Macroprolactinemia, a benign form of hyperprolactinemia

In a 34-year-old woman with primary subfertility, a strongly increased serum concentration of prolactin was found in combination with normal levels of oestradiol, which is an indication for the presence of prolactin forms without clinical effect. She appeared to have macroprolactinaemia, i.e. the presence of circulating large forms of prolactin (up to > 100 kDa), which may be detected by the immunoassays currently used. They give no clinical signs or symptoms. Diagnosing macroprolactinaemia means that further diagnostic tests for hypopituitarism abnormalities using MRI need not be carried out and unjustified treatment of otherwise healthy persons may be prevented.     

Hyperprolactinaemia and sexual function in the male

Although an uncommon cause of sexual dysfunction, hyperprolactinaemia is almost invariably associated with loss of libido and impotence in men. The finding of hyperprolactinaemia should prompt a systematic search for an underlying cause, particularly prolactin-secreting pituitary adenomas; in this condition, sexual dysfunction may antedate other complications of the pituitary tumour by many years.     

Posttraumatic hypopituitarism

A 39-year-old woman was admitted with complaints of weight gain, a decreased sense of well-being and amenorrhoea. One and a half year prior to admission she had been involved in a serious road accident and had spent several days in coma due to an epidural haematoma. She was found to have hypopituitarism with deficient somatotropic and gonadotropic axes, as well as mild hyperprolactinaemia, probably due to a pituitary stalk lesion. All patients with severe trauma to the skull are at risk of developing posttraumatic hypopituitarism, so that pituitary function testing should be performed routinely, certainly in the presence of symptoms.     

控制性超促排卵对正常妇女心脏物理学的影响

目的:通过对正常妇女自然周期和控制性超促排卵过程中监测心脏彩超,探讨控制性超促排卵对心脏物理学的影响。方法:选择2005年2月～2008年10月,在青岛市妇女儿童医疗保健中心接受IVF-ET治疗单纯输卵管因素或男方因素的患者48例,采用每例患者促排卵周期和自然周期自身对照,分别于自然周期月经第3天、LH日、降调后月经第3天及HCG日进行内分泌激素和心脏彩超检测。结果:自然周期月经第3天与降调后月经第3天及自然周期LH日与促排周期HCG日的心脏结构各腔室、心室壁厚度、心脏血流动力学、心室顺应性相比较无统计学差异(P0.05)。结论:控制性超促排卵对女性心血管系统从心脏物理学角度没有明显影响,是比较安全的。     

Macroprolactinemia. Is treatment necessary?

A 26-year old symptom-free woman was admitted to our Clinic for evaluation of hyperprolactinemia. The patient, who had normal menstrual cycles, was found accidentally to have a cystic adnexal mass and was placed on oral contraceptives (OC) for 3 months. During the first OC-cycle a bilateral breast nipple discharge was noticed and an elevated serum prolactin (PRL) was detected (2.7 nmol/l). The OC was discontinued and bromocriptine therapy was started. Serum PRL levels were restored and spontaneous menses resumed. The Pituitary magnetic resonance imaging (MRI), the anterior pituitary function, assessed by dynamic tests, and the thyroid hormone levels were normal. Upon bromocriptine discontinuation, PRL levels increased to 13.8 nmol/l. Poly-ethylene-glycol precipitation of the patient's serum, in two consecutive measurements, demonstrated the presence of macroprolactinemia. Since the patient was asymptomatic, a dopamine agonist was not resumed. Macroprolactinemia is characterized by most authors, as a benign condition with no clinical implications. However, a number of investigators challenge this view, suggesting that in some cases mild symptomatology is present possibly requiring therapeutic intervention.     

Stereotypes of women in different stages of their reproductive life: data from Mexico and the United States

College students from Mexico and the United States (n = 349) were surveyed to explore stereotypes regarding women in different menstrual cycle phases and other stages of reproductive life. Participants from both countries defined a premenstrual or menstrual woman as irritable and moody and a menopausal woman as old and irritable. A woman with a hysterectomy was defined as sad, and only Americans used other words that did not have any negative connotation. Participants used some positive adjectives to describe other stages. For example, a pregnant woman was defined as happy, but only by Mexicans. Finally, a woman with a young baby was defined in both countries as happy; however, Americans implied that having a baby is complicated. The findings are discussed in light of sociocultural differences and similarities.     

