血清C反应蛋白、正五聚蛋白-3对小儿肺动脉高压的诊断价值

目的:研究血清C反应蛋白(CRP)和正五聚蛋白-3(PTX-3)在小儿肺动脉高压(PAH)诊断中的临床价值。方法:选择32例PAH患儿及32例健康小儿,检测和比较其血清CRP、PTX-3水平,分析血清CRP、PTX-3水平的相关性,通过绘制ROC曲线评价其对于PAH的诊断价值。结果:PAH组血清CRP水平(29.63±15.82 mg/L)、PTX-3水平(1.20±1.03 ng/m L)与对照组[CRP水平(3.38±1.74 mg/L)、PTX-3水平(0.64±0.43 ng/m L)]相比均显著升高(P0.01)。血清CRP与PTX-3的相关系数r为0.356(P0.05)。血清CRP诊断PAH的ROC曲线AUC为0.983,临界点为6.6 mg/L;PTX-3诊断PAH的ROC曲线AUC为0.669,临界点为0.95ng/m L;两者联合诊断的AUC为0.986,临界点为1.01。结论:PAH患儿血清PTX-3和CRP水平均显著升高,CRP大于PTX对PAH的诊断价值,两者联合诊断的价值更大。     

泌乳素及其受体的研究进展

泌乳素(PRL)又名催乳素,是由腺垂体及一些垂体外器官如乳腺、胸腺、脾脏等合成的一种多肽类激素,以内分泌、自分泌、旁分泌的形式发挥作用,其广泛参与机体生长发育、物质代谢、性腺功能调节、应激反应、免疫调节等。泌乳素通过与其受体(PRL receptor,PRLR)在靶细胞的细胞膜表面结合,激活下游的信号转导通路,发挥其生物学作用。由于泌乳素在人体内复杂的生物学效应,泌乳素及其受体又与乳腺癌、泌乳素瘤等多种疾病的发生发展及其预后密切相关。本文就泌乳素发挥效应时对其受体的激活、受体激活后的信号转导机制以及泌乳素同相关疾病的联系进行了综述,相信泌乳素及其受体的研究将为这些疾病的治疗提供重要的方向。     

CK-MB、cTnI、Myo和NT-proBNP联合检测在诊断急性心肌梗死中的应用

为了评估肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)和N端脑钠肽前体(NT-proBNP)这4种体外诊断试剂在诊断急性心肌梗死中的价值,本研究检测了200例急性心肌梗死患者和100例健康受试者血清中各项指标的水平。研究结果显示,急性心肌梗死患者的血清CK-MB、cTnI、Myo和NT-proBNP水平依次为36.74 ng/mL、14.29 ng/mL、381.96μg/mL和1 375.54 pg/mL,而健康受试者的血清CK-MB、cTnI、Myo和NT-proBNP水平依次为3.21 ng/mL、0.33 ng/mL、65.2μg/mL和72.78 pg/mL。心肌梗死患者的上述4种指标均显著高于健康受试者(p0.05)。4项指标中,cTnI的敏感度、特异性和曲线下面积均为最高,依次为0.764、0.719和0.747。此外,4项指标联合诊断的敏感度、特异性和曲线下面积依次为0.836、0.812和0.828,均高于单独指标诊断。本研究说明CK-MB、cTnI、Myo和NT-proBNP水平在急性心肌梗死患者的血清中明显升高,并且4项指标联合检测有利于急性心肌梗死的早期诊断。     

