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A variety of neuropharmacologic agents, including anticholinergic drugs, amantadine hydrochloride, levodopa, selegiline, bromocriptine, and pergolide, are now available for the treatment of Parkinson's disease. Of patients treated with dopaminergic agents, 30% develop visual hallucinations, 10% exhibit delusions, 10% have euphoria, 1% have mania, 10% to 15% experience increased anxiety, 15% have confusional periods, and a few exhibit altered sexual behavior. Anticholinergic drugs have a greater tendency to produce confusional states than dopaminergic compounds. Elderly patients and those with underlying dementia are most likely to have untoward side effects with anti-parkinsonism treatment. Dosage reduction is the optimum management strategy, although anti-psychotic agents may be necessary in patients with delusions, and lithium may help control drug-induced mania. Dopaminergic agents share the property of stimulation of D2 dopamine receptors, and this action may play an essential role in mediating their neuropsychiatric effects.
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We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL, PsycINFO in June 2011 and researchers for unpublished trials
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The role of PRL in sexual maturation of female ferrets was examined in these studies. Longitudinal profiles of PRL secretion were obtained by thrice weekly blood sampling of intact female ferrets undergoing photoperiod-stimulated development as well as age-matched control females which remained in nonstimulatory short days. Two additional groups of intact females, one in each photocycle, were treated with the dopamine agonist drug bromocriptine throughout the study. The relationship between developmental changes in PRL secretion and the critical pubertal decrease in the efficacy of estradiol (E2) inhibitory feedback on LH secretion was studied by using additional groups of females which were ovariectomized and treated with E2 implants (OVX + E2). These latter females were housed in either long or short day photoperiods; some were treated with bromocriptine, the remainder were treated with the vehicle only. Results of this study revealed that PRL secretion in ferrets does not change acutely with an abrupt increase in day length. After 4 weeks of exposure to long days, however, a marked increase in PRL secretion occurred. This increased secretion of PRL was contemporaneous with the onset of pubertal ovarian activity in intact females and with the escape of LH from the negative feedback of E2 in OVX + E2-treated females. The further observation that pharmacological blockade of the long day-induced rise in PRL secretion also prevented the pubertal onset of ovarian activity suggested that PRL may play a critical role in the induction of puberty in this species. The mechanism by which bromocriptine prevented puberty induction was illustrated in the OVX + E2-treated ferrets in stimulatory photoperiod. The drug treatment prevented the pubertal decrease in the efficacy of E2 negative feedback on LH. These studies suggest an important interaction between the dopamine-PRL system and the GnRH-LH system in the regulation of sexual maturation of female ferrets.
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A 49-yr-old woman with a large pituitary tumor leading to visual loss and galactorrhea- amenorrhea was submitted to transcranial pituitary surgery, when a clinically nonfunctioning pituitary adenoma was partially removed. Histopathology and immunohistochemistry confirmed the diagnosis of "non-secreting atypical adenoma." At that time, serum and urinary free cortisol were normal, with low T4 levels and hyperprolactinemia. The patient was discharged on thyroxine and bromocriptine and treated with conventional radiotherapy. Two years later, she presented high free urinary cortisol levels and a positive ACTH response to desmopressin testing on dexametasone 2 mg overnight. A pituitary biopsy confirmed aggressive growth as well as positive immunoreactivity for ACTH, p53, Ki-67, and c-erb-B2. The patient was then treated with radiosurgery on ketoconazole therapy. The overall clinical, laboratory, and pathological data suggest a transition from a clinically nonfunctioning to a hypersecreting ACTH-producing tumor. Putative mechanisms of tumor transformation and the possibility of a silent corticotropinoma evolving into clinical Cushing s syndrome are discussed.
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The nutritional needs of developing young place a large energetic demand on lactating females. In this paper some of the mechanisms through which lactating rats meet these demands are described. Emphasis is placed on the mechanisms that drive increased food intake in suckled rats that are independent of milk delivery and negative energy balance. Evidence is presented to suggest that prolactin (PRL), released from the pituitary in response to suckling stimulation, acts centrally to stimulate food intake during lactation. Brain areas in which PRL may act to stimulate food intake as well as its interactions with other hormones and neuropeptides involved in energy balance are discussed.
The authors begin by stressing the importance of the role of prolactin in the metabolism of testosterone in the cells of the prostate. They studied three groups of patients: 9 patients with prostatic cancer, 15 patients with benign prostatic adenoma and 11 healthy young men. Inhibition of the dopaminergic receptors by metoclopramide only resulted in a significant increase in serum prolactin in the patients with prostatic cancer, while the serum prolactin level remained unchanged in the young men and in the patients with prostatic adenoma. The authors believe that this increased secretion of prolactin in patients with prostatic cancer is related to a decrease in the testosterone: oestradiol ratio. They suggest the use of bromocriptine in patients with prostatic cancer no longer responding to oestrogen therapy in the event of prolactin over-secretion. Some papers have reported the beneficial effect of bromocriptine on the general health of these patients.
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Open label study of 5-months of duration. The first agonist was given for two months and, after a period of substitution of one month, the second agonist was also maintained for two months.
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Neuroleptic malignant syndrome (NMS) is a rare life-threatening disorder resulting from treatment with neuroleptic agents and other drugs that act as dopamine antagonists. NMS most often occurs shortly after the initiation, dose increase or withdrawal of the offending agent, but can rarely occur after long-term treatment at stable doses. Immediate discontinuation of the causative agent (or re-administration if the cause is the withdrawal of neuroleptic therapy) along with supportive therapy to maintain cardiorespiratory stability and to reduce fever are the cornerstone of the management of NMS. Additional 'specific' treatments include dantrolene, bromocriptine and amantadine, but their role in the management of NMS is controversial.
