ergoline and Hypothyroidism

Topics: Adenoma; Adult; Diagnosis, Differential; Ergolines; Female; Follow-Up Studies; Galactorrhea; Genital Diseases, Female; Humans; Hypophysectomy; Hypothyroidism; Infertility, Female; Pergolide; Pituitary Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Prolactin; Sella Turcica; Tomography, X-Ray Computed; Visual Field Tests

Hypogonadism is the most common form of hypopituitarism in men with macroprolactinoma. However, evidence on factors related to hypogonadism recovery is limited.. We estimated the proportion of hypogonadism in men with macroprolactinoma exclusively treated with dopamine agonists, and we assessed the factors predicting hypogonadism recovery.. This was a multicenter retrospective study of men with macroprolactinoma identified using ICD 9 and 10 codes and treated between 2009 and 2019 in five centers in the United Arab Emirates and Saudi Arabia. We evaluated hypogonadism, defined as low total testosterone (TT) level with normal or low gonadotropins on presentation and during the last clinic visit.. A total of 79 patients (median age 32 years) were included in the study. The most common symptoms at presentation were headache (73.7%), erectile dysfunction (55.4%), and low libido (54.3%). The median tumor size was 2.9 cm (1.0-9.7) at diagnosis. Sixty-three patients (79.7%) had hypogonadism at baseline. Growth hormone deficiency (GHD) and hypothyroidism were present in 34.4% and 32.9% of patients, respectively. The median serum prolactin (PRL) level was 20,175 (min-max 2254 - 500,000) mIU/l with a median serum TT of 4.5 (min-max 0.4-28.2) nmol/l. Most patients were treated with cabergoline (n = 77, 97.5%) with a median of 6 (min-max 0.6-22) years. At follow-up, 65% of patients recovered their pituitary-testicular axis. Patients with recovered hypogonadism had smaller median tumor size (2.4 [1-5.4] vs. 4.3 [1.6-9.7], p = 0.003), lower PRL level (18, 277 [2254 - 274, 250] vs. 63,703 [ 3,365-500,000], p = 0.008 ), higher TT level (4.6 [0.6-9.2] vs. 2.3 [0.5-7.3], p = 0.008), lower PRL normalization time on medical therapy (8 months (0.7-72) vs. 24 (3-120), p = 0.009) as well as lower frequency of GHD (17.1% vs. 60%, p = 0.006) and secondary hypothyroidism (17.9% vs. 57.1%, p = 0.003) compared with those with persistent hypogonadism respectively. Age at diagnosis, presenting symptoms and duration of medical therapy did not predict hypogonadism recovery.. About two-thirds of men with macroprolactinoma recover from hypogonadism, mostly with 24 months of therapy. Smaller adenoma size, lower prolactin level, earlier prolactin normalization, and higher testosterone patients were related to testosterone normalization.

Topics: Adult; Dopamine Agonists; Ergolines; Humans; Hypogonadism; Hypothyroidism; Male; Pituitary Neoplasms; Prolactin; Prolactinoma; Retrospective Studies; Testosterone

Presently, the standard of care for prolactinomas, a type of pituitary adenoma, is dopaminergic agents such as bromocriptine and cabergoline. However, dopaminergic agents may induce fibrosis of cardiac valves leading to valvular insufficiency, necessitating surgical treatment of prolactinoma. Fibrosis of prolactinoma can be induced by prolonged medical treatment with bromocriptine, and this usually occurs after years of treatment. In comparison to bromocriptine, there have been no reports of cabergoline-induced fibrosis of prolactinoma. There is a potential for greater emphasis to be placed on assessing the tumour consistency from preoperative MRI scans, or even preoperative contrast-enhanced 3D Fast Imaging Employing Steady-state Acquisition imaging to allow better planning of the surgery. We report a rare case of fibrosis of prolactinoma after cabergoline treatment resulting in its subsequent difficult surgical removal. This patient had early MRI changes of fibrosis of prolactinoma after a short period of 6 months of cabergoline treatment.