人KRT2促进体外培养的羊驼皮肤黑色素细胞的黑色素生成北大核心CSCD

基因表达谱显示,绵羊角蛋白2(keratin2,Krt2)的mRNA在不同毛色皮肤的表达不同,暗示Krt2基因可能对皮肤黑色素生成有一定的影响。为探索角蛋白2对体外培养的羊驼皮肤黑色素细胞黑色素生成的影响,首先采用PCR扩增产物测序,结合DNAMAN软件比对分析发现,羊驼Krt2编码序列(c DNA)与NCBI公布的人KRT2高度同源(91%);将人KRT2添加于培养的羊驼皮肤黑色素细胞,观察人KRT2对羊驼皮肤黑色素细胞黑色素的生成作用。免疫组织化学显示,外源性的人KRT2处理羊驼皮肤黑色素细胞72 h后,黑色素细胞的细胞质中Krt2表达增强。实时定量PCR及Western印迹实验揭示,与胎牛血清清蛋白处理的羊驼皮肤黑色素细胞比较,1 ng/m L、10 ng/m L和100 ng/m L人KTR2处理的羊驼皮肤黑色素细胞酪氨酸酶(Tyr)、酪氨酸相关蛋白-1(Tyrp1)、小眼畸形相关转录因子(Mitf)基因表达明显上调(P<0.05);尤其在添加10 ng/m L KTR2的细胞中,3个基因的mRNA相对表达水平升高尤其显著,分别是对照细胞的4倍、10倍和12.9倍(P<0.01),蛋白质相对表达水平分别是对照细胞的2倍、2.1倍和1.7倍(P<0.01)。分光光度法测量A490结果证明,1 ng/m L、10 ng/m L和100 ng/m L人KTR2处理的羊驼皮肤黑色素细胞产生的黑色素含量分别是对照细胞的1.3倍(P<0.05)、1.8倍(P<0.01)和1.5倍(P<0.05)。上述结果说明,人KTR2处理可通过刺激羊驼皮肤黑色素细胞黑色素合成相关信号通路,促进黑色素的合成。     

血清降钙素原水平对血流感染患者病原菌的诊断价值

探讨血清降钙素原(PCT)水平对不同病原菌血流感染的诊断价值。选取2015年7月~2016年7月我院收治的血培养阳性的血流感染患者77例,其中革兰氏阳性菌感染41例(53.25%),革兰氏阴性菌感染36例(46.75%)。检测患者的PCT水平,绘制ROC曲线,计算曲线下面积(AUC)。革兰氏阳性菌组的血清PCT水平明显低于革兰氏阴性菌组,(0.62±0.17)ng/m L vs(12.87±3.43)ng/m L,差异具有统计学意义(t=2.193,p0.05);血清PCT区分革兰氏阳性和阴性菌的诊断价值较高(ACU=0.759),最佳阈值为4.45 ng/L。当血清PCT水平4.45 ng/L时诊断革兰氏阴性菌感染的敏感度、特异度和准确度分别为80.34%、86.91%、88.14%,阳性预测值92.1%,阴性预测值84.9%。在革兰氏阴性菌中,大肠埃希菌组的血清PCT水平明显高于鲍氏不动杆菌组,鲍氏不动杆菌组明显高于肺炎克雷伯菌组,差异具有统计学意义(p0.05);在革兰氏阳性菌中,金黄色葡萄球菌组的血清PCT水平明显高于肠球菌属组,肠球菌属组明显高于酿脓链球菌组,差异具有统计学意义(p0.05)。不同病原菌血流感染患者的血清PCT水平存在差异,血清PCT水平对早期区分革兰氏阳性菌和阴性菌感染具有较高的诊断价值。     

正常月经周期妇女卵泡液中激素水平的变化

本文测定了24例正常月经妇女在不同时相、不同大小卵泡的卵泡液中雌二醇(E_2)、孕酮(P_0)、雄烯二酮(A)、睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)和催乳素(PRL)的含量,并分析其与外周血中相应激素浓度的关系。测定结果显示:小卵泡的卵泡液中E_2、Po,FSH,LH水平低于大卵泡中水平,而A和T水平则相反。排卵前大卵泡中E_2(9815nmol/L),P_0(3316nmol/L),FSH(1.34IU/L)和LH(3.9lIU/L)达最高值。A(280nmol/L)和T(137nmol/L)却较小卵泡中水平低(相应为692nmol/L和176nmol/L)。PRL水平在大小卵泡中无显著性差异。卵泡液中甾体激素水平高于外周血7—20.000倍,FSH、LH水平为外周血的10—80％,PRL水平为60％—3倍。     