性激素六项在女性精神分裂症患者诊断中的应用

目的比较月经周期正常女性精神分裂症患者治疗前与健康对照组及治疗前、后血清睾酮（TSTO）、促卵泡成熟激素（FSH）、垂体泌乳素（PRL）、孕酮（PRGE）、黄体生成素（LH）及雌二醇（E26III）的含量差异。方法采用化学发光法,收集40例月经周期正常女性精神分裂症患者未用药的检查结果,用药1月后测定结果及健康对照组数据进行比较。结果患者组（治疗前）与正常组比较PRL、E26III、PRGE组与其对照组差异有统计学意义（P〈0.05）,TSTO、FSH、LH组无统计学意义（P〉0.05）;患者组治疗前后比较,FSH、PRL、PRGE、E26III组与其对照组差异有统计学意义（P〈0.05）,TSTO、LH组无统计学意义（P〉0.05）。结论女性血清PRL、PRGE、E26III含量检测对于女性精神分裂症的诊断、疗效评价有较好的临床意义。     

Endocrinological studies in two patients with post contraceptive cyclic dysfunction

Serial assays of urinary estrogens, pregnanediol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), WERE PERFORMED IN 2 NORMAL women who developed amenorrhea as a result of oral contraceptive use. Case 1, a woman aged 28 with 2 children took Ovulen (mestranol .1 mg and ethynodiol diacetate 1.0 mg) for 25 months followed by a substitution of chlormadinone acetate (.5 mg per day) when she developed increased menstrual irregularity. Following withdrawal of the medication, vaginal bleeding began and lasted 4 days, and she experienced regular cycles for the subsequent 2 years. The second woman aged 21 developed amenorrhea after 17 months' use of Gynovlar (ethinyl estradiol .05 mg and norethistrone acetate 3.0 mg). Amenorrheic for 21 months at the time of investigation, she was given clomiphene citrate for 5 days (50 mg/day). Further treatment with clomiphene and Pergonal (Serono-Rome) was necessary to resume normal cycles and permit conception which led to full term delivery. Estrogen levels were similar to those of the follicular phase of the normal menstrual cycle; however, they rose spontaneously to midcycle levels in case 1 and as a result of clomiphene treatment in case 2. FSH levels were normal but failed to show consistent patterns; LH patterns were highly irregular in both cases. The findings are consistent with the hypothesis that longterm therapy by oral contraceptives may cause irregular cyclic release of gonadotrophins at the hypothalamic level resulting in amenorrhea and anovulation.     

不孕妇女性激素水平与月经周期的相关性分析

目的 综合分析160例不孕妇女六项性激素指标检测结果,探讨其浓度水平变化与月经的相关性.方法 选择2013年1月-2014年6月在我院就诊的不孕妇女160例,随机分为月经正常组和月经异常组,每组80例,选择同期进行健康体检且结果正常的女性80例为对照组,所有纳入对象均进行血清促卵泡生成激素、促黄体生成激素、催乳激素、雌二醇、睾酮和孕酮指标检测,并对结果进行综合分析.结果 与对照组比较,月经正常组女性六项性激素浓度水平无明显差异（P＞0.05）;与月经异常组比较,月经正常组和对照组女性六项性激素浓度水平差异明显,具有统计学意义（P＜0.05）;六项性激素指标联合检测月经正常组和月经异常组阳性率分别为21.25％和91.25％;以临床确诊结果为金标准,月经异常组患者与临床结果一致性Kappa值等于0.91.结论 六项性激素的浓度水平变化与妇女月经具有一定的相关性,进行联合分析可以为不孕症病因、确诊、治疗和指导临床用药等方面提供重要的实验室依据.     

Stereotypes of Women in Different Stages of Their Reproductive Life: Data From Mexico and the United States

College students from Mexico and the United States (n = 349) were surveyed to explore stereotypes regarding women in different menstrual cycle phases and other stages of reproductive life. Participants from both countries defined a premenstrual or menstrual woman as irritable and moody and a menopausal woman as old and irritable. A woman with a hysterectomy was defined as sad, and only Americans used other words that did not have any negative connotation. Participants used some positive adjectives to describe other stages. For example, a pregnant woman was defined as happy, but only by Mexicans. Finally, a woman with a young baby was defined in both countries as happy; however, Americans implied that having a baby is complicated. The findings are discussed in light of sociocultural differences and similarities.     

