Endocrine contribution to the sexual dysfunction in patients with advanced chronic kidney disease and the role of hyperprolactinemia

In this study, we investigated the prevalence of sexual dysfunction among males with advanced chronic kidney disease and the effect of treating hyperprolactinemia among these patients. In this prospective study, patients were assessed with history, physical examination, hormonal assessment, and two questionnaires, IIEF and AIPE. Patients with hyperprolactinemia received treatment with cabergoline 0.5 mg once per week for 6 months and were re-evaluated. A total of 102 patients were included in this study, 75 (73.53%) were on hemodialysis, 13 (12.75%) on peritoneal dialysis and 14 (13.73%) on medical treatment alone. Ninety (88.24%) patients had premature ejaculation, 85 (83.33%) had anything from mild-to-moderate-to-severe erectile dysfunction. The incidence of hypogonadism and hyperprolactinemia was 34.4%. Patients treated with cabergoline (n = 26) showed a significant increase in LH levels (p = .003) and a significant decrease in prolactin levels (p = .003). Testosterone levels and the incidence of erectile dysfunction or premature ejaculation did not improve significantly. There is a high incidence of sexual dysfunction among patients. Treatment of hyperprolactinemia is effective in correcting prolactin levels, but does not improve erectile dysfunction or premature ejaculation. Therefore, treating hyperprolactinemia is not an overall effective treatment for erectile dysfunction in these patients.     

清肝袋泡剂治疗高催乳素血症临床与实验研究

目的：进一步观察清肝袋泡剂对高催乳素血症（ＨＰＲＬ）患者的临床疗效,探讨其作用机制。方法：随机将患者分为治疗组１２０例（清肝袋泡剂）,对照组４０例（溴隐亭）。观察血中催乳素（ＰＲＬ）和相关激素水平及症状变化情况,进行疗效对比。同时通过动物实验对内分泌水平及卵巢、子宫、乳腺的组织形态变化进行同步观察。结果：清肝袋泡剂可显著降低患者血清ＰＲＬ水平,对相关激素有良性调节作用,临床疗效良好,与对照组比较无显著性差异（Ｐ＞０．０５）;动物实验证明能促进卵泡发育,使子宫内膜出现各动情周期的变化,抑制乳腺腺体增生。结论：清肝袋泡剂可有效治疗ＨＰＲＬ。     

化痰泄浊法治疗高催乳素血症的临床研究

用化痰泄浊法组方用药治疗高催乳素血症(HPRL)62例,观察其临床疗效以及对血清泌乳素(PRL)和相关激素的影响,疗程3～6个月.结果临床总有效率为91.94%;中药可显著降低PRL值(P＜0.01),对相关激素有良好调节作用.     

泌乳素瘤多巴胺受体激动剂治疗相关冲动控制障碍的诊疗进展

泌乳素瘤是最常见的功能性垂体腺瘤,首选多巴胺受体激动剂作为一线治疗方案。在接受多巴胺受体激动剂治疗的泌乳素瘤患者中可能出现各种类型的冲动控制障碍(impulse control disorders,ICDs),如病理性赌博、强迫性购物、性欲亢进、强迫性进食等。这些不良反应会对患者的工作和生活造成严重的影响。然而目前国内缺少相关研究报道,内分泌学界对冲动控制障碍的临床表现、诊断及治疗缺乏全面的认识。本文就泌乳素瘤中ICDs的发生比例、发生机制、危险因素、诊断及治疗等方面展开综述,以深入了解泌乳素瘤多巴胺受体激动剂治疗相关ICDs,为今后在临床诊治中筛查识别及诊治提供帮助。     

Progressive prostate hyperplasia in adult prolactin transgenic mice is not dependent on elevated serum androgen levels

BACKGROUND: Transgenic mice overexpressing the rat prolactin (PRL) gene under control of the metallothionein-1 promoter (Mt-1) develop a dramatic prostatic enlargement. These animals also display significantly elevated testosterone serum levels. In this study, we aim to clarify the role of circulating androgen levels in the promotion of abnormal prostate growth in the adult PRL transgenic mouse prostate. METHODS: Prostate morphology and androgen-receptor distribution patterns were analyzed in castrated and testosterone substituted adult PRL transgenic and in wild-type males. RESULTS: Progressive prostatic hyperplasia in adult PRL transgenic males was not affected by substitution to serum testosterone levels corresponding to wild-type. Furthermore, prolonged testosterone treatment in adult wild-type males did not produce any significant changes in prostate growth or morphology compared with wild-type controls. Immunohistochemical studies revealed a significantly increased proportion of androgen receptor positive epithelial cells in all lobes of the PRL transgenic prostate versus wild-type. CONCLUSION: The present study demonstrates that progressive prostate hyperplasia in adult PRL transgenic mice is not dependent on elevated serum androgen levels. Furthermore, prolonged androgen treatment in adult wild-type male mice appears to have no significant effect on prostate growth. In addition, our results suggest that prolonged hyperprolactinemia results in changes in prostate epithelial and stromal cell androgen receptor distribution.     

