溴隐亭治疗垂体催乳素大腺瘤

目的 :探讨单纯溴隐亭治疗垂体催乳素大腺瘤的疗效。方法 :垂体催乳素大腺瘤 2 3例 ,用溴隐亭 7.5～ 10mg·d-1,口服 ,肿瘤愈大 ,催乳素 (PRL)水平愈高 ,则用药剂量愈大。当肿瘤缩小至直径 <1cm、PRL <10 0 μg·L-1时减至 2 .5～5mg·d-1。结果 :2 3例服药 1个月时PRL下降 (6 7± 15 ) %。服药 6个月肿瘤直径缩小 0 .4～ 0 .9cm。 12个月时 2 1例缩小0 .6～ 1.3cm ,2例肿瘤消失。 3年时复查 15例 ,有 11例肿瘤直径仅为 0 .5～ 0 .7cm ,其中 1例伴囊性变 ;3例肿瘤消失 (含上述2例 ) ;1例空蝶鞍。服药 6～ 14周停止溢乳 ,5～ 8周月经恢复。结论 :单纯溴隐亭治疗可使垂体PRL大腺瘤缩小或消失 ,且能恢复病人的生殖内分泌功能。     

首选溴隐亭治疗泌乳素瘤后血清泌乳素水平变化和MRI变化的相关性分析

目的:观察首选溴隐亭治疗泌乳素瘤后血清泌乳素变化和MRI变化的相关性。方法:确诊为泌乳素瘤的患者共计22例,首选溴隐亭治疗,根据治疗反应配合手术及放射治疗。结果:平均随访25个月,7例患者单纯口服药物达完全缓解,MRI上肿瘤完全消失,PRL水平下降至正常,8例患者治疗后期联用手术治疗,4例患者使用药物+手术+放疗方法治疗。1例患者并发脑脊液漏,3例患者出现严重的胃肠道反应,1例耐药。22例患者中,PRL的下降程度与肿瘤体积的缩小程度的相关性分析结果显示,相关系数0.841,经相关系数的假设检验P0.01,两者显著相关。结论:首选溴隐亭治疗泌乳素瘤,辅以手术及放疗,大部分患者可达影像学上的明显改善及泌乳素水平的显著降低,随泌乳素水平下降,瘤体体积也逐渐缩小,溴隐亭可作为泌乳素瘤患者的首选治疗。     

溴隐亭或伽玛刀治疗垂体泌乳素腺瘤30例

目的：探讨口服溴隐亭和伽玛刀治疗垂体泌乳素腺瘤的临床疗效。方法：对３０例垂体泌乳素腺瘤患者,经口服溴隐亭或伽玛刀治疗前后的临床症状、血清泌乳素（ＰＲＬ）水平、肿瘤体积等方面的改变进行了比较。结果：口服溴隐亭组,经皇其血甭ＰＲＬ水平降低优于伽玛刀组,两组有显著性差异（Ｐ〈０．０１）,肿瘤体积缩小则伽玛刀组优于省隐亭组（Ｐ〈０．０１）。结论：垂体沁乳腺瘤患者口服溴隐亭近期疗效显著,伽玛刀治疗后症着改善     

溴隐亭治疗高泌乳素血症的临床观察

目的:评价溴隐亭治疗高泌乳素(PRL)血症的临床疗效。方法:治疗组87例,其中单纯性高PRL血症24例,脑垂体PRL微腺瘤42例、大腺瘤21例。设健康对照组36例。治疗组均予口服溴隐亭,开始量每晚为1.25mg,隔3d增加1.25mg,直到2.5mg,tid;在治疗前及治疗后12周、24周分别测定血清PRL,同时做脑垂体磁共振。结果:治疗12周后与治疗前同性别组比较,PRL值明显下降(P<0.05),但仍高于同性别对照组(P<0.05);治疗24周后PRL值比治疗前同性别组显著下降(P<0.01),且与同性别对照组无显著性差异(P>0.05)。12周后,单纯性高PRL血症治愈率达100%,垂体PRL微腺瘤总有效率为42.86%;24周后,垂体PRL微腺瘤治愈率为14.29%,总有效率为80.95%,垂体PRL大腺瘤总有效率为42.86%。结论:溴隐亭治疗高PRL血症可使血PRL恢复正常,垂体PRL腺瘤缩小甚至消失。     