非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精结果的相关性研究

目的:探讨非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精术(TESA)结果的相关性,以及可用于预测TESA结果的睾丸体积、生殖激素水平的切点值,从而为非梗阻性无精子症患者进一步诊疗提供重要资料.方法:121例研究对象均为非梗阻性无精子症患者(NOA),测定其睾丸体积和生殖激素水平,并根据TESA结果分为无精子组和有精子组.结果:无精子组和有精子组的左侧睾丸体积(ml)、右侧睾丸体积(ml)、泌乳素(PRL,ng/ml)、卵泡刺激素(FSH,mIU/ml)、黄体生成素(LH,mIU/ml)、雌二醇(E2,pmol/L)、血清总睾酮(TT,nmol/L)水平分别为7.07±1.06和11.75±1.38、7.37±1.37和11.70±1.98、12.43±11.69和9.60±4.55、15.77±10.84和8.01±7.43、6.12±2.92和8.11±20.11、119.36±43.52和141.12±48.33、11.43±4.05和12.46 ±4.60.无精子组血清FSH和PRL水平平均值高于有精子组,并且有显著的统计学差异.虽然无精子组的睾丸体积平均数小于有精子组,但两组之间没有统计学差异.对于年龄、血清E2和Tr水平,两组之间也没有统计学差异.利用ROC曲线优选的睾丸体积切点值为9ml,此点其敏感性为93.8％/89.6％(左/右),特异性为100％/94.3％(左/右),睾丸体积ROC曲线的AUC为0.984/0.961(左/右),表明其诊断准确性较高;优选的血清FSH水平切点值为8.18 mIU/ml,此点其敏感性为71.2％,特异性为75.0％,FSH水平ROC曲线的AUC为0.743,表明其诊断准确性中等.结论:睾丸体积和FSH水平对于预测NOA患者TESA结果具有重要意义,并且睾丸体积诊断准确性明显优于FSH.     

人附睾蛋白4与糖类抗原125在子宫内膜癌诊治中的临床价值

目的:探讨人附睾蛋白4(HE4)与糖类抗原125(CA-125)在子宫内膜癌(EC)诊治中的临床价值。方法:选择60例EC患者、60例功能失调性子宫出血(DUB)患者为研究对象(分别记为EC组、DUB组),以同期体检健康的60名女性为对照(NC组)。采用酶联免疫吸附法(ELISA)、电化学发光法(ECLA)分别检测三组受检者的血清HE4、CA-125水平并比较,绘制ROC曲线评价两指标单项及联合检测对EC的诊断效能。结果:EC组血清HE4[(141.16±46.43)pmol/L]、CA-125[(33.14±7.52)U/mL]水平均明显高于DUB组和NC组(P0.05),DUB组血清CA-125水平[(19.05±7.20)U/mL]明显高于NC组(P0.05),而HE4水平与NC组无显著差异(P0.05)。术前,ECⅢ期患者的血清HE4[(172.04±18.66)pmol/L]和CA-125[(45.05±4.11)U/mL]水平均明显高于Ⅱ期和Ⅰ期患者(P0.05);ECⅠ期的HE4阳性率(67.9%)明显高于CA-125阳性率(P0.05);HE4、CA-125诊断EC的临界值分别为65.42pmol/L和25.53 U/mL;单独检测HE4、CA-125诊断EC的敏感性分别为97.5%、78.3%,特异性分别为95.0%、98.3%,曲线下面积(AUC)分别为0.993、0.954;二者联合检测诊断EC的敏感性、特异性及AUC分别99.2%、95.0%和0.995;与术前比,EC患者术后血清HE4[(45.13±8.06)pmol/L]、CA-125[(11.22±5.50)U/mL]水平均显著降低(P0.05)。结论:血清HE4水平监测对EC的诊断、术前评估及疗效评判具有重要的参考价值,其与CA-125联合检测可提高EC诊断的准确性。     