Topics: Adult; Antineoplastic Agents; Cabergoline; Combined Modality Therapy; Diagnosis, Differential; Dopamine Agonists; Ergolines; Fibrosis; Humans; Hypogonadism; Hypothyroidism; Magnetic Resonance Imaging; Male; Pituitary Neoplasms; Prolactinoma; Thyroxine; Tricuspid Valve Insufficiency

We report the management of spontaneous ovarian hyperstimulation syndrome in a 23-year-old patient, diagnosed at 8 gestational weeks, in a context of moderate hypothyroidism. The etiology of spontaneous ovarian hyperstimulation syndrome should seek hypersecretion of glycoprotein hormones (hCG, TSH, FSH and LH) and/or mutation of FSH and LH receptors. It will eliminate an incipient ovarian neoplasia. The laparoscopic exploration can be done if diagnosis doubt persists. A diagnostic algorithm can be proposed.

Topics: Abdominal Pain; Adrenal Cortex Hormones; Adult; Cabergoline; Chorionic Gonadotropin; Ergolines; Female; Fibrinolytic Agents; Follicle Stimulating Hormone; Gestational Age; Graves Disease; Humans; Hypothyroidism; Luteinizing Hormone; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy Complications; Thyroidectomy; Thyrotropin

The present study reports the case of a 70-year-old Caucasian man who was referred to the Military Hospital of Buenos Aires for evaluation of a giant sellar-extrasellar mass with extension in the right temporal lobe and compression of the third ventricle. Patient was initially responsive to cabergoline with reduction of prolactin levels and shrinkage of tumor burden for at least 36 months. Thereafter, prolactin levels and tumor size increased even though cabergoline dosage was increased. Transcraneal surgery was performed at 56 months of treatment. Prolactin levels and tumor proliferation did not subside and the patient died 14 months later. High GH and IGF-I levels were observed in the late stages of tumor development, with no evidence of acromegalic features. Immunohistochemistry of the excised tumor revealed strong immunoreactivity for VEGF and FGF-2, two potent angiogenic factors, and CD31 (an endothelial marker) indicating high vascularization of the adenoma.

Topics: Aged; Antineoplastic Agents; Biomarkers, Tumor; Cabergoline; Drug Resistance, Neoplasm; Ergolines; Humans; Hypothyroidism; Immunohistochemistry; Magnetic Resonance Imaging; Male; Neovascularization, Pathologic; Pituitary Neoplasms; Prolactin; Prolactinoma

We report a case of a 10-y-old boy who presented with persistent headache and was found to have a giant prolactinoma. Laboratory evaluation revealed markedly elevated prolactin (PRL) level, thyroid-stimulating hormone (TSH) deficiency, and elevated insulin-like growth factor-I (IGF-I). He had normal random growth hormone (GH) but non-suppressible GH during oral glucose tolerance test (OGTT). Cabergoline treatment was initiated and was well tolerated. Therapy successfully reduced PRL levels, normalized IGF-I levels, and reduced tumor size.. Our patient presented with a GH-PRL-secreting tumor. Dopamine agonists are recommended as the treatment of choice for prolactinomas. However, there should be careful attention to GH status when treating GH-PRL-secreting tumor with dopamine agonists alone. IGF-I levels should be followed in all patients with prolactinoma, even in those with normal basal GH concentrations, because of the possibility of GH co-secretion.