Inhibition of ovulation in women by chronic treatment with a stimulatory lrh analogue — A new approach to birth control?

A stimulatory luteinizing hormone-releasing hormone (LRH) analogue D-Ser (TBU)⁶-EA¹⁰-LRH was administered subcutaneously once daily in a dose of 5 ug to four regularly menstruating women. Treatment was instituted within the first three days of the menstrual bleeding and continued for 22 – 30 days. Ovulation was inhibited in all the women during the treatment cycle. The treatment resulted in disturbances in the pituitary gonadotropin secretion which presumably led to disordered follicular maturation and anovulation. The maximum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) responses to the LRH analogue were obtained during the first few days of treatment. The gonadotropin responses then rapidly decreased during the prolonged treatment. This change in the pituitary responsiveness probably prevented the release of a normal preovulatory LH surge. After the treatment, all the women resumed normal ovulatory menstrual cycles. The results suggest that it might be possible to use stimulatory LRH analogues for birth control.     

Inhibition of ovulation in women by chronic treatment with a stimulatory LRH analogue - a new approach to birth control?

A stimulatory luteinizing hormone-releasing hormone (LRH) analogue D-Ser (TBU)6-EA10-LRH was administered subcutaneously once daily in a dose of 5/microgram to four regularly menstruating women. Treatment was instituted within the first three days of the menstrual bleeding and continued for 22--30 days. Ovulation was inhibited in all the women during the treatment cycle. The treatment resulted in disturbances in the pituitary gonadotropin secretion which presumably led to disordered follicular maturation and anovulation. The maximum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) responses to the LRH analogue were obtained during the first few days of treatment. The gonadotropin responses then rapidly decreased during the prolonged treatment. This change in the pituitary responsiveness probably prevented the release of a normal preovulatory LH surge. After the treatment, all the women resumed normal ovulatory menstrual cycles. The results suggest that it might be possible to use stimulatory LRH analogues for birth control.     

Quantitation of menstrual blood loss — Further evaluation of the alkaline hematin method

Investigation of reliability and practicality of a method for measuring menstrual blood loss was required for research into the problem of uterine hemorrhage caused by intrauterine contraceptive devices. The method selected for evaluation was the photometric alkaline hematin procedure. Our studies of this technic indicate a sensitivity to less than 0.1 ml of blood, within-batch precision of 5% or less (2 C.V.), and an accuracy of measuring human menstrual blood from most types of sanitary devices generally within ± 5%. The method appears to be specific for menstrual blood and independent of other materials in genital fluids. Menstrual discharge may be stored for at lease one month prior to determination without alteration of results. The procedure, once optimized for our purposes, was found to be very practical.

Using this technic, blood loss was measured during 15 menstrual periods in 6 subjects. The results were consistent with the available literature which indicates that maximum normal menstrual blood flow is between 60 and 80 ml, and the mean is near 30 ml. Variation of measured flow between consecutive menstrual cycles in some individuals (both normal and menorrhagic) reveals the necessity for repeated measurements to properly assess average blood flow in certain cases.     

