extrasellar, 11 invasive).. Height, body mass index (BMI), GH and IGF-I levels, tumour volume at diagnosis and after treatment.. Transsphenoidal surgery, octreotide subcutaneous (OCT, 0.3-0.8 mg/day), octreotide-LAR i.m. (LAR, 20-30 mg/q28 days), lanreotide i.m. (LAN, 60-90 mg/q28 days), bromocriptine (BRC, 5 mg/day), cabergoline (CAB, 1-2 mg/week).. Concomitant hyperprolactinaemia was found in eight patients (61.5%). All girls presented with amenorrhoea, which was associated with galactorrhoea in two patients; all boys presented with symptoms of tumour mass compression such as visual disturbance or headache; two girls also had these symptoms. Height at diagnosis was above the 97th centile in four of five girls and in six of eight boys. None of the patients had altered lipid profile while homeostasis model assessment of insulin resistance (HOMA-IR; 2.8 +/- 0.9) and beta-cell function (HOMA-beta, 207.6 +/- 98.1%) were higher than predicted (1% and 100%, respectively). First-line treatment was surgery in two patients and somatostatin analogues associated with dopaminergic drugs in 11 patients. None of the patients operated on were cured while six of 11 patients receiving pharmacotherapy (6-24 months) were controlled. In these six, tumour volume was reduced by 51.0 +/- 25.2% (median 51.5%). As second-line treatment, all the 11 patients treated with somatostatin analogues underwent surgical removal of their tumours. Surgery was successful in four patients and second-line pharmacotherapy in six patients. One patient was lost at follow-up and two patients maintained active acromegaly despite different treatment schedules; both patients were then treated with radiotherapy. At the last follow-up, there was a significant decrease in insulin levels, HOMA-IR and HOMA-beta without any change in lipid profile.. The clinical presentation of GH-secreting adenomas in adolescent girls is associated with menstrual disturbances and in boys with symptoms of mass effects; tall stature is characteristic in both. First-line treatment with depot somatostatin analogues followed by surgery and then by a second course of somatostatin analogues was successful and safe in 11 of 13 patients.

Topics: Adolescent; Adult; Antineoplastic Agents, Hormonal; Body Height; Body Mass Index; Bromocriptine; Cabergoline; Combined Modality Therapy; Ergolines; Female; Growth Hormone; Growth Hormone-Secreting Pituitary Adenoma; Headache; Hormone Antagonists; Humans; Insulin Resistance; Insulin-Like Growth Factor I; Male; Menstruation Disturbances; Octreotide; Peptides, Cyclic; Pituitary Neoplasms; Retrospective Studies; Somatostatin; Treatment Outcome

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome may be associated with pituitary prolactinoma and may be induced by treatment of prolactinoma with dopamine agonists. Endocrinologists treating patients with prolactinoma need to be aware of this syndrome as its pathophysiology and treatment differ from that of other headache syndromes.

Topics: Adult; Cabergoline; Dopamine Agonists; Ergolines; Headache; Humans; Male; Prolactinoma; Syndrome

The clinical characteristics of 84 patients with pituitary tumour who had troublesome headache were investigated. The patients presented with chronic (46%) and episodic (30%) migraine, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT; 5%), cluster headache (4%), hemicrania continua (1%) and primary stabbing headache (27%). It was not possible to classify the headache according to International Headache Society diagnostic criteria in six cases (7%). Cavernous sinus invasion was present in the minority of presentations (21%), but was present in two of three patients with cluster headache. SUNCT-like headache was only seen in patients with acromegaly and prolactinoma. Hypophysectomy improved headache in 49% and exacerbated headache in 15% of cases. Somatostatin analogues improved acromegaly-associated headache in 64% of cases, although rebound headache was described in three patients. Dopamine agonists improved headache in 25% and exacerbated headache in 21% of cases. In certain cases, severe exacerbations in headache were observed with dopamine agonists. Headache appears to be a significant problem in pituitary disease and is associated with a range of headache phenotypes. The presenting phenotype is likely to be governed by a combination of factors, including tumour activity, relationship to the cavernous sinus and patient predisposition to headache. A proposed modification of the current classification of pituitary-associated headache is given.

