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RESULTS : Ninety-two patients (50 F, 42 M) were analyzed. At diagnosis, most had macroprolactinomas (82.6 males were significantly older than females (P0.0003) and presented with a more aggressive disease. A genetic basis was identified in 12 patients.Thirty-six patients (39.1) received only medical therapy, most.
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Stimulating dopamine receptors reduces the production of the pituitary hormone prolactin, reduces the levels of growth hormone in people with acromegaly, and improves symptoms of Parkinson s. The FDA approved bromocriptine on June 28, 1978.Your doctor may start you on 0.375 mg and adjust your.
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Prolactinomas occur in both men and women but are more commonly diagnosed in women who are less than 50 years than in older women or men. Prolactinomas can usually be treated successfully with medication alone. The upper normal value for serum prolactin in most laboratories is about 20 ng/mL (20 mcg/L SI units). In premenopausal women, ovarian function returns, estrogen levels increase, menstrual periods return, and fertility returns.
Furthermore, some small adenomas (microadenomas) cannot be detected by MRI, and not all adenomas secrete prolactin or other hormones. Evaluating other causes Other causes of a high blood prolactin level include certain medications, especially those used to treat psychiatric conditions and estrogens taken by mouth, and.
Women When a high blood prolactin concentration interferes with the function of the ovaries in a premenopausal woman, secretion of estradiol, the main estrogen, decreases. Symptoms include irregular or absent menstrual periods, infertility, menopausal symptoms (hot flashes and vaginal dryness) and, after several years, osteoporosis.
When the adenoma affects vision, improvement in vision may begin within days of starting treatment. If the prolactin level decreases to normal or near normal levels, the effects of the elevated prolactin are reversed.
Because other conditions can cause an elevated prolactin, those causes must be evaluated as well. Measurement of prolactin The prolactin level can be measured in a single blood sample. The result can range from slightly elevated to a thousand times the upper limit of normal.
The prolactin levels decreased by 93.6 with normal levels obtained in 73 of patients at doses of mg per week. Three of 5 patients who had failed to normalize prolactin on prior dopamine agonists achieved normal levels.
The authors concluded that cabergoline is more effective and better tolerated than bromocriptine in women with hyperprolactinemic amenorrhea. In a United States multicenter study of patients with macroprolactinomas, we also found cabergoline to he effective and well tolerated.
Patient compliance is high, related to the few mild side effects and once-weekly dosing. References: Webster J, et al. 1994. Comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea.
Psychiatric effects and severe constipation sometimes occur, but they are uncommon. Unfortunately, starting with a low dose does not prevent them, and if they occur, they do not seem to get better with time.
It may be effective for treating prolactinomas that are resistant to bromocriptine. For all these reasons, cabergoline is the best first choice, except in women who are trying to become pregnant.
Medication lowers the prolactin level in the blood substantially, often to normal, and also usually reduces adenoma size. However, a minority of these adenomas do not respond to medication and must be treated with surgery or, less commonly, radiation therapy.
N Engl J Med. Biller BMK, et al. 1996. Treatment of prolactin secreting macroadenomas with once weekly agonist cabergoline. J Clin Endocrinol Metab. Updated BS and KKM.
A total of 459 women, the majority of whom had microprolactinomas or idiopathic hyperprolactinernia, were treated with either cabergoline or bromocriptine in a double blind study for 8 weeks, followed by an open label study for 16 weeks during which dose adjustments were made according.