ergoline and Pituitary-Diseases

Prolactin-secreting pituitary adenomas--prolactinomas--are the most common type of functional pituitary tumor. Treatment of hyperprolactinemia is indicated because of the consequences of infertility, gonadal dysfunction, and osteoporosis. Making the correct diagnosis is important because the first line of therapy is medical management with dopamine agonists. Medical therapy is effective in normalizing prolactin levels in more than 90% of patients, but longterm treatment may be required in some patients. Transsphenoidal surgery is usually indicated in those patients in whom medical therapy fails or cannot be tolerated, or in patients who harbor microprolactinomas. In experienced hands, a hormonal and oncological cure can be achieved in more than 90% of patients after transsphenoidal removal of microprolactinomas with minimal risks. Thus, surgery may be an option for microprolactinomas in a young patient who desires restoration of fertility and avoidance of long-term medical therapy. The authors review the diagnosis and management of prolactinomas, including medical therapy, surgical therapy, and stereotactic radiosurgery.

Topics: Bromocriptine; Cabergoline; Contraindications; Diagnosis, Differential; Ergolines; Female; Humans; Hypophysectomy; Magnetic Resonance Imaging; Male; Pituitary Diseases; Pituitary Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Prolactin; Prolactinoma; Radiosurgery; Remission Induction

Metergoline (4 mg) and methysergide (3 mg), two serotonin antagonists known to inhibit prolactin secretion in normal subjects, and the dopaminergic agonist, bromocriptine (2.5 mg) were orally administered in hyperprolactinemic patients. Mean serum prolactin concentration was significantly decreased between 120 and 240 min following the ingestion of all three drugs in comparison with a placebo; a consistent reduction to below 50% of basal values occurred in 10 of 14 patients after metergoline, in 5 of 10 after methysergide, and in 11 of 14 after bromocriptine administration. These data indicate that serotonin antagonists may acutely lower serum prolactin levels in hyperprolactinemic patients similarly to bromocriptine, though their mechanism of action is most likely different.

Topics: Adult; Bromocriptine; Ergolines; Female; Humans; Male; Metergoline; Methysergide; Pituitary Diseases; Prolactin

Topics: Adult; Cabergoline; Choristoma; Diagnosis, Differential; Ergolines; Female; Hormone Antagonists; Humans; Hyperprolactinemia; Magnetic Resonance Imaging; Oligomenorrhea; Pituitary Diseases; Pituitary Gland, Posterior; Prolactin; Recurrence; Treatment Outcome

The occurrence of antipituitary antibodies (APA) in patients with idiopathic hyperprolactinaemia (IH) and the effects of dopamine agonists on these antibodies and long-term pituitary function outcome have been so far not evaluated. This longitudinal study was aimed at investigating, in patients with IH the occurrence of APA and the effect of cabergoline on the pituitary function and behaviour of APA.. Sixty-six patients with IH were studied. APA (by indirect immunofluorescence) and pituitary function were investigated every year for 3 years.. Seventeen patients resulted APA positive (Group 1) and 49 APA negative (Group 2). Eight patients of Group 1 (Group 1a) and 24 of Group 2 (Group 2a) were asymptomatic and then not treated; instead, nine patients in Group 1 (Group 1b) and 25 in Group 2 (Group 2b), showing symptoms of hyperprolactinaemia, were treated with cabergoline for 2 years. Among the untreated patients, during the follow-up, those with APA positive (Group 1a) showed an increase of APA titres and PRL levels with partial pituitary impairment in some of them; instead those with APA negative (Group 2a) persisted negative with normal pituitary function despite persistent hyperprolactinaemia. Among the treated patients, those with APA positive (Group 1b) showed normalization of PRL levels, APA disappearance and recovery of pituitary function (when initially impaired) during cabergoline treatment, persisting also at last observation (off-therapy). Instead all patients of Group 2b persisted with APA negative during the follow-up with normalization of PRL levels and stable normal pituitary function during cabergoline therapy but showing a further increase of PRL at the last observation.. The presence of APA in some patients with IH suggests a possible occurrence of autoimmune hypophysitis at potential/subclinical stage; an early and prolonged cabergoline therapy could interrupt the progression to an overt clinical stage of the disease. However, the small amount of patients investigated suggests caution against generalization of our assumption and prompts to further controlled studies on a more numerous population to verify these conclusions.

Topics: Adult; Autoantibodies; Autoimmune Diseases; Cabergoline; Cohort Studies; Dopamine Agonists; Ergolines; Female; Hormone Antagonists; Humans; Hyperprolactinemia; Longitudinal Studies; Male; Pituitary Diseases; Pituitary Function Tests; Pituitary Gland; Seroepidemiologic Studies; Thyroid Hormones; Thyrotropin; Time Factors

Pituitary adenomas are rare in young patients. Prolactinomas are the most common type of pituitary adenomas in children older than 12 years, occurring more often in girls, at a 4.5:1 female-to-male ratio. The clinical presentation may vary according to the age and sex of the patient. Pituitary apoplexy is a rare life-threatening condition caused by a sudden infarction or hemorrhagic necrosis of the pituitary containing an adenoma. A wide variety of conditions can trigger apoplexy such as pituitary irradiation, general anesthesia, traumatic head injury, pituitary stimulatory tests and a wide variety of medications including bromocriptine. We report a case of a 16-year-old male patient with puberty arrest harboring a macroprolactinoma, who developed a sudden clinical picture of pituitary apoplexy during the 12th month of treatment with cabergoline.

Topics: Adenoma; Adolescent; Antineoplastic Agents; Cabergoline; Ergolines; Humans; Hypopituitarism; Magnetic Resonance Imaging; Male; Pituitary Diseases; Pituitary Neoplasms; Prolactin; Prolactinoma; Stroke

Growth hormone release-inhibiting hormone (GHR-IH) was administered to five patients with abnormal pituitary-adrenal function. There was immediate suppression by about 50% of ACTH levels in two patients who had undergone bilateral adrenalectomy because of Cushing's disease; one of them had Nelson's syndrome. Bromocryptine (2-5 mg) suppressed ACTH levels by 62-67% for more than 6 h in these patients. GHR-IH did not significantly influence cortisol secretion by an adrenal carcinoma and only slight changes were seen in two patients with Addison's disease. The possible therapeutic implications are discussed.

Topics: Adrenal Gland Diseases; Adrenocorticotropic Hormone; Adult; Bromocriptine; Ergolines; Female; Humans; Hydrocortisone; Male; Middle Aged; Pituitary Diseases; Somatostatin

Topics: Animals; Ergolines; Ergot Alkaloids; Female; Gonadotropins; Gonadotropins, Pituitary; Pituitary Diseases; Pituitary Gland; Pregnancy; Rats