Topics: Adenoma; Adult; Aminoquinolines; Antineoplastic Agents, Hormonal; Bromocriptine; Cabergoline; Disability Evaluation; Dopamine Agonists; Ergolines; Female; Headache; Humans; Male; Migraine Disorders; Octreotide; Peptides, Cyclic; Pituitary Neoplasms; Severity of Illness Index; Somatostatin; Time Factors

Topics: Adolescent; Cabergoline; Central Nervous System Cysts; Dopamine Agonists; Ergolines; Female; Headache; Humans; Hyperprolactinemia; Treatment Outcome

Headache is a common problem in patients with pituitary tumours. Small pituitary lesions can cause debilitating headache, suggesting that the size of the pituitary tumour may not be the only causal factor in pituitary-related headache. We present two cases of prolactinoma-associated headache. The first case has a clinical diagnosis of short-lasting unilateral headache attacks with conjunctival injection and tearing (SUNCT). The second case has a clinical diagnosis of hemicrania continua and idiopathic stabbing headache. In each case, the administration of dopamine agonists has led to an exacerbation of symptoms. We review the relevant literature to understand the pathophysiological implications of these cases.

Topics: Adult; Amenorrhea; Anti-Inflammatory Agents, Non-Steroidal; Bromocriptine; Cabergoline; Dopamine Agonists; Ergolines; Female; Headache; Humans; Indomethacin; Magnetic Resonance Imaging; Pituitary Neoplasms; Prolactin; Prolactinoma; Radiography

The differential diagnosis of tumors at the base of the skull comprises meningiomas, neurinomas, gliomas, metastatic carcinomas, chordomas, epidermoids, and pituitary adenomas. About half of the pituitary adenomas are prolactinomas which are unique in a sense that medical therapy causes rapid tumor shrinkage and symptomatic improvement. We report on two patients in which the diagnosis of an invasive macroprolactinoma was masked by apparently low prolactin levels caused by a high-dose hook effect in the chemiluminometric assay. The first case a 49 year old male with impairment of hearing on the left side was presented in the Department of Otorhinolaryngology. A massive invasively growing tumor was demonstrated on a cranial MRI. Endocrine tests revealed normal pituitary function and normoprolactinemia. The patient underwent debulking surgery, occipitocervical fusion because of destruction of the first cervical vertebra and subsequent irradiation. The histopathological diagnosis was invasive prolactinoma. A repeat prolactin (PRL) sample, which was assayed using serial dilutions, revealed a real PRL level of 89,700 ng/ml. Dopamine agonist therapy was initiated under which PRL levels declined in parallel with tumor size. The second case a 40 year old male was presented with acute visual loss. Cranial MRI showed a large tumor at the base of the skull. Based on a transnasal biopsy, the preliminary diagnosis was a poorly differentiated carcinoma for which emergency irradiation was performed. Endocrine tests demonstrated partial hypopituitarism and moderate hyperprolactinemia. Hydrocortisone was substituted and dopamine agonist therapy was started because of moderate hyperprolactinemia. The final histopathological diagnosis was invasive prolactinoma. A repeat PRL sample assayed in serial dilution demonstrated an apparent rise in PRL with a maximum value of 6,460 ng/ml. Under dopamine agonist therapy, PRL declined to normal values, tumor size decreased and cranial nerve palsies disappeared. The apparently falsely low prolactin levels in the initial work-up of both patients were caused by a high-dose hook effect in the PRL assay. Serial dilutions of serum PRL samples is, therefore, mandatory in the diagnostic work-up of patients with large invasive tumors at the base of the skull. This avoids unnecessary aggressive and dangerous treatment like surgery or radiotherapy in cases where pharmacological treatment may be the choice.

Topics: Adult; Cabergoline; Dopamine Agonists; Ergolines; False Negative Reactions; Headache; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Pituitary Function Tests; Pituitary Neoplasms; Prolactin; Prolactinoma; Skull Base Neoplasms; Vision Disorders

Pituitary adenomas in childhood and adolescence constitute 2-6% of all operated pituitary adenomas. We report the clinical features, treatment and follow-up of 10 pediatric patients affected by pituitary adenomas. All patients underwent clinical evaluation, endocrine tests, magnetic resonance imaging and visual field assessment. Follow-up ranged from 8 to 132 months (median 52.6). All patients were older than 10 years of age; 60% were males. In 50% the initial complaints were headache and/or visual impairment, all except one had clear evidence of endocrine dysfunction. Ninety percent were macroadenomas. According to hormone measurements and immunostaining 50% were prolactinomas, 20% were pure GH-secreting and 30% were non-functioning adenomas. Prolactinomas in two females were successfully treated with cabergoline. The other patients underwent surgery: three prolactinomas are still being treated with dopamine agonists and a GH-secreting adenoma is being treated with octreotide LAR and cabergoline. Two patients were also treated with conventional radiotherapy. Treatments were completely successful in 50% of patients: these have normal hormone secretion, full pubertal development, no significant tumor mass and normal visual field. Hypersecretion of prolactin persists in two cases; partial or complete hypopituitarism is present in four, relevant tumor remnant in another four and impairment of visual field is present in two cases. In conclusion, pediatric adenomas occur mostly in pubertal age, are prevalently macroadenomas and clinically functioning. Medical therapy should be preferred for secreting adenomas, but in some cases, notably prolactinomas in males, surgery and eventual radiotherapy may be needed.