绝经后女性血清25(OH)D水平与高血压的相关性分析

目的:探讨绝经后女性血清25羟维生素D[25(OH)D]与高血压的相关性。方法:选取456例绝经后女性为研究对象,按照是否存在高血压分为高血压组(n=102例)和非高血压组(n=354例),测定所有患者的血清25(OH)D水平;血清25(OH)D水平分为四组:即25(OH)D≥30 ng/m L组(n=50例)、21~29 ng/m L组(n=110例)、10~20 ng/m L组(n=240例)、25(OH)D10 ng/m L组(n=56例);比较各组相关指标的差异。并利用Logistic回归方程分析血清25(OH)D与高血压发生的关系。结果:高血压组与非高血压组在体质指数(BMI)、收缩压(SBP)、舒张压(SDP)、雌激素、高敏C反应蛋白(hs-CRP)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)方面存在统计学差异(P0.05);高血压组血清25(OH)D[14.56±3.21(ng/ml)]低于非高血压组[19.89±4.75(ng/ml)](t=10.649,P0.001);在血清25(OH)D10 ng/m L组中,SBP和SDP值、高血压发生率均高于25(OH)D≥30 ng/m L组、21~29ng/m L组(n=110例)、10~20 ng/m L组(P0.05);血清25(OH)D水平与绝经后女性发生高血压呈现负相关(P0.05)。在血清25(OH)D不同分组中,从25(OH)D≥30 ng/m L组到25(OH)D10 ng/m L组发生高血压的风险值依次增加。结论:血清25(OH)D水平与绝经后高血压的发生密切相关,随着血清25(OH)D水平的逐渐降低,高血压发生的风险亦逐渐增大。     

乙型肝炎肝硬化患者血清sICAM-1、IL-6、IL-18及TNF-α水平的表达及临床意义

目的:检测乙型肝炎肝硬化患者血清可溶性细胞间黏附分子-1(s ICAM-1)、白细胞介素-6(IL-6)、白细胞介素-18(IL-18)及肿瘤坏死因子-α(TNF-α)水平,并探讨其临床意义。方法:选取2017年1月至2019年6月我院收治的乙型肝炎肝硬化患者82例作为研究组,同期健康体检者80例作为对照组。比较研究组和对照组及不同Child-Pugh分级乙型肝炎肝硬化患者血清s ICAM-1、IL-6、IL-18、TNF-α、肝功能指标血浆谷丙氨酸氨基转移酶(ALT)、白蛋白(ALB)水平,并分析各指标之间的相关性。结果:研究组血清s ICAM-1、IL-6、IL-18、TNF-α和血浆ALT水平分别为(820.78±85.73)ng/mL、(41.71±13.24)ng/mL、(119.85±45.56)pg/mL、(52.23±22.24)ng/L、(155.20±56.27)U/L,显著高于对照组的(175.51±41.82)ng/mL、(6.67±2.23)ng/mL、(68.71±23.24)pg/mL、(5.65±1.28)ng/L、(15.65±5.23)U/L(P0.05),血浆ALB水平显著低于对照组[(27.69±4.32)g/L vs(45.16±5.65)g/L](P0.05)。随Child-Pugh分级的升高,乙型肝炎肝硬化患者血清s ICAM-1、IL-6、IL-18、TNF-α和血浆ALT水平逐渐升高,血浆ALB水平逐渐降低(P0.05)。乙型肝炎肝硬化患者血清s ICAM-1、IL-6、IL-18及TNF-α水平与血浆ALT水平呈正相关(P均0.05),与血浆ALB水平呈负相关(P均0.05),乙型肝炎肝硬化患者血清s ICAM-1与IL-6、IL-18及TNF-α呈正相关(P均0.05)。结论:乙型肝炎肝硬化患者血清s ICAM-1、IL-6、IL-18、TNF-α水平异常升高,与Child-Pugh分级和肝功能有关,检测血清s ICAM-1、IL-6、IL-18、TNF-α可能为乙型肝炎肝硬化的诊断和病情严重程度的判断提供依据。     

Hypercalcemia and Acromegaly-Clarifying the Connections: A Case Report and Review of the Literature