Topics: Antineoplastic Agents; Cabergoline; Child; Ergolines; Glucose Tolerance Test; Humans; Hypothyroidism; Insulin-Like Growth Factor I; Male; Pituitary Neoplasms; Prolactinoma

The aim of the present work was to investigate the role of the serotoninergic system in the control of sodium appetite of hypothyroid rats (HTR) by administering drugs that affect the serotoninergic activity, and to compare the same homeostatic behaviour in euthyroid rats (ETR) also given these drugs. Fenfluramine (FEN; 5.0 mg x kg(-1), I.P.), which releases serotonin in the brain, significantly reduced the intake of 1.8 % NaCl in HTR subjected to water and sodium depletion (depleted) or water, sodium and food deprivation (deprived) by 31 and 45 %, respectively, 120 min after FEN injection, compared to HTR that received vehicle alone. Similarly, administration of FEN to ETR reduced 1.8 % NaCl intake in depleted and deprived rats by 64 and 46 %, respectively. The presynaptic serotonin reuptake inhibitor fluoxetine (20.0 mg x kg(-1), I.P.) led to the inhibition of sodium appetite in HTR during the initial 30 min in depleted rats and for up to 60 min post-injection in deprived rats, while sodium appetite inhibition persisted for longer periods in ETR. The 5HT2C receptor agonist mCPP (5.0 mg x kg(-1), I.P.) caused a drastic reduction in sodium appetite in HTR and ETR in depleted and deprived rats, respectively, after 120 min. Prior administration of the 5HT2C receptor antagonist LY53857 (5.0 mg x kg(-1), I.P.) completely blocked the inhibitory action of mCPP on sodium appetite in both HTR and ETR. In summary, our results suggest that the recruitment of serotoninergic neurons involved in the modulation of sodium appetite seems to be decreased in hypothyroidism due to a probable deficiency in the cerebral signalling pathway.

Topics: Animals; Appetite Regulation; Brain; Drinking; Ergolines; Fenfluramine; Fluoxetine; Hypothyroidism; Male; Methimazole; Rats; Rats, Wistar; Selective Serotonin Reuptake Inhibitors; Serotonin; Serotonin Antagonists; Sodium Chloride, Dietary

The term 'giant prolactinoma' can be used for tumours larger than 4 cm in diameter and/or with massive extrasellar extension. Cabergoline (CAB), a long-lasting dopamine agonist (DA), safe and well tolerated, is effective in normalizing PRL levels and inducing tumour shrinkage in micro- and macroprolactinomas. The purpose of this prospective study was to evaluate the efficacy and safety of CAB also for giant prolactinomas.. Ten men with giant prolactinomas with a median age of 44.8 years were treated with CAB. Before CAB, four patients had previously undergone transsphenoidal surgery without modifying the parasellar extension of the tumour or their visual defects. Pretreatment serum prolactin (PRL) levels ranged between 1230 and 22 916 micro g/l (mean +/- SEM: 5794 +/- 1996) and tumour volume was between 21.8 and 105.5 cm3 (mean +/- SEM: 50.7 +/- 8.8). CAB was administered at an initial low dose of 0.5 mg three times a week and, in five patients who did not achieve serum PRL normalization, the dose was progressively increased up to 10.5 mg/week. The duration of treatment was 13-68 months (mean 38.9). PRL levels and pituitary target organ hormones were assayed before, after 30 days and then every 3 months after the beginning of CAB treatment. Magnetic resonance imaging (MRI) was carried out before, after 1-3 months, after 6 months and then every 10-12 months to evaluate tumour shrinkage.. In every patient, a significant PRL decrease (P = 0.0086) of at least 96% of the pretreatment values occurred (from 5794 +/- 1996 to 77 +/- 38, mean +/- SEM); a persistent normalization of PRL levels was achieved in five out of 10 patients (50%) beginning from the first 3-6 months of CAB treatment (only one patient needed 12 months of therapy). A significant tumour shrinkage (P = 0.0003) was achieved after 12 months of therapy in nine out of 10 patients (90%), with a volume reduction greater than 95% in three, of 50% in four and 25% in two patients. Tumour volume decreased from 50.7 +/- 8.8 to 28.6 +/- 9.4 and then to 22.3 +/- 8.8 cm3 (mean +/- SEM) after 6 and 12 months of CAB treatment, respectively. An improvement of visual field defects (VFD) was obtained in six of the seven patients presenting visual impairment before CAB treatment. Among the eight patients presenting libido and potency (L-P) failure, five normalized their PRL levels. In two of these a complete restoration of libido and potency was observed. Three patients with secondary hypoadrenalism and a patient with secondary hypothyroidism were treated with substitutive therapy during all the study time. The drug was well tolerated by all patients and no one discontinued the therapy.. These data suggest that, in giant, aggressive prolactinomas, CAB represents a first-line therapy effective in reducing PRL levels and determining tumour shrinkage.