溴隐亭或伽玛刀治疗垂体泌乳素腺瘤30例

目的：探讨口服溴隐亭和伽玛刀治疗垂体泌乳素腺瘤的临床疗效。方法：对３０ 例垂体泌乳素腺瘤患者,经口服溴隐亭或伽玛刀治疗前后的临床症状、血清泌乳素（ Ｐ Ｒ Ｌ） 水平、肿瘤体积等方面的改变进行了比较。结果：口服溴隐亭组,经治疗后其血清 Ｐ Ｒ Ｌ 水平降低优于伽玛刀组,两者有显著性差异（ Ｐ＜ ００１） , 肿瘤体积缩小则伽玛刀组优于溴隐亭组（ Ｐ＜ ００１） 。结论：垂体泌乳素腺瘤患者口服溴隐亭近期疗效显著,伽玛刀治疗后症状改善不显著者加服溴隐亭仍有效,其远期疗效尚待进一步观察。     

溴隐亭治疗垂体泌乳素微腺瘤和大腺瘤的疗效比较

目的:比较溴隐亭治疗脑垂体泌乳素微腺瘤和大腺瘤的临床疗效。方法:脑垂体泌乳素微腺瘤60例;大腺瘤30例。两组均予口服溴隐亭,开始量每晚为1.25 mg,隔3 d增加1.25 mg,直到2.5 mg,Tid;在治疗前及治疗后28周分别测定血清泌乳素,同时做脑垂体磁共振。结果:两组治疗28周后血泌乳素值比治疗前同性别组显著下降(P<0.01),微腺瘤组血泌乳素基本恢复正常,但大腺瘤组无论男女,血泌乳素值仍超过正常值,微腺瘤组与大腺瘤组治疗后同性别相比血泌乳素值有统计学差异(P<0.01)。28周后,垂体泌乳素微腺瘤治愈率为16.7%,总有效率为75.0%,而垂体泌乳素大腺瘤组未发现瘤体消失者,总有效率仅为46.7%。结论:溴隐亭治疗垂体泌乳素微腺瘤可使血泌乳素恢复正常,垂体泌乳素微腺瘤缩小甚至消失;而对泌乳素大腺瘤应采用综合治疗模式,如手术合并药物或结合放射治疗。     

溴隐亭对泌乳素腺瘤术后治疗作用的临床研究

目的 探讨溴隐亭对泌乳素腺瘤术后的治疗效果.方法 回顾性分析非侵袭性泌乳素腺瘤15例、侵袭性泌乳素腺瘤6例患者的术后治疗效果.结果 术后口服溴隐亭在控制术后高泌乳素血症、随访中控制肿瘤复发方面均与未口服组比较存在显著性差异（P＜0.05）.结论 肿瘤的生物学性质影响治疗方式的选择和最终预后水平.对于手术切除肿瘤后部分患者仍存在内分泌紊乱的激素异常和临床症状,术后合理地口服溴隐亭能有效恢复垂体正常生理功能,缩小肿瘤和降低肿瘤复发,增强手术效果,提高患者生活质量.     