ObjectiveHypercalcemia in patients with acromegaly is rare and usually due to co-existent primary hyperparathyroidism. The etiology of hypercalcemia directly related to acromegaly is debated.MethodsWe present a case report of 1,25(OH)2D3-mediated hypercalcemia in a patient with acromegaly and discuss potential pathophysiological mechanisms contributing to the development of hypercalcemia late in the course of the disease.ResultsA 67-year-old female presented with classical features of acromegaly. A review of her previous photographs suggested a disease duration of approximately 10 years, and her serum calcium (Ca) was normal during this period. A biochemical work up confirmed a combined growth hormone (GH-) and prolactin (PRL-) cosecreting tumor with a GH level of 92.03 ng/mL (normal 0-3.61), an insulin-like growth factor-1 (IGF-1) level of 1,498 ng/ mL (59-225), and a PRL level of 223.3 ng/mL (2-17.4). Magnetic resonance imaging (MRI) of the pituitary showed a 1.9-cm macroadenoma. Her preoperative work up revealed new onset hypercalcemia with a corrected serum Ca level of 10.7 mg/dL (8.5-10.5), an ionized Ca level of 1.37 mmol/L (1.08-1.30), a parathyroid hormone (PTH) level of 13.0 pg/mL (10-60), and a high 1,25(OH)2D3 level of 72.6 pg/mL (15-60). She underwent resection of the pituitary adenoma with normalization of GH and PRL levels, and her IGF-1 level decreased to 304 ng/mL. Her serum Ca (9.3 mg/dL), ionized Ca(1.22) and 1,25(OH)2D3 levels (38.6 pg/mL) normalized after surgery.ConclusionWhile overt hypercalcemia in acromegaly is rare, it tends to occur late in the disease course. The hypercalcemia is mediated by elevated 1,25(OH)2D3 levels rather than PTH. (Endocr Pract. 2014;20:e86-e90)     

Positive Prolactin Response to Bromocriptine in 2 Patients with Cabergoline-Resistant Prolactinomas

ObjectiveTo describe a positive prolactin response to bromocriptine treatment in 2 patients with cabergolineresistant prolactinomas.MethodsWe report the patients’ clinical presentations, laboratory test results, imaging findings, and clinical courses.ResultsPatient 1 had a 5-mm pituitary microadenoma that was initially diagnosed at age 30 years. After initial diagnosis, she was treated with transvaginal bromocriptine for 9 years and then subsequently went untreated for 2 years. After developing symptoms of amenorrhea, decreased libido, and hyperprolactinemia, oral cabergoline, 0.5 mg twice weekly, was initiated. Her prolactin concentration remained elevated at 80 ng/mL while taking cabergoline. Her prolactin concentration decreased to 13 ng/mL after her regimen was switched to bromocriptine, 5 mg daily. Patient 2 had a 17-mm pituitary macroadenoma that was initially diagnosed at age 15 years. Oral cabergoline was started at 0.5 mg twice weekly and increased to 1 mg 3 times weekly when prolactin levels continued to rise to 340 ng/mL over 18 months. After visual field defects developed, transsphenoidal surgery was performed. One year after surgery, magnetic resonance imaging showed a 6-to 7-mm pituitary adenoma, and there was a gradual rise in serum prolactin. Her serum prolactin concentration continued to rise to 212 ng/mL with increasing tumor size over 3 years. Cabergoline was discontinued and oral bromocriptine was initiated at a dosage of 10 mg daily. After 4.5 months of bromocriptine therapy, her serum prolactin concentration decreased to 133 ng/mL. However, after 2 months, the macroadenoma continued to increase in size and a visual field defect developed, so another transsphenoidal operation was performed.ConclusionsAlthough cabergoline is generally preferred to bromocriptine for the treatment of patients with prolactinomas because of its better tolerance profile and greater effectiveness, in patients with cabergoline-resistant prolactinomas, a bromocriptine trial should be considered a safe, relatively inexpensive, and well-tolerated alternative. (Endocr Pract. 2011;17:e55-e58)     