Topics: Adrenal Glands; Adult; Aged; Antineoplastic Agents; Cabergoline; Erectile Dysfunction; Ergolines; Humans; Hypothyroidism; Libido; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Gland; Pituitary Neoplasms; Prolactin; Prolactinoma; Vision Disorders

Control and hypothyroid rats were challenged with a range of doses (0.5-4 mumol/kg) of either the nonselective dopamine agonist, apomorphine, or the selective D2 receptor agonist. LY 171555, and their stereotyped head-down sniffing (SHDS) responses measured. The dose-response curves for both agonists were shifted to the left in the hypothyroid rats compared to water-treated controls. Increasing doses of the selective D2 antagonist, raclopride, caused a parallel shift to the right in the LY 171555-induced SHDS dose-response curve. Schild analysis revealed a decreased sensitivity to raclopride in the hypothyroid animals. The selective D1 antagonist SCH 23390 was observed to decrease the maximal response elicited by LY 171555 in a dose-dependent manner and the hypothyroid rats were more sensitive to this effect. It was concluded that hypothyroid rats showed an apparent increased sensitivity to D2 receptor agonists and a decreased sensitivity to D2 antagonists. In addition, the facilitation effect of the D1 receptor on the D2 receptor appeared less tightly coupled in the hypothyroid rats.

Topics: Animals; Benzazepines; Dopamine Agents; Dopamine Antagonists; Dose-Response Relationship, Drug; Ergolines; Hypothyroidism; Male; Models, Biological; Propylthiouracil; Quinpirole; Raclopride; Rats; Rats, Inbred Strains; Receptors, Dopamine; Salicylamides; Stereotyped Behavior; Thyroxine; Triiodothyronine

1. Hypothyroidism was maintained for four weeks in male rats by administration of PTU daily. 2. Hypothyroid rats showed increased behavioural responses to apomorphine, a mixed D1/D2 dopamine receptor agonist, LY 171555, a selective D2 agonist and to SKF 38393, a selective D1 agonist, compared with euthyroid controls. 3. Responses to the selective D1 antagonist, SCH 23390, were decreased, but were increased to the D2 antagonist, haloperidol, in hypothyroid rats. 4. Ligand binding studies showed no significant differences in the affinity and concentration of D1 or D2 receptor sub-types in the striatum of hypothyroid compared with euthyroid rats. 5. However, hypothyroid rats had a greater increase in dopamine stimulated cyclic AMP in the striatum than euthyroid controls. 6. It is concluded that the changes in behavioural sensitivity observed in hypothyroid rats may be associated with these alterations in post-synaptic events.

Topics: 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine; Animals; Apomorphine; Benzazepines; Brain; Dopamine Antagonists; Ergolines; Haloperidol; Hypothyroidism; Male; Motor Activity; Propylthiouracil; Quinpirole; Rats; Rats, Inbred Strains; Receptors, Dopamine; Reference Values; Stereotyped Behavior; Synapses

Hypothyroid rats showed increased behavioral sensitivity to both selective and non-selective dopamine agonists. Ligand binding analysis revealed no differences in concentration or affinity of striatal dopamine receptor subtypes in hypothyroid rats. Measurement of striatal cAMP levels however, indicated that hypothyroid rats showed a greater increase in cAMP production in response to stimulation by dopamine. It is concluded that the changes in behavioural sensitivity observed may be associated with alterations in post-synaptic mechanisms.