溴隐亭治疗垂体泌乳素瘤57例

作者分析了１９８７年至１９９４年经妇科内分泌门诊确诊为脑垂体泌乳素瘤５７例用溴隐亭治疗的情况。５７例中巨大腺瘤１１例，微腺瘤４６例。５７例均用溴隐亭治疗，其中９例手术，术后继续服用溴隐亭。结果血清泌乳素值迅速下降至正常范围者占８９．４７％，８５．９６％病例泌乳减少或停止，８７．７２％月经恢复，６３．４１％病例妊娠。所有足月产的２３例婴儿无一例畸形或先天性疾病。可见，溴隐亭治疗垂体泌乳素瘤的效果非常显著，而且副作用小，无致畸作用。     

Unmodified prolactin (PRL) promotes PRL secretion and acidophil hypertrophy and is associated with pituitary hyperplasia in female rats

In this study, we have tested the hypothesis that unmodified prolactin (U-PRL) and phosphorylated prolactin (P-PRL) have differential roles in the autoregulation of PRL secretion in vivo. Recombinant human U-PRL and a molecular mimic of P-PRL (S179D PRL) were administered to male rats and to female rats in different physiological states and the effect on rat PRL release was measured. Administration of U-PRL elevated rat PRL in all female animals, but was without effect in males. By contrast, S179D PRL was inactive in females, but inhibited PRL release in males. Morphometric and immunohistochemical analyses demonstrated acidophil hypertrophy and evidence of increased PRL secretion in the pituitaries of U-PRL-treated females. Analysis of the two forms of PRL during prolactinoma induction in two differentially susceptible strains of rats found a strong temporal correlation among increased ratios of U-PRL: P-PRL, increased circulating PRL, and increased cell proliferation. We conclude (1) that the autoregulatory mechanism(s) can distinguish between the two major forms of PRL and that higher proportions of U-PRL not only allow for higher circulating levels of PRL, but are also autostimulatory, (2) that the autoregulatory mechanism(s) are set differently in males and females such that females are more sensitive to autostimulation by U-PRL and less sensitive to inhibition by P-PRL, and (3) that U-PRL and P-PRL may also have differential roles in the regulation of pituitary cell proliferation.     

高泌乳血症的诊治分析

目的 探讨高泌乳血症的诊断和治疗。方法 观察分析本院62例高泌乳血症病例（功能性高泌乳血症40例，垂体微小腺瘤22例）。结果 功能性高泌乳血症药物（溴隐亭）治疗后80％患者泌乳停止，月经恢复，妊娠率达30％。垂体微小腺瘤（10mm左右），经蝶显微手术后全部恢复排卵性月经，PRL降至20ng／ml以内。结论 功能性高泌乳血症予药物治疗，而垂体微小腺瘤以手术为宜。     

Effects of Estrogen and Ectopic Pituitary Transplants on the Responsiveness of Pituitary Prolactin Release to Luteinizing Hormone-Releasing Hormone and Dopamine

The responsiveness of prolactin release to regulatory inputs depends on the functional state of the lactotrophs. In the present study, we have examined the effects of luteinizing hormone-releasing hormone (LHRH; 10^–7 or 10^–6 M) on the release of prolactin in vitro from hyperplastic pituitaries of estrogen-treated male Fischer rats, ectopic pituitary transplants and in situ pituitaries of grafted and control rats. The effects of dopamine (10^–8 or 10^–7 M) in this system were also examined. The extent of inhibition of prolactin release by dopamine was not related to the amounts of prolactin secreted under basal conditions or to plasma prolactin levels. LHRH significantly suppressed prolactin secretion in all groups but its effect was most pronounced in the ectopic pituitary transplants and in the hyperplastic pituitaries of animals after chronic exposure to estrogen followed by a period of recovery. Thus, the effects of LHRH on prolactin release appear to be related to the secretory activity and/or to the absolute or relative number of the lactotrophs.