The Effect of Raloxifene on Serum Prolactin Level in Patients with Prolactinoma

Objective: To evaluate the effect of raloxifene on prolactin (PRL) levels in addition to dopamine agonist (DA) therapy in patients with prolactinoma.Methods: We conducted a retrospective chart review of 14 patients with prolactinoma on stable dose of DA for 6 months who received raloxifene 60 mg daily, as PRL could not be normalized despite being on fairly high doses of DA. Patients were informed that raloxifene is not approved by the Food and Drug Administration for prolactinoma treatment. PRL level was measured at 1 to 6 months after starting raloxifene and at 1 to 3 months following its discontinuation. Raloxifene was stopped in 8 out of 14 patients after 2 (1 to 6) months of treatment as the absolute change in PRL level was felt to be small.Results: The median age and female/male sex ratios were 50 years (range 18 to 63 years), 6/8 respectively. The baseline DA dose was 3 mg/week (0.5 to 7 mg/week) for cabergoline and 15 mg/day for bromocriptine. Ten patients had an absolute and percentage decrease in PRL of 8.3 ng/mL (1.5 to 54.2 ng/mL) and 25.9% (8 to 55%) from baseline, respectively, after 1 to 6 months on raloxifene treatment. Among 10 patients with a decrease in PRL level, 2 (20%) achieved PRL normalization. Two patients had no change in PRL and two patients had an increase in PRL level by 22.8 ng/mL and 8.8 ng/mL (47% and 23.6%), respectively.Conclusion: Raloxifene was associated with a 25.9% (8 to 55%) decrease in PRL level in 10/14 (71%) patients with prolactinoma who were on stable doses of DA including 2 patients (14%) who achieved normoprolactinemia.Abbreviations: CV = coefficient of variation; DA = dopamine agonist; FSH = follicule-stimulating hormone; LH = luteinizing hormone; PRL = prolactin; PTTG = pituitary tumor transforming gene     

Diagnostic value of thyrotropin releasing hormone test in 129 patients with suspected tumoral hyperprolactinemia

In 129 hyperprolactinemic (PRL > or = 100 ng/mL) and 100 normoprolactinemic patients (PRL 0-25 ng/mL), delta max. PRL (the difference between maximal prolactin (PRL) after thyrotropin releasing hormone (TRH) injection and basal value) was compared with basal PRL and computed tomography (CT) of the sellar region. In 122 hyperprolactinemic patients delta max. PRL was < 100%, while tumor was found in 106 of them. In the remainder seven hyperprolactinemic patients delta max. PRL was > or = 100% and CT showed no tumor. A significant difference in delta max. PRL between hyperprolactinemic patients without and those with verified adenoma was found and showed a significant negative correlation with basal PRL. Between 122 hyperprolactinemic patients with delta max. PRL < 100%, mean basal PRL and duration of clinical symptoms were significantly lower in 16 patients with normal CT compared to 106 patients with tumor. All normoprolactinemic patients showed delta max. PRL > or = 100% and no tumor on CT. PRL stimulation disturbance precedes tumor visualization and represents a decisive diagnostic parameter in hyperprolactinemic patients with no tumor signs.     

Short-Term Decline in Prolactin Concentrations Can Predict Future Prolactin Normalization,Tumor Shrinkage,and Time to Remission in Men with Macroprolactinomas

Objective: To identify early follow-up measures that will predict the dynamics of prolactin (PRL) decrease and adenoma shrinkage in men harboring macroprolactinomas.Methods: A single-center historical prospective study including a consecutive group of 71 men with pituitary macroadenomas (≥10 mm) and hyperprolactinemia (PRL >7 times the upper limit of normal &lsqb;ULN]) treated medically with cabergoline. Comparisons of PRL normalization rates were performed according to PRL levels achieved at 6 months, maximal adenoma shrinkage during follow-up, and other patient characteristics. Correlations were analyzed to identify characteristics of PRL suppression dynamics.Results: PRL levels after 6 months of treatment correlated positively with current PRL levels (r = 0.74; P<.001), with time to PRL normalization (r = 0.75; P<.001), and with adenoma diameter following treatment (r = 0.38; P = .01). Adenoma shrinkage depicted by first magnetic resonance imaging on treatment correlated with maximal adenoma shrinkage during follow-up (r = 0.56; P = .006). Five patients had nadir PRL levels ≥3 times the ULN (51 ng/mL) and showed slower response to cabergoline treatment, with consistently higher PRL levels compared with responding patients throughout follow-up (mean 6-month PRL levels, 519 ± 403 ng/mL versus 59 ± 118 ng/mL; P<.001).Conclusion: Six-month PRL level might serve as a surrogate marker for PRL normalization and adenoma shrinkage dynamics among men harboring macroprolactinomas.Abbreviations: CAB = cabergoline MRI = magnetic resonance imaging PRL = prolactin RMC = Rabin Medical Centre ULN = upper limit of normal     