不同剂量溴隐亭对催乳素瘤临床疗效、血清催乳素水平及肿瘤体积的影响

目的:探讨不同剂量溴隐亭治疗催乳素瘤的临床疗效、对血清催乳素(PRL)水平和肿瘤体积的影响及安全性。方法:选取2015年1-12月我院收治的催乳素瘤患者60例为研究对象,按照随机数字表法分为A组和B组,各30例。两组患者均餐中口服甲磺酸溴隐亭片,A组患者首次给药剂量为2.5 mg/d,3 d后增至3.75 mg/d,服用2~3 d后每周增加2.5 mg至血清PRL水平得到控制,剂量恢复至3.75 mg/d。B组患者首次给药剂量为1.25 mg/d,3 d后增至2.5 mg/d,服用2~3 d后每周增加1.25~2.5 mg至血清PRL水平得到控制,剂量恢复至2.5 mg/d。两组患者均连续治疗3个月。观察两组患者的临床疗效、治疗前后的血清PRL水平和肿瘤长径,并记录不良反应发生情况。结果:A组患者临床总有效率(83.33%)较B组(66.67%)高,但差异无统计学意义(P>0.05)。治疗前,两组患者血清PRL水平和各类型肿瘤的长径比较,差异均无统计学意义(P>0.05)。治疗1、2个月,两组患者血清PRL水平均较治疗前明显降低,且A组明显低于B组,差异均有统计学意义(P<0.05);治疗3个月,两组患者血清PRL水平均较治疗前明显降低,但组间比较差异并无统计学意义(P>0.05)。治疗后,两组患者各类型肿瘤的长径均明显减小,A组患者大腺瘤和巨大腺瘤的长径均明显小于B组,差异均有统计学意义(P<0.05);但A组患者的微腺瘤长径与B组比较,差异无统计学意义(P>0.05)。A组患者的不良反应发生率(12例,40.00%)明显高于B组(5例,16.67%),差异有统计学意义(P<0.05)。结论:增大溴隐亭的剂量对催乳素瘤的临床疗效无显著影响,但可缩短患者血清PRL水平恢复正常的时间、缩小肿瘤体积,而其不良反应发生率随剂量增大而增加。     

再谈溴隐亭的临床应用

澳隐亭的临床应用已有过综述报道,近年来国内外对澳隐亭的作用、用途和毒性等进行了大量的研究,尚可用于下述病症:一、催乳素Tindall等对6例患者有巨腺瘤(直径>10mm)和血清高催乳素(PRL)水平420～9800ng/ml。4例服溴隐亭7.5mg/日4～6周后。用计算机体层摄影(CT)证明血清PRL水平降低和肿瘤范围缩小。用光显微镜证实6例全部是嫌色腺瘤。经溴隐亭治疗后切下的腺瘤免疫染色强度和免疫染色细胞数目明显减少,肿瘤细胞显示受累。与没有治疗者比较,细胞质、细胞核和核仁区域明显减少。粗糙内质网和高尔基氏复合体的百分容积密度减少,但它们的分泌颗粒增多。     

溴隐亭不同给药途径治疗女性高泌乳素血症临床分析

目的观察溴隐亭不同给药途径治疗女性高泌乳素血症的临床疗效。方法选取我院2010年1月~2013年12月于我院妇科就诊的高泌乳素血症患者128例,随机分为试验组(63例)和对照组(65例),试验组予阴道放置溴隐亭治疗,对照组口服溴隐亭,3个月后进行疗效对比。结果两组治疗不同时期血清催乳素(PRL)水平均与治疗前相比,差异有统计学意义(P<0.05)。试验组治疗后0.5个月、1个月、2个月、3个月PRL水平与对照组比较差异无统计学意义(P>0.05),试验组治疗后月经失调、闭经、泌乳、多毛等临床症状发生率与对照组比较差异无统计学意义(P>0.05)。结论采用溴隐亭治疗女性高泌乳素血症,不同的给药途径对疾病的疗效无明显差异,因此可根据患者的个体差异制定个性化治疗方案,避免不良反应发生,缩短疗程。     

Programme of stepping down from twice daily proton pump inhibitor therapy for symptomatic gastro-oesophageal reflux disease associated with a formulary change at a VA medical center

