Treatment of Non-puerperal Galactorrhoea with an Ergot Alkaloid

Three patients suffering from non-puerperal galactorrhoea over periods ranging from two months to six years were treated with an ergot alkaloid, 2-Br-alpha-ergocryptine (CB 154). In all three cases the galactorrhoea was terminated. The apparent prolactin antagonism exhibited by this compound is discussed.     

Galactorrhoea: Successful Treatment with Reduction of Plasma Prolactin Levels by Brom-ergocryptine

In five patients with inappropriate lactation and amenorrhoea or impotence brom-ergocryptine was found to suppress the lactation and to diminish the raised plasma prolactin levels. The responses to treatment suggest that there may be an inverse relationship between prolactin secretion and gonadotrophin secretion in man.     

Treatment of Hypogonadism with Testosterone in Patients with Type 2 Diabetes Mellitus

ObjectiveTo investigate the effect of testosterone treatment on insulin resistance, glycemic control, and dyslipidemia in Asian Indian men with type 2 diabetes mellitus (T2DM) and hypogonadism.MethodsWe conducted a double-blind, placebo-controlled, crossover study in 22 men, 25 to 50 years old, with T2DM and hypogonadism. Patients were treated with intramuscularly administered testosterone (200 mg every 15 days) or placebo for 3 months in random order, followed by a washout period of 1 month before the alternative treatment phase. The primary outcomes were changes in fasting insulin sensitivity (as measured by homeostasis model assessment [HOMA] in those patients not receiving insulin), fasting blood glucose, and hemoglobin A1c. The secondary outcomes were changes in fasting lipids, blood pressure, body mass index, waist circumference, waist-to-hip ratio, and androgen deficiency symptoms. Statistical analysis was performed on the delta values, with the treatment effect of placebo compared with the effect of testosterone.ResultsTreatment with testosterone did not significantly influence insulin resistance measured by the HOMA index (mean treatment effect, 1.67 ± 4.29; confidence interval, -6.91 to 10.25; P > .05). Mean change in hemoglobin A1c (%) (-1.75 ± 5.35; -12.46 to 8.95) and fasting blood glucose (mg/dL) (20.20 ± 67.87; -115.54 to 155.94) also did not reach statistical significance. Testosterone treatment did not affect fasting lipids, blood pressure, and anthropometric determinations significantly.ConclusionIn this study, testosterone treatment showed a neutral effect on insulin resistance and glycemic control and failed to improve dyslipidemia, control blood pressure, or reduce visceral fat significantly in Asian Indian men with T2DM and hypogonadism. (Endocr Pract. 2010;16:570-576)     

Camurati-Engelmann Disease in Conjunction with Hypogonadism

ObjectiveTo report a case of Camurati-Engelmann disease (CED) in conjunction with hypogonadism, an association that has not been previously described.MethodsWe present the clinical, laboratory, and histopathologic features of our case. In addition, we review the molecular genetics of CED.ResultsCED is a rare autosomal dominant disorder of the skeleton, characterized by bilaterally symmetric, progressive dysplasia of the bones. The typical features of this disorder are hyperostotic and sclerotic changes in the bones, primarily of the extremities. Our patient, a 49-year-old male resident of a nursing home, presented with muscle weakness, waddling gait, bone pain, and increased fatigability, usual features of CED (which had been formally diagnosed when he was 8 years old). He also had hyponatremia, hyperkalemia, and almost undetectable serum testosterone. The gene responsible for CED has been mapped to the same locus as the gene for the synthesis of transforming growth factor (TGF-β1). Mutations in the TGFβ31 gene have been identified in patients with CED. TGF-β1 also has an important role in reproductive function, both during embryogenesis and in adulthood. It has predominant effects on steroidogenesis as well as spermatogenesis. We discuss the hormonal and histopathologic changes in our patient and postulate that the association of CED with hypogonadism could be attributable to the impaired regulation of gonadal growth and steroidogenesis, in which TGF-β1 has an important role.ConclusionWe propose that the association of CED with hypogonadism could be explained on the basis of a common underlying mutation in the TGFβ31 gene, leading to accumulation of excessive TGF-β1. (Endocr Pract. 2005;11:399-407)     

Amenorrhoea,Galactorrhoea, and Primary Hypothyroidism with High Circulating Levels of Prolactin

A 22-year-old woman with primary hypothyroidism developed amenorrhoea and galactorrhoea during oral contraceptive therapy. Investigation showed high levels of circulating prolactin which rose in response to insulin-induced hypoglycaemia and were suppressed by an oral glucose load. After treatment with thyroxine normal periods returned, the galactorrhoea improved, and the prolactin levels fell to undetectable levels. The results of the prolactin and human growth hormone assays confirm that it is possible to distinguish between human growth hormone and human prolactin.     

Recovery of Adrenocortical Function during Long-term Treatment with Corticosteroids

The recovery of adrenocortical function during very slow withdrawal of corticosteroids was studied in a homogeneous group of patients suffering from sarcoidosis. All patients had been treated with gradually decreasing doses of prednisone for at least two years. The initial dose had been 40 mg. daily in all cases. Determination of the cortisol production rate and of plasma fluorogenic corticosteroids was done under basal conditions and after tetracosactrin stimulation. There was good correlation between cortisol production rate and plasma fluorogenic corticosteroids throughout all the tests. Cortisol production rate and plasma fluorogenic corticosteroids started to rise when the dosage of prednisone was lowered to 7·5 mg. daily and reached normal values when the dosage was reduced to 2·5 mg. The response to tetracosactrin began to increase at the same dosage level, but was not normal at 2·5 mg., or when prednisone treatment was stopped. At a dosage level of 7·5 mg. of prednisone plasma fluorogenic corticosteroids already showed a nyctohemeral rhythm.It may be calculated that even very low dosages of prednisone given during the last stage of a treatment schedule enhance total corticosteroid activity beyond the normal level, which would account for their therapeutic value.     

Recovery of Adrenocortical Function during Long-term Treatment with Corticosteroids

The recovery of adrenocortical function during long-term corticosteroid treatment in a group of patients with asthmatic bronchitis was compared with that in a group of patients with sarcoidosis. At corresponding dosages of prednisone basal adrenocortical function as well as adrenocortical response to tetracosactrin stimulation was higher in the asthma patients than in those with sarcoidosis.The rate of recovery of adrenocortical function seems mainly to be determined by the dosage of corticosteroids during the initial stages of treatment rather than by the nature of the disease.     

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。     

Bromocriptine treatment of acromegaly.

The effects of oral bromocriptine in acromegaly have been studied. A dose of 5 mg six-hourly suppressed circulating growth hormone (GH) levels in nine out of 11 patients treated for seven to 11 weeks. This was associated with considerable clinical improvement in all patients, with abolition of excessive sweating, reduction in soft-tissue thichening, loosening of rings, decrease in shoe size, improvement in facial features, and loosening of dentures. Metabolic changes included improvement in glucose tolerance and reduction in hydroxyproline excretion. Unlike the actions of growth hormone release inhibiting hormone the suppression of GH was not accompanied by a reduction in insulin or glucagon secretion, though prolactin levels were suppressed. Side effects other than mild constipation were not seen when the full dose regimen was reached by slowly increasing the dose from 2-5 mg once daily. Bromocriptine holds promise as a safe and orally effective medical treatment to augment surgical or radiotherapeutic measures directed at the pituitary tumour. Its efficacy during longterm administration remains to be established.