溴隐亭治疗非急症性泌乳素型垂体腺瘤的临床效果

目的:研究溴隐亭治疗非急症性泌乳素型垂体腺瘤的临床效果。方法:选择2016年1月~2019年12月内蒙古医科大学第三附属医院神经外科和妇产科收治的120例非急症性泌乳素型垂体腺瘤患者,随机分为两组。对照组给予手术治疗,观察组在对照组基础上口服溴隐亭治疗,起始时每天的剂量为2.5 mg,给药3~5 d后,逐渐将每天的剂量增加至7.5 mg,分成2~3次服用,维持给药3个月。比较两组治疗前、治疗1个月和3个月,比较两组的血清泌乳素水平和症状评分,并观察两组的心理领域、社会领域、环境领域和生理领域评分。结果:观察组的有效率明显高于对照组(P<0.05);治疗1个月和3个月,两组非急症性泌乳素型垂体腺瘤患者的血清泌乳素水平均明显降低(P<0.05),且观察组的血清泌乳素水平明显低于对照组(P<0.05);治疗1个月和3个月,两组的泌乳素型垂体腺瘤症状评分均明显降低(P<0.05),且观察组的泌乳素型垂体腺瘤症状评分明显低于对照组(P<0.05);治疗后,两组的心理领域、社会领域、环境领域和生理领域评分明显升高(P<0.05),且观察组的心理领域、社会领域、环境领域和生理领域评分明显高于对照组(P<0.05)。结论:肿瘤切除术后联合服用溴隐亭能更好的改善非急症性泌乳素型垂体腺瘤患者的症状,降低血清泌乳素水平,提高生活质量,值得推广。     

Plasma progesterone and prolactin concentrations in overtly pseudopregnant bitches: a clinical study

Plasma concentrations of progesterone (P(4)) and prolactin (PRL) were measured in 35 bitches presented at veterinary clinics for symptoms of overt pseudopregnancy (PSP) between 50 and 95 days after the onset of proestrus. Results were compared to those from samples collected from 35 control bitches at comparable stages of the ovarian cycle (expressed as days after the onset of observed signs of proestrus). In the PSP bitches at 71.4+/-1.6 (mean+/-S.E.M.) days of the cycle, P(4) (1.5+/-0.2ng/mL) was lower (P<0.01) and PRL (16.0+/-1.9ng/mL) was higher (P<0.01), compared to P(4) (2.7+/-0.4ng/mL) and PRL (2.9+/-0.6ng/mL) in control bitches at 70.6+/-1.5 days of the cycle. Low P(4) was not a prerequisite for elevated PRL. Although elevated (> or =10ng/mL) PRL (20.9+/-2.0ng/mL) occurred more often with low (<2ng/mL) P(4) (20 of 24 cases) it also occurred with P(4) above 3ng/mL in two affected bitches and in two control bitches. Whether the occurrence of relatively low PRL concentrations (<4ng/mL) in samples obtained from 4 of the 35 pseudopregnant bitches reflected variable and often elevated PRL secretion or increased sensitivity to PRL in the absence of elevated prolactin in those animals was not determined. We inferred that elevated plasma PRL was often involved in the etiology of overt PSP; furthermore, a premature decline in circulating P(4) concentrations may be a factor in some instances.     