BACKGROUND: In July 2001, our Veterans' Affairs hospital changed its formulary proton pump inhibitor (PPI) from lansoprazole to rabeprazole. All patients previously receiving lansoprazole 30 mg twice daily were switched to rabeprazole 20 mg once daily. AIM: To determine if patients with gastro-oesophageal reflux disease (GERD), who were previously managed on lansoprazole 30 mg twice daily, could be maintained on rabeprazole 20 mg once daily. PATIENTS AND METHODS: Four hundred and thirty-five patients had received lansoprazole 30 mg twice daily for at least 12 months before the formulary change. Medical records were reviewed for 12 months before and after the formulary change. RESULTS: There were 432 men and three women with a mean age of 66.7 years (range: 38-91). Two hundred and twelve patients were excluded. Of the remaining 223, 111 (50%) were maintained successfully on rabeprazole 20 mg once daily. Twenty-three (10%) stayed off all acid suppression during follow-up. The number of endoscopies and clinic visits did not significantly change during the follow-up. Fifty-six percent who had erosive oesophagitis failed a dose taper compared with 31% of those with endoscopy-negative GERD (P<0.025). CONCLUSIONS: Most patients receiving twice daily PPI therapy for GERD could be maintained on once daily PPI or no acid suppression for 12 months of follow-up. Dose reduction was more successful in those without erosive oesophagitis.     

Bromocriptine treatment for cocaine addiction: association with plasma prolactin levels

Bromocriptine is a dopamine receptor agonist used with mixed success in the treatment of cocaine addiction. Variations in dopamine receptor sensitivity may help account for these differences. We evaluated this question in a 24-week outpatient controlled clinical trial in 70 cocaine-abusing (DSM-III) men (86% African-American, mean age 34 years, mean 39 months of regular cocaine use [predominantly smoked]). Subjects received 4 weeks of inpatient treatment. During the last 2 weeks they were inducted onto bromocriptine (maximum dose 2.5mg po tid) (n=35) or placebo (n=35). Plasma prolactin concentrations were assayed before and after the first bromocriptine dose (1.25mg po) as a measure of dopamine receptor sensitivity. After discharge, subjects continued on medication with weekly group counseling. Bromocriptine significantly suppressed prolactin concentrations (4.4 ng/ml decrease), while placebo did not (0.1 ng/ml decrease). Both groups decreased their cocaine use, with no significant group differences in retention in treatment or proportion of cocaine-positive urine samples. There was no significant association between basal plasma prolactin concentrations or prolactin response to first bromocriptine dose and either outcome measure. These data do not support the efficacy of bromocriptine treatment nor a role for prolactin concentration in predicting treatment response.     

Locomotor-activating effects of the D2 agonist bromocriptine show environment-specific sensitization following repeated injections

Biphasic effects of bromocriptine (2.0, 5.0, 10.0, and 20.0 mg/kg IP) on locomotion were quantified in photocell activity boxes in rats. Following early suppression of activity, bromocriptine produced a clear, dose-dependent increase in locomotion that lasted several hours. When a low dose of bromocriptine (5.0 mg/kg) was administered daily over a 3-week period, the locomotor-activating effects of the drug showed progressive enhancement over days. The sensitization was environment specific; rats administered bromocriptine six times in the home cage showed no sign of a sensitized response to bromocriptine when subsequently tested in the activity box. Thus, selective stimulation of D₂ receptors stimulates locomotion and sensitizes animals to subsequent injections, just as do the indirect-acting dopamine agonists cocaine and amphetamine.     

Modification of morphine-induced analgesia, tolerance and dependence by bromocriptine

The effect of two doses of bromocriptine, a dopamine agonist, on morphine-induced analgesia, tolerance and dependence was investigated in mice. Bromocriptine at doses of 0.04 and 0.08 mg/kg did not affect the baseline tail flick latency of mice but potentiated the morphine analgesia. Pretreatment of mice with 5 mg/kg of sulpiride, a D-2 antagonist, not only blocked the effect of 0.08 mg/kg of bromocriptine but also antagonized the morphine analgesia. Control animals given daily injections of 10 mg/kg of morphine rapidly developed tolerance to the analgesic effect. A combined treatment of bromocriptine with morphine given daily suppressed the development of tolerance to morphine analgesia. However, development of tolerance to morphine analgesia was not significantly modified in the animals treated daily with bromocriptine (0.08 mg/kg) plus sulpiride (5 mg/kg). Acute dependence was induced by the administration of 100 mg/kg of morphine. The administration of bromocriptine 30 min before naloxone significantly decreased the ED₅₀ value for naloxone for inducing jumping in mice. Coadministration of sulpiride and bromocriptine attenuated the ability of bromocriptine to potentiate the withdrawal syndrome of morphine dependence. The results indicate that bromocriptine potentiates morphine analgesia, suppresses the development of tolerance to morphine analgesia but exacerbates opiate withdrawal signs in morphine-dependent mice. These effects of bromocriptine appear to be mediated via D-2 receptors.     