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In the present investigation the function of the Leydig cells, as the response of gonadal steroids to the injections i.m. of 2000 UI of hCG, was studied in 11 normal men, before and after the induction of hyper or hypoprolactinemia with sulpiride and bromocriptine treatments respectively. The normal response to hCG, showed an increment of serum estradiol concentration 24 h and another of serum testosterone 72 h after the administration of the gonadotropin. The serum FSH concentration decreased during the test. An increase of serum LH levels was observed in the hypoprolactinemic state, but the increment of estradiol was lower after injection of hCG. On the other hand, the hyperprolactinemia induced a low basal level of testosterone with a higher response of this steroid to hCG. The results suggest that hyperprolactinemia interfers the estradiol synthesis by Leydig cells while the loss of the trophic effect of prolactin on gonadal steroidogenesis, as seen in hypoprolactinemia produces a decrease of basal testosterone levels without any alteration of the response of this steroid to hCG. We conclude that prolactin plays an important role in the steroidogenesis of Leydig cells in normal men.
A 21-year-old goitrous hypothyroid Chinese woman had elevated serum iodotyrosines with a monoiodotyrosine level of 85.9 nmol/l (normal 0.49-0.89 nmol/l) and a diiodotyrosine level of 25.3 nmol/l (normal 0.023-0.53 nmol/l). She was amenorrheic with low luteinizing hormone and follicle-stimulating hormone levels at 5.8 and 2.8 U/l, respectively. The hypogonadotropic hypogonadism was due to an elevated prolactin level of 8.8 nmol/l. She also had a low potassium level of 3.2 mmol/l, and a high urinary aldosterone level of 158 nmol/day. The hyperprolactinemia, hypogonadotropic hypogonadism, hyperaldosteronism and hypokalemia subsided with the administration of bromocriptine 5 mg/day. However, bromocriptine accentuated the hyperiodotyrosinemia, and the patient remained hypothyroid. Levothyroxine therapy lowered the monoiodotyrosine and diiodotyrosine levels, ameliorated all her endocrinopathies, started her periods, and shrank the goiter. She probably had a deiodinase defect which permitted the discharge of accumulated iodotyrosines from the thyroid gland. Since iodotyrosines are tyrosine hydroxylase inhibitors, the hyperiodotyrosinemia causes dopamine synthesis inhibition, and induces the hyperprolactinemia and hyperaldosteronism.
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In a non-randomized retrospective study n = 36 prolactinoma patients (n = 7 micro- and n = 29 macroadenomas) were evaluated before (E0), 4 (E1) and 52 weeks (E2) after applying 3 different treatment modalities: A dopamine agonist (DA) therapy (n = 14), B surgery as initial procedure (n = 12) and oral DA therapy, C DA preinjection, subsequent surgery (n = 10) and oral DA medication. T0 outline the effect of the 3 regimens upon serum prolactin (PRL) and tumour size reduction, clinical signs and symptoms, anterior/posterior pituitary lobe function and MRI/CT findings were evaluated in each patient at E0, E1 and E2. In group A, PRL normalization was achieved in n = 10 patients (71%), although the frequency of an empty sella was only one out of 12 macroprolactinoma patients (less than 10%). Patients of group C showed the lowest PRLE2 levels (32 +/- 11 ng/ml, normalization rate 60%), although not statistically significant when compared with the other groups (A: 41 +/- 28 ng/ml, B: 114 +/- 33 ng/ml, normalization rate 31%). According to MRI studies in groups B and C total removal was achieved in 33% and 50% of macroprolactinomas, respectively. The most favourable ratio of the leading pre/posttreatment signs and symptoms was observed in patients of group C. It was concluded that no superiority of either treatment regimen exists for prolactinoma patients. Each mode of therapy has its own benefits which may be applied to the different biological behaviour of a prolactinoma in the respective patient.
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To investigate the potential risk for developing visual loss during single or multiple pregnancies in women with pituitary adenomas.
SM was demonstrated in 4.87%. SM has revealed MPRL in 3 cases and appeared after bromocriptine intake in the 4(th) one. Endocrinologists should be aware of this severe condition, which can be avoided by repairing as soon as possible the bony defect secondary to aggressive tumors, unless it is clogged by fibrosis: What probably happened in our cases.
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In 44 patients with acromegaly treated by transsphenoidal pituitary microsurgery, the relationship between changes in pre- and post-operative GH dynamics and postoperative fasting plasma GH levels was examined to clarify which is the optimal approach for evaluating postoperative removal of the tumour. TRH, LHRH and bromocriptine tests, which act directly on the pituitary somatotroph, and the oral glucose tolerance test (oGTT) and insulin tolerance test (ITT), which act via hypothalamus, were carried out pre- and post-operatively. Abnormal responses postoperatively were found in most patients with fasting postoperative plasma GH over 5 ng/ml. In 24 patients with postoperative fasting plasma GH level of 5 ng/ml or below, 7 of 17 (41%) showed abnormal responses in the TRH test, 2 of 5 (40%) in the LHRH test and 3 of 13 (23%) patients in the bromocriptine test. All patients with a fasting plasma GH level less than 10 ng/ml, except for those with panhypopituitarism, showed normal responses to ITT and the paradoxical increases with the oGTT were absent. These results indicate that abnormal responses caused by a direct action on adenoma cells do not necessarily disappear even when the fasting plasma GH level is below 5 ng/ml. Abnormal responses caused by indirect actions, through the hypothalamus, disappear when the level is less than 10 ng/ml.