Giant Prolactinoma and Effectiveness of Medical Management

ObjectiveTo review our experience with long-term cabergoline and bromocriptine therapy in the treatment of giant prolactinomas.MethodsPatients with giant prolactinomas diagnosed and treated at our center in Mumbai, India, between January 2005 and January 2009 were included. Diagnostic criteria for giant prolactinoma included tumor diameter greater than 40 mm, serum prolactin concentration higher than 1000 ng/mL, and invasive tumor growth pattern with mass effects. Cabergoline was started at a dosage of 0.5 mg weekly and progressively increased as necessary up to 3.5 mg weekly. Patients were followed up with hormone measurements, sellar magnetic resonance imaging, and vision examinations.ResultsThe study group included 10 patients (5 male and 5 female), aged 17 to 50 years (mean, 36.1 years), treated for giant prolactinoma. In 8 patients, cabergoline was first-line therapy. Two patients had previously been prescribed bromocriptine, and this regimen was maintained. Mean serum prolactin concentration before treatment was 10789 ± 14278 ng/mL (range, 1256-43 163 ng/mL; reference range, 5-17 ng/mL). Following treatment, levels normalized in 7 patients within 2 to 18 months (mean, 8.8 months) and decreased in 1 patient to a level 3 to 4 times that of normal. Tumor diameter, which measured from 4 to 7 cm at diagnosis, showed a mean maximal decrease of 49.28 ± 18.27%; response was first noted about 6 months after treatment was begun. Seven patients had visual field defects at diagnosis; vision returned to normal in 3 and improved in 4. Testosterone levels, initially low in all male patients, normalized in 3.ConclusionCabergoline should be first-line therapy for aggressive prolactinomas, even in those patients who present with visual field defects. (Endocr Pract. 2010; 16:42-46)     

Management and Outcomes of Giant Prolactinoma: A Series of 71 Patients

Objective: To describe outcomes of patients with giant prolactinoma (≥4 cm) and identify predictors of therapeutic response.Methods: In this retrospective study, complete biochemical and structural response were defined as prolactin (PRL) ≤25 ng/mL and no visible tumor at follow-up, respectively.Results: Giant prolactinoma (median size, 4.8 cm [range, 4 to 9.8 cm]; median PRL, 5,927 ng/mL [range, 120 to 100,000 ng/mL]) was diagnosed in 71 patients. Treatments included: dopamine agonists (DAs) (n = 70, 99%), surgery (n = 30, 42%), radiation (n = 10, 14%), and somatostatin analogs (n = 2, 3%). Patients treated with DA monotherapy were older compared with those who received subsequent therapies (47 years vs. 28 years; P = .003) but had similar initial PRL and tumor size. Surgically managed patients were younger compared with the nonsurgical group (35 years vs. 46 years; P = .02) and had lower initial PRL (3,121 ng/mL vs. 6,920 ng/mL; P = .02), yet they had similar tumor response. Hypopituitarism was more common following surgery compared to medical management: adrenal insufficiency (69% vs. 27%; P<.001), hypothyroidism (67% vs. 38%; P = .02), growth hormone deficiency (24% vs. 6%; P = .04), and diabetes insipidus (17% vs. 3%; P = .04). Therapeutic response did not correlate with sex, age, initial PRL, tumor size, or first-line therapy mode. At median follow-up of 4.8 years, the median PRL was 18.3 ng/mL (range, 0.6 to 12,680 ng/mL), and final volume was 0.9 cm³ (range, 0 to 43.0 cm³). In those with available data, 36/65 (55%) patients achieved PRL normalization, and 16/61 (26%) had no visible tumor at follow-up.Conclusion: Most patients with giant prolactinoma have excellent response to DA. Sex, age, initial PRL, and tumor size do not predict therapeutic response.Abbreviations: BRC = bromocriptine; CAB = cabergoline; CSF = cerebrospinal fluid; DA = dopamine agonist; MRI = magnetic resonance imaging; PRL = prolactin     

Effect of synthetic luteinizing hormone releasing hormone on prolactin secretion from clonal pituitary cells.

The influence of LHRH, an analog of LHRH (hydroxy-PRO¹) and inulin on prolactin (PRL) secretion was studied using a clonal strain of pituitary cells. At low concentrations, 0.08 ng to 8 ng/ml, LHRH stimulated PRL release while at higher concentrations the opposite effect was obtained. The analog of LHRH inhibited PRL secretion at all concentrations studied. No effect was measured with inulin.