月经失调与甲状腺功能的联系——对1495例临庆系列病例的分析

目的探究月经失调形式和甲状腺功能（甲功）之间的联系。方法系列分析2006年1月4日至2011年3月2日妇科内分泌中心就诊的1495例患者的临床资料,均填写详细病史表格及检测促甲状腺激素、游离三碘甲状腺氨酸与游离甲状腺素水平。结果①临床月经失调和不育患者在系列病例中甲功异常发生率为13．4％;②甲功正常与甲功异常的月经分布情况无统计学差异（P=0．107）。但甲功异常者发生月经失调率是甲功正常者的1．49倍;③不同甲状腺功能状态下的月经分布情况均无统计学差异（P〉0．05）。但甲亢者发生月经失调率是甲功正常者的2．31倍。亚甲亢者是甲功正常的1．40倍。亚甲减者是甲功正常的1．27倍。甲减者发生月经失调率最高,是甲功正常的3．31倍;④甲亢与甲功正常者相比,月经过少发生率有统计学差异（P=0．025）。亚甲减者发生子宫异常出血率和月经稀发率分别是甲功正常者的1．36倍和1．34倍;甲减者发生闭经率最高,是甲功正常者的5．96倍;亚甲亢和甲亢发生月经过少率均最高,分别是甲功正常者的3．42倍和10．3倍;⑤各类与甲功异常类型联系最密切的月经失调患者的促甲状腺激素、游离三碘甲状腺氨酸与游离甲状腺素水平均有统计学差异（P〈0．001）。结论甲状腺功能低落或亢进均有可能发生月经失调。甲减合并的月经失调类型总体偏于月经稀发和闭经。亚甲减与合并子宫异常出血和月经稀发的发生都较密切。甲亢和亚甲亢的月经失调类型均以月经过少为主。     

An intrasellar germinoma with normal cerebrospinal fluid beta-HCG concentrations misdiagnosed as hypophysitis

A patient with an intrasellar germinoma leading to pituitary stalk thickening is reported. The patient, a 24-year old woman, presented with hyperprolactinemia, secondary hypothyroidism, and hypogonadotropic hypogonadism with no evidence of diabetes insipidus. Cerebrospinal fluid (CSF) examination revealed an increased number of lymphocytes and histiocytes. Although beta-HCG concentration was normal (<2 mIU/mL) in the CSF, increased beta-HCG concentration was detected in the serum. Systemic glucocorticoid treatment led to a decrease in CSF cell count, but no regression of the sellar mass was noted. A diagnostic biopsy was performed and showed an intrasellar germinoma. The patient underwent conventional radiotherapy. Complete resolution of the mass lesion and normalization of beta-HCG concentration in the serum were observed three months after radiotherapy. The presence of intrasellar mass lesion in association with pituitary stalk thickening may cause difficulties in the differential diagnosis. Histopathological examination is essential in equivocal cases in order to reach accurate diagnosis and apply the most appropriate therapy.     

Assessment of menstrual blood loss in Belgian users of a new T-shaped levonorgestrel-releasing intrauterine system

OBJECTIVE: This study was conducted to evaluate the effect of a T-shaped levonorgestrel-releasing intrauterine system (Femilis, LNG IUS) on the amount of menstrual blood loss (MBL) in women with and without menorrhagia. The daily release of the LNG IUS was approximately 20 mug. MATERIALS AND METHODS: In 60 Belgian women, less than 48 years of age at study enrollment, using the Femilis LNG IUS for 4 to more than 30 months, MBL was assessed with the visual assessment technique. Twenty-eight women had normal menstrual periods at baseline (menstrual score <185) and 32 women had idiopathic menorrhagia (menstrual score > or =185). RESULTS: Menstrual blood loss scores dropped significantly during the observation period in all women except one. The median menstrual score at baseline in women with normal menstrual bleeding was 140 (range 80-160) and dropped to a median score of 5 (range 0-150) at follow-up, a decrease of 96%. In the 32 women with menorrhagic bleeding at baseline, menstrual flow dropped from a median score of 232 (range 185-450) at baseline to a median score of 3 (range 0-50) at follow-up, a decrease of 99%. Twenty women developed amenorrhea (33%): 10 in the group of women with normal menstruation and 10 in those women with menorrhagia. Most of the remaining women had oligomenorrhea requiring the use of a few panty-liners only. In one woman, MBL did not decrease, thus requiring further evaluation. CONCLUSION: The impact on MBL of this new 20 mug/day LNG-releasing IUS confirms other studies with devices releasing the same or lower amounts of LNG. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The strong effect on MBL of this contraceptive method offers an important health benefit and improvement in quality of life, particularly in women with heavy bleeding and anemia, as other treatment modalities are less effective, more costly, more invasive or not readily available.     

Clinical thinking and decision making in practice. A patient with postpartum malaise, anorexia, and ventricular tachycardia]

A 34-year-old woman was hospitalised with hypotension, lethargy and ventricular tachycardia, five months after an uneventful pregnancy and delivery. Laboratory values were compatible with anterior (abnormal concentrations of adrenocorticotropin hormone, thyroid stimulating hormone, prolactin) and posterior (diabetes insipidus) pituitary gland insufficiency. An MRI scan revealed that there was no pituitary enlargement and that the pituitary stalk was normal. The prompt recognition of hypophysitis as a potentially fatal condition is important, as a life-saving treatment is available.     

