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Article
Hyperprolactinaemia: when MRI is indicated?

Author: Wasan I. Majeed
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2009 Volume: 8 Issue: 1 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Design This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
Hyperprolactinaemia: when MRI is indicated?

Authors: Wasan I. Majeed --- Mohammed Abd Kadhim
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2008 Volume: 7 Issue: 2 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Design: This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods: We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results: At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion: MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
HLA Class I and Class II Polymorphisms and Anti-nuclear Antibodies in Hyperprolactinaemic Iraqi Females with Primary Infertility

Author: Ali H. Ad'hiah
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2008 Volume: 50 Issue: 4 Pages: 475-479
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The study was conducted to investigate the association between hyperprolactinaemia and markers of human leukocyte antigen (HLA) system in a sample of Iraqi infertile females, together with the profile anti-nuclear antibodies (ANA). Objectives: One hundred and seventy five female patients (age range: 20 -40 years) were recruited in this study. They were attending the Institute for Embryo Research and Infertility Treatment (Al-Nahrain University) during the period January 2005 - September 2006. Results:After clinical and laboratry evaluations, it was found that 100 patients were hyperprolactinaemic, whereas the other 75 patients were euprolactinaemic, therefore, they were considered as a control group. Based on serum level of prolactin (22-29, 30-39 and ≥ 40 ng/ml), the total hyperprolactinaemic patients were divided into three groups; I (35 patients), II (40 patients) and III (25 patients), respectively. The HLA antigens showed significant variations between patients (total and groups) and controls. In total patients, B8 (25.0 vs. 9.3%), DR3 (48.0 vs. 17.3%) and DR4 (39.0 vs. 13.3%) showed significant increased frequencies, while B35 showed a significant decreased frequency (7.0 vs. 24%). The latter decrease was also observed (5.7 vs. 24.0%) in group I of patients, which also showed a significant increased frequency of DR3 (54.3 vs. 17.3%). In groups II and III of patients, only DR3 (45.0 and 56.0, respectively vs. 17.3%) and DR4 (37.5 and 56.0, respectively vs. 13.3%) showed significant increased frequencies. Autoantibody evaluation by ANA test revealed that 22% of the total patients was positive, while all control subjects were negative, and such positivity paralleled the increased level of serum prolactin.


Article
Effects of Olanazapine and Haloperidol on Serum Malondialdehyde, Prolactin Level, Blood Glucose and Lipid Profile in Schizophrenic Patients
آثار أولانازابين وهالوبيريدول على مصل Malondialdehyde ، مستوى البرولاكتين ، نسبة الجلوكوز في الدم والدهون في مرضى الفصام

Authors: Sirwan Kamil Ali --- Muhammad A. Hassan --- Kawa F. Dizaye
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 2 Pages: 13-21
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: The association of the atypical antipsychotics with hypergly-cemia, elevated lipids, and weight gain was recognized soon after the introduction of clozapine and has become of increased concern as the use and uses of atypical antipsy-chotics have been expanded. The aim of the present study was to investigate the preva-lence of diabetes, dyslipidaemia, lipid peroxidation and hyperprolactinemia in Olanzepine treated patients in comparison with patients treated with haloperidol.Methods: Fifty patients were selected randomly from psychiatric inpatient clinic in Erbil city in Iraqi Kurdistan Region between November 2007 and June 2008.All patients were diagnosed as schizophrenia, and none of them were in acute severe state. Thirty Schizophrenic patients received Haloperidol orally as typical antipsychotic and 20 patients received Olanazapine orally as atypical antipsychotic for a minimum of one month. Fasting blood samples for the assessment of serum malondialdehyde (MDA), lipid profile, fasting blood glucose (FBG) and prolactin levels were obtained after one month of the drug prescribing time. From those fifty patients, 16 patients were selected to follow them prospectively over a mean period of time of 112 days for olanzapine and 75 days for haloperidol. The prospective study includes FBG, lipid profile, BMI and serum MDA.Results: The prevalence of hyperprolactinaemia and lipid peroxidation was higher in Haloperidol treated patients. Whereas, the prevalence of diabetes and dyslipidaemia were higher in Olanazapine treated patients, The mean level of BMI of the Olanazapine group was significantly higher than BMI of the Haloperidol group. There was 6.66 % prevalence of DM in Olanazapine treated patients, but there was no prevalence of DM in Haloperidol treated patients. There was no incidence of diabetes mellitus in the prospective study for both Haloperidol and Olanazapine treated patients.Conclusions:No absolute evidence indicates that the atypical antipsychotic Olanazapine is the cause of diabetes, since the glucose levels of all patients were within normal range and there was no incidence of diabetes in the prospective study in spite of their higher weight and body mass index.

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