Hyperprolactinemia 2

Prolactinoma 郝立智醫師永康榮民醫院新陳代謝科 NEJM, Vol 349:2035-2041, Nov. 20, 2003, No. 21.

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Clinical Problem ,[object Object],[object Object],[object Object],[object Object]

Prolactin inhibits oestrogen synthesis in the ovary ,[object Object],[object Object],[object Object],[object Object],Nature. 1981 Apr 16;290(5807):600-2.

Clinical Presentation (1) ,[object Object],[object Object],[object Object],[object Object]

Clinical Presentation (2) ,[object Object],[object Object],[object Object],[object Object]

Prolactin-secreting tumors and hypogonadism in 22 men ,[object Object],[object Object],[object Object],N Engl J Med 1978;299:847-852.

Bone Marker and Bone Density Responses to Dopamine Agonist Therapy in Hyperprolactinemic Males ,[object Object],[object Object],[object Object],[object Object],[object Object],J Clin Endocrinol Metab 1998;83:807-813

[object Object],[object Object],[object Object],[object Object],J Clin Endocrinol Metab 1998;83:807-813

[object Object],[object Object],[object Object],J Clin Endocrinol Metab 1998;83:807-813

[object Object],[object Object],J Clin Endocrinol Metab 1998;83:807-813

Causes of Hyperprolactinemia (1) ,[object Object],[object Object],[object Object],[object Object]

The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in p’ts with schizophrenia. ,[object Object],[object Object],Clin Ther 2000;22:1085-1096

[object Object],[object Object],Clin Ther 2000;22:1085-1096

[object Object],[object Object],[object Object],[object Object],[object Object],Clin Ther 2000;22:1085-1096

Effects of methyldopa on prolactin and GH ,[object Object],[object Object],[object Object],[object Object],Br Med J 1976;1:1186-1188.

Augmentation of prolactin secretion by estrogen in hypogonadal women ,[object Object],[object Object],[object Object],[object Object],J Clin Invest 1974;53:652-655.

Causes of Hyperprolactinemia (4) ,[object Object],[object Object],[object Object],[object Object],Br Med J 1976;1:1186-1188.

Clinical history and outcome of 59 p'ts with idiopathic hyperprolactinemia ,[object Object],[object Object],[object Object],[object Object],[object Object],Fertil Steril 1992;58:72-77.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fertil Steril 1992;58:72-77.

[object Object],[object Object],[object Object],[object Object],[object Object],Fertil Steril 1992;58:72-77.

Strategies and Evidence--Diagnostic Studies (1) ,[object Object],[object Object],[object Object],[object Object]

Strategies and Evidence--Diagnostic Studies(2) ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

Strategies and Evidence--Diagnostic Studies (3) ,[object Object],[object Object],[object Object],[object Object]

High prolactin levels may be missed by immunoradiometric assay in p'ts with macroprolactinomas. ,[object Object],[object Object],Clin Endocrinol (Oxf). 1996 Mar;44(3):305-9.

[object Object],Clin Endocrinol (Oxf). 1996 Mar;44(3):305-9 .

[object Object],[object Object],[object Object],Clin Endocrinol (Oxf). 1996 Mar;44(3):305-9 .

Strategies and Evidence -- Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Treatment of Prolactin-Secreting Pituitary Adenomas: Early Results and Long-Term Outcome ,[object Object],[object Object],J Clin Endocrinol Metab 2002;87:3180-3186.

[object Object],[object Object],[object Object],J Clin Endocrinol Metab 2002;87:3180-3186.

Long term follow-up of women with surgically treated prolactin- secreting pituitary tumors ,[object Object],[object Object],[object Object],N Engl J Med 1983;309:280-283

[object Object],[object Object],[object Object],[object Object],N Engl J Med 1983;309:280-283

Microadenomas (1) ,[object Object],[object Object],[object Object]

Microadenomas (2) ,[object Object],[object Object],[object Object]

Vaginal bromocriptine in hyperprolactinemic p'ts and puerperal women. ,[object Object],[object Object],Acta Obstet Gynecol Scand 1991;70:493-495.

Effectiveness of vaginal bromocriptine in treating women with hyperprolactinemia. ,[object Object],[object Object],[object Object],[object Object],Fertil Steril. 1989 Feb;51(2):269-72.

Microadenomas (3) ,[object Object],[object Object],[object Object],[object Object]

Pregnancy outcome after cabergoline treatment in early wks of gestation. ,[object Object],[object Object],[object Object],Reprod Toxicol. 2002 Nov-Dec;16(6):791-3.

Microadenomas (5) ,[object Object],[object Object]

Microadenomas (7) ,[object Object],[object Object]

Long-term follow-up of p'ts with hyperprolactinaemia. ,[object Object],[object Object],[object Object],[object Object],Clin Endocrinol (Oxf). 1996 Sep;45(3):299-303.

[object Object],[object Object],[object Object],Clin Endocrinol (Oxf). 1996 Sep;45(3):299-303.

The effect of combined estrogen/progestogen treatment in women with hyperprolactinemic amenorrhea. ,[object Object],[object Object],Gynecol Endocrinol. 1992 Sep;6(3):183-8.

[object Object],[object Object],Gynecol Endocrinol. 1992 Sep;6(3):183-8.

Macroadenomas (1) ,[object Object],[object Object]

Macroadenomas (2) ,[object Object],[object Object]

Macroadenomas (3) ,[object Object],[object Object],[object Object]

Hypogonadism (1) ,[object Object],[object Object],[object Object]

Hypogonadism (2) ,[object Object],[object Object],[object Object],[object Object]

Hypogonadism (3) ,[object Object],[object Object],[object Object]

Withdrawal of bromocriptine after long-term therapy for macroprolactinomas: effect on plasma prolactin and tumor size ,[object Object],[object Object],[object Object],[object Object],Clin Endocrinol (Oxf) 1991;34:175-178.

[object Object],[object Object],[object Object],[object Object],[object Object],Clin Endocrinol (Oxf) 1991;34:175-178.

Hypogonadism (4) ,[object Object],[object Object],[object Object],[object Object]

Areas of Uncertainty ,[object Object],[object Object],[object Object]

Necrotic changes in prolactinomas after long term administration of bromocriptine ,[object Object],[object Object],[object Object],[object Object],J Clin Endocrinol Metab 1984;59:463-470.

Conclusions and Recommendations (1) ,[object Object],[object Object],[object Object]

謝謝聆聽請多多指教 !

Hyperprolactinemia 2

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Hyperprolactinemia 2