Inhibitory effects of treatment with an LHRH antagonist on the ovulatory cycle are reduced when administered during the late follicular phase

To compare the effects of transitory suppression of pituitary gonadotropin secretion by an LHRH antagonist at the mid or late follicular phase of the menstrual cycle, adult macaques with normal menstrual cycles were treated with an LHRH antagonist (N-Ac-D-Nal(2)1,D-pCl-Phe2,D-Trp3,D-hArg(Et2)6,D-Ala10 ]LHRH (detirelix) administered subcutaneously at a dose of 300 micrograms/kg, daily for 3 days beginning either during the mid or late follicular phase. In all eight animals treated during the mid follicular phase, serum concentrations of LH and FSH declined and remained suppressed for 4 days. This caused a fall in serum concentrations of estradiol and the expected ovulation failed to occur. During the recovery period a marked rise in serum FSH occurred followed by normal follicular development and ovulation 14.8 +/- 0.6 days after the last injection of antagonist. Of the 9 macaques given the same treatment during the late follicular phase, only in two was the expected rise in serum progesterone prevented. In 4 of the animals a transitory suppression in LH and estradiol was observed but this was followed by a recovery and occurrence of an LH surge and rise in serum progesterone indicating ovulation during the course of treatment. In the remaining 3 macaques treatment commenced on the day of the initiation of the LH surge and was associated with a progesterone rise of normal duration but lower than normal magnitude during the early luteal phase. These results show that LHRH antagonist treatment causes rapid inhibition of pituitary-ovarian function when administered up to the mid follicular phase of the cycle and is effective in blocking ovulation. The suppressive effects of the antagonist are reduced when administered during the late follicular phase. This may be due to decreased dependence of the pituitary gonadotrope on LHRH at this time and on decreased dependence of the dominant follicle on the gonadotropins.     

垂体形态与月经周期相关变化的MR影像分析

目的:观察月经周期中性腺分泌不同时相的垂体形态,了解垂体体积形态变化的相关关系。方法:选取90名20~49岁健康女性志愿者,分别于月经干净后7d内(滤泡期)和20d(黄体期)作性腺激素测定,并于验血当天行垂体MRI扫描,测定垂体正中层面的面积。结果:各个体的滤泡期和黄体期腺垂体的面积值均无明显变化,经t检测,P≤0·5。结论:月经周期中滤泡期和黄体期性腺激素分泌的水平高低与垂体体积变化无正相关关系。     

Dietary habits, reproductive and menstrual factors and risk of dysmenorrhoea

In order to analyze risk factors for dysmenorrhoea, we conducted a case-control study. Cases were 106 women (median age 27 years) with moderate or severe dysmenorrhoea lasting 12 months or more. Controls were 145 women (median age 26 years) without dysmenorrhoea, admitted for routine gynecological examination at the outpatient gynecological services of the same clinic where cases had been identified. In comparison with women reporting short menstrual cycles (every 25 days or less) the relative risk (RR) of dysmenorrhoea was 2.0 and 2.6, respectively, in those reporting their menstrual cycles of 26–30 days and of 31 days or more, and the RR was 3.6 (95% confidence interval (CI): 1.0– 13.4) for women reporting totally irregular menstrual cycles. The estimated RRs were, in comparison with women reporting menstrual flows lasting 4 days or less, respectively 2.2 and 1.9 in those reporting menstrual flows lasting 5 and 6 days or more. Fourty-four (58%) cases but only seven (5%) controls reported heavy menstrual flows (RR in comparison with women reporting slight or normal menstrual flow 12.6, 95% CI: 5.0–32.1). As regards dietary factors, no associations emerged between the various food items, with the exception of cheese and eggs, which tended to be more frequently consumed by cases than controls. The results of this study suggest that the risk of dysmenorrhoea is higher in women with irregular, long and heavy menstrual flows. No association emerged between reproductive history and dysmenorrhoea. Likewise, no clear relationship emerged between intake of several dietary factors and risk dysmenorrhoea.