Use of omeprazole in Zollinger-Ellison syndrome: a prospective nine-year study of efficacy and safety

H⁺, K⁺-ATPase inhibitors such as omeprazole are the antisecretory agents of choice for the management of gastric acid hypersecretory states, including the Zollinger-Ellison syndrome. However, long-term follow-up data on the overall efficacy and safety of these agents in large numbers of patients are lacking. In the current study we examined the long-term efficacy and safety of omeprazole in 116 patients with Zollinger-Ellison syndrome treated with oral omeprazole at a single centre for up to 114 months (mean ± S.E.M. = 38 ± 3 months). The initial omeprazole maintenance dose was established according to the acute upward dose titration method in 89/116 patients (77%). Gastric acid output was effectively controlled using 60 mg of omeprazole once daily in 41/89 patients (46%) and 22/89 patients (25 %) required twice daily omeprazole therapy. The mean ranitidine equivalent dose for patients who required 60 mg omeprazole once daily (2.5 ± 0.2 g/day) was significantly lower than the mean ranitidine equivalent dose for patients who required more than 60 mg omeprazole once daily (4.3 ± 0.3 g/day). Long-term omeprazole maintenance therapy was discontinued in 36/116 patients (31%) but in no cases was discontinuation due either to drug-induced side-effects or uncontrolled gastric acid output. Fasting serum gastrin levels were significantly elevated above pre-treatment levels at only one time point during follow-up and were likely due to tumour growth rather than a drug effect. The final long-term omeprazole maintenance doses were lower than the initial doses but correlated closely with the preomeprazole basal acid output (r= 0.41, P < 0.001) and ranitidine equivalent dose requirements (r= 0.49, P < 0.001). We conclude that omeprazole effectively and safely controls gastric acid hypersecretion in all patients with Zollinger-Ellison syndrome for up to nine years without evidence by tachyphylaxis.     

Tardive dyskinesia: clinical and neuroendocrine response to low dose bromocriptine

Twelve patients with a long-standing history of moderate to severe symptoms of tardive dyskinesia, which had remained stable for several months, participated in a 6-week trial with bromocriptine. All patients were receiving a concomitant neuroleptic medication and were treated with a low dose of bromocriptine (0.75 to 7.5 mg). Patients showed a modest overall improvement of 16.6%, with a trend for greater improvement in male patients (23.6%). Baseline prolactin levels in the female patients showed a positive correlation with age and duration of tardive dyskinesia symptomatology. Plasma prolactin levels 4 hours following administration of bromocriptine were negatively correlated with the dose of bromocriptine. There appears to be a differential sensitivity for prolactin and growth hormone response to bromocriptine at these low doses in the presence of chronic neuroleptic treatment.     

Effects of bromocriptine on pituitary tumour size

In a prospective study designed to assess the influence of bromocriptine on pituitary tumour size 12 patients with pituitary tumours, eight of whom had suprasellar extensions, were treated for three months with 20 mg of bromocriptine daily after a gradual increase to this dose. The group comprised eight women and four men, five with prolactin-secreting adenomas, four with acromegaly, two with functionless adenomas, and one with Nelson's syndrome. All five patients with prolactin-secreting adenomas showed a reduction in pituitary tumour size as assessed by computerised tomography and metrizamide cisternography accompanied by a fall in prolactin concentrations and clinical and biochemical improvement in their hypopituitarism. One patient in this group had a visual-field defect before treatment, and this resolved. There was no radiological evidence of reduction in tumour size in the remaining seven patients, though this might refect the fairly short duration of treatment, particularly in view of the ancillary evidence of clinical, biochemical, and visual-field improvement in some of the patients. These results emphasise the potential value of bromocriptine in treating patients with large prolactinomas or recurrences of such tumours after previous chiasmal decompression and conventional external megavoltage irradiation on the pituitary.     