Topics: Acromegaly; Adenoma; Adolescent; Amenorrhea; Bromocriptine; Cabergoline; Child; Ergolines; Female; Headache; Human Growth Hormone; Humans; Male; Neoplasm Recurrence, Local; Octreotide; Pituitary Neoplasms; Prolactinoma; Puberty, Delayed; Radiotherapy; Treatment Outcome; Vision Disorders; Visual Fields

PRL exists in different forms in human serum. The predominant form is little PRL (molecular mass 23 kDa) with smaller amounts of big PRL (molecular mass 50--60 kDa) and at times big big or macroprolactin (molecular mass 150--170 kDa). The frequency and clinical consequences of macroprolactinemia have not been clearly established, mainly because of difficulty in identifying these patients biochemically. This previously required the use of gel filtration chromatography, which could not be used routinely. Recently, a screening test using polyethylene glycol (PEG) has been used to identify macroprolactin in serum. Consequently, this study was designed to examine the use of PEG precipitation in the identification of patients with a predominance of macroprolactin and to establish the clinical characteristics of such a cohort. Over 12 months, 18,258 requests for serum PRL were received and of these 1225 patients had a serum PRL more than 700 mU/L. A total of 322 of these patients (26%) had a percentage recovery after PEG precipitation of less than 40%, thus indicating the presence of a predominance of macroprolactin. Fifty-five of these patients were referred for detailed clinical assessment. Symptoms typical of hyperprolactinemia were not common in this cohort. None had sustained amenorrhea and eight have had oligomenorrhea at age less than 40 yr. One had galactorrhea. All had pituitary imaging, and four had a microadenoma with none having a macroadenoma. PEG precipitation allows easy identification of macroprolactin in routine clinical practice. As the clinical consequences of this entity at this stage seem relatively benign, referral and intensive investigation of these patients may not be necessary. However, follow-up of a large cohort is required to ensure that the long-term outlook is likewise benign. This would have important implications for both patients and healthcare systems.

Topics: Adult; Bromocriptine; Cabergoline; Cohort Studies; Ergolines; Female; Fertility; Headache; Humans; Magnetic Resonance Imaging; Medical Records; Menstruation; Menstruation Disturbances; Middle Aged; Pituitary Gland; Polyethylene Glycols; Prolactin; Tomography, X-Ray Computed

The influence of lisuride in three several dosages (600, 750, and 900 micrograms) was studied on prolactin secretion and inhibition of lactation in 30 normal postpartum patients. 10 normal nursing postpartum patients served as controls. A rebound effect of prolactin secretion was demonstrable following lisuride medication during 10 days. This effect did not occur after a therapy lasting 15 days. 600 micrograms of lisuride daily showed a good inhibition of lactation and suppression of prolactin secretion. Severe side effects could be only observed during lisuride treatment with a dosage of 900 micrograms.

Topics: Adolescent; Adult; Dose-Response Relationship, Drug; Ergolines; Female; Headache; Humans; Lactation; Lisuride; Nausea; Pregnancy; Prolactin; Time Factors

Topics: Adult; Aged; Drug Evaluation; Ergolines; Female; Headache; Humans; Lisuride; Male; Middle Aged

Data on the treatment of 136 patients with essential headache using Lisuride are reported and discussed. The excellent tolerability of the drug and its considerable efficacy even after suspension of treatment are emphasised.

Topics: Consumer Behavior; Drug Tolerance; Ergolines; Female; Headache; Humans; Lisuride; Male

Topics: Adrenocorticotropic Hormone; Child; Circadian Rhythm; Ergolines; Female; Growth Hormone; Growth Hormone-Releasing Hormone; Headache; Humans; Lisuride; Male; Thyrotropin-Releasing Hormone

Topics: Adult; Aged; Cerebrovascular Disorders; Ergolines; Erythrocytes; Female; Giant Cell Arteritis; Headache; Humans; Hypertension; Male; Meningitis; Metabolic Clearance Rate; Middle Aged; Migraine Disorders; Osteoarthritis; Serotonin Antagonists; Sinusitis; Urea; Vascular Headaches

Topics: Analgesics; Cerebrovascular Disorders; Ergolines; Ergotamine; Headache; Humans; Hypertension; Hypnotics and Sedatives; Metabolic Diseases; Methysergide; Migraine Disorders; Psychotherapy; Tranquilizing Agents

Topics: Ergolines; Headache; Humans; Methysergide; Migraine Disorders; Serotonin Antagonists