Topics: 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine; Adenylyl Cyclases; Animals; Apomorphine; Behavior, Animal; Benzazepines; Corpus Striatum; Cyclic AMP; Dopamine; Ergolines; Hypothyroidism; Male; Propylthiouracil; Quinpirole; Rats; Rats, Inbred Strains; Receptors, Dopamine; Receptors, Dopamine D1; Receptors, Dopamine D2

The effect of acute oral administration of metergoline on serum thyrotrophin and prolactin levels in six patients with primary hypothyroidism was studied. Metergoline 4 mg by mouth caused a significant decrease in the concentration of serum thyrotrophin and prolactin in all subjects. There was no consistent change in serum thyroxine and triiodothyronine concentrations during the experiment. These findings suggest that metergoline inhibits prolactin and thyrotrophin secretion by a direct action on the hypothalamus or pituitary gland.

Topics: Adult; Ergolines; Female; Humans; Hypothyroidism; Metergoline; Middle Aged; Prolactin; Secretory Rate; Thyrotropin

Topics: Acromegaly; Adult; Aged; Bromocriptine; Ergolines; Growth Hormone; Humans; Hypothyroidism; Middle Aged; Prolactin; Thyrotropin-Releasing Hormone

Bromocryptine (CB-154) virtually abolished the rise of serum Pr after TRH stimulation in hypothyroid and euthyroid subjects. The response of serum TSH to TRH stimulation was significantly depressed in hypothyroid but not in euthyroid subjects. No significant changes of serum HGH, T4 and T3 after CB-154 were observed. The dual mode of action of CB-154 in pituitary and hypothalamus is discussed.

Topics: Adult; Aged; Bromocriptine; Ergolines; Female; Growth Hormone; Humans; Hypothyroidism; Middle Aged; Prolactin; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine

Of 28 patients presenting with amenorrhea-galactorrhea, pituitary tumors were confirmed in eight. Six patients had occult hypothyroidism and the rest had an endocrine profile suggestive of pituitary tumor or of an idiopathic etiology. Treatment with bromocryptine resulted in suppression of the inappropriate lactation and restoration of regular menstrual function. In five cases, however, the galactorrhea was only diminished and in four of these cases, normal ovarian function did not return. Of the 19 patients that were seeking fertility and continued the medication for at least 20 days, nine pregnancies resulted. A similar response to bromocryptine was observed regardless of the underlying cause of the amenorrhea-galactorrhea.. 28 women with amenorrhea-galactorrhea were investigated endocrinologically and treated with bromocryptine 2.5 mg twice daily, ranging from 18 to 150 days. These women were classified into 6 with hypothyroidism, having prolactin (PRL) over 30 ng/ml, thyroid stimulating hormone (TSH) over 8 mcU/ml, luteinizing hormone (LH)6-20 mlU/ml and greater than follicle stimulating hormone (FSH); 8 with radiologically diagnosed pituitary tumors, LH, FSH, and increased PRL; 9 with similar endocrine profiles and suspected pituitary tumors; and 3 with high PRL considered idiopathic. 5 of the hypothyroid group were followed, and achieved ovulation, reduced TSH, PRL, and lactation, and 3 became pregnant. Of the 8 with tumors, 5 menstruated, 4 ovulated, 3 conceived, 3 had reduced lactation, 2 had reduced PRL, and 1 failed to respond clinically; 9 with suspected tumors took bromocryptine for at least 20 days, resulting in 4 pregnancies and 3 with regular menses. The 3 idiopathic cases showed lower PRL and regular ovarian function, 1 pregnancy, yet 1 developed pseudocyesis and recurrent galactorrhea. 2 women had to stop bromocryptine because of vomiting. This drug is longer-acting than L-dopa and safer than estrogen-progestagen combinations in cases of pituitary tumors. Bromocryptine reduces galactorrhea and associated hypothyroidism temporarily.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Hypothyroidism; Lactation Disorders; Luteinizing Hormone; Pituitary Neoplasms; Pregnancy; Prolactin; Thyrotropin