A comparative, multicenter trial between bromocriptine and amitriptyline in the treatment of endogenous depression

A double-blind, multicenter trial compared bromocriptine (Parlodel) with amitriptyline in 83 endogenously depressed patients. The patient sample consisted mainly of agitated endogenous depression, and most of the patients were treated within a daily dose range of 30--50 mg bromocriptine or 120--200 mg amitriptyline. In both the global assessment and the Hamilton Depression Rating Scale, amitriptyline scored higher than bromocriptine, but the differences were not statistically significant. There was little difference between the drugs with respect to tolerability. Bromocriptine's potential role in psychiatry will probably be in those patients in whom an alternative treatment to standard antidepressant therapy is required and a less sedative effect with minimal anticholinergic response is indicated. Bromocriptine's use in Parkinson's disease, where the incidence of depression has been reported to be as high as 37%, has been well documented. Bromocriptine's antidepressant properties add to its therapeutic value in this disease.     

In-vitro and in-vivo evaluation of a matrix-controlled bromocriptine mesilate-releasing vaginal ring.

The aim of this study was to evaluate the in-vitro release rates and in-vivo effectiveness of a controlled release, intravaginal dosage form of bromocriptine mesilate. The dimeticone (poly(dimethylsiloxane)) elastomer vaginal ring contained 3 mg bromocriptine mesilate and low molecular weight gelatin in a ratio of 1:3, and 10% propylene glycol. The daily release rate of the drug was designed to be 10% of the total administered dose and was confirmed with release experiments under sink conditions. The effect of the vaginal ring preparation on plasma prolactin level in the rabbit was investigated over a 10-day period. The results showed that the vaginal ring of bromocriptine mesilate significantly decreased the plasma prolactin level of the test group (P < 0.001-0.05) compared with the control and placebo groups. It was concluded that bromocriptine mesilate was effectively absorbed from rabbit vagina and that this controlled release intravaginal ring preparation of bromocriptine mesilate was effective in decreasing the plasma prolactin level in rabbits for ten days.     

Effects of age on behavioral responses to dopamine agonists in the rat

This study served to examine the differential effects of age (rats aged 2 or 12 months) on behavioral responses induced by bromocriptine and apomorphine. Intraperitoneal (i.p.) injection of bromocriptine or apomorphine produced a lower frequency of yawning responses, in 12-month-old rats than in 2-month-old rats. Apomorphine produced a more pronounced stereotyped behavior in 12-month-old rats than in 2-month-old rats. Apomorphine, at 0.1 mg/kg administered after bromocriptine (1.0-20 mg/kg) potentiated yawning behavior. The frequency of yawning in 2-month-old rats was pronounced at 2.5 mg/kg of bromocriptine but only at 5 mg/kg 12-month-old rats. Apomorphine (0.1 mg/kg) did not produce perioral behavior in 2-month-old rats but did in 12-month-old rats. The apomorphine (1.0 mg/kg)-induced stereotypy was stimulated dose dependently by bromocriptine in 2-month-old-rats but not in 12-month-old rats. Bromocriptine did not produce this behavior when administered alone. Pretreatment of 2-month-old rats with reserpine, a catecholamine depletor, plus alpha-methyl-p-tyrosine, a tyrosine hydroxylase inhibitor, inhibited the yawning induced by bromocriptine but potentiated that induced by apomorphine. Such treatment did not significantly alter either bromocriptine or apomorphine-induced yawning responses in 12-month-old rats. The apomorphine-induced stereotypy in 2-month-old rats was markedly potentiated by catecholamine depletion but was not affected in 12-month-old rats. These results suggest that the increasing effect on stereotypy and decreasing effects on yawning in the 12-month-old rats seem to result in an alteration of potency and of the ratio of D-2 versus D-1 receptor activity.