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The presence of amenorrhea with galactorrhea, elevated prolactin levels, and a pituitary tumor does not always imply the diagnosis of a prolactinoma. Other pituitary disorders, including acromegaly, should be considered.
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Data collection related to farrowing performances and health parameters was performed in 20 intensive pig farms in Portugal (100-800 sows each) over 7 yr (1985-1992). At-risk profiles were obtained regarding the metritis-mastitis-agalaxia (MMA) syndrome. Using prospective surveys and subsequent preventive veterinary medicine programs in pig farms, the profile of 347 sows was analyzed by multidimensional statistical methods, and we demonstrated the value of risk-factor analysis to fight this enzootic problem. We observed a decrease in the prevalence of MMA syndrome, an increase in piglet survival and in the number of weaned piglets per sow, and a decrease in sow mortality rate. Our studies have shown the value of risk-factor analysis to fight enzootic disorders.
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Two cases with expanding pituitary tumours following treatment with 2-bromo-alpha-ergocryptine are presented. The lack of normal response to the usual therapeutic dose of the drug suggests the presence of an organic hypothalamo-pituitary disorder that might favour the expansion of a pituitary tumour.
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The effect of bromocriptine administration was studied in 34 patients, whose presenting symptoms included amenorrhoea, galactorrhoea, infertility, dyspareunia, delayed puberty, and impotence. Two patients were found to have raised plasma prolactin values during investigation for acromegaly. With the exception of three individuals all patients had hyperprolactinaemia. Pituitary fossa enlargement or asymmetry was reported in 16 patients and one patient had primary hypothyroidism. Virtually all patients complained of side effects when first starting bromocriptine but only two patients were unable to tolerate prolonged therapy with doses which ranged from 5--40 mg daily. A single oral dose of 2.5 mg resulted in a greater than 50% reduction in plasma prolactin within five hours in 22 of 26 patients. Over the course of one month, five patients with significant pituitary fossa enlargement appeared to show less rapid suppression of plasma prolactin than five patients without fossa enlargement. At two months this trend was still evident but eventually all patients showed acceptable control of plasma prolactin, with the exception of one patient who required pituitary surgery. Galactorrhoea ceased in 13 of 15 patients, menstrual periods resumed in ten of 13 patients, two patients becoming pregnant first. Potency returned and puberty proceeded in two hypogonadal males. Six of the nine patients requesting treatment for infertility became pregnant. It is concluded that bromocriptine provides effective treatment for galactorrhoea, amenorrhoea or gonadal disorders when there is associated hyperprolactinaemia.
The syndrome of hyperprolactinemia, galactorrhea, and amenorrhea is frequently caused by a pituitary tumor. Transsphenoidal surgical removal is often advocated for microadenomas, tumors smaller than 10 mm, to prevent the progression of these small adenomas into large tumors. Because no strong evidence indicates that microadenomas naturally progress to macroadenomas, we studied 25 women who had had hyperprolactinemia, amenorrhea, or galactorrhea for a mean duration of 11.3 years. Their mean initial prolactin level was 225 ng/mL (normal, less than 36 ng/mL). Of 22 patients presenting with amenorrhea, 7 resumed menses spontaneously. Galactorrhea resolved completely in 6 of the 19 patients with this disorder. Only 1 patient had progression of a sellar abnormality, and this was slight. Visual fields remained full in all patients, and basal adrenal and thyroid functions remained normal. The mean prolactin level was 155 ng/mL at the reevaluation (p less than 0.01, initial versus reevaluation levels). Hyperprolactinemia apparently has a benign clinical course in most women, and we advocate a conservative approach to management of this disorder.
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Four days after parturition 17 weeks old rats of Porton Wistar strain were given 8 mg/kg mercury as methylmercury chloride for 5 days. Virgin females or mothers separated from their offspring immediately after delivery received the same treatment and served as controls. Compared with these controls, lactation delayed the onset of weight loss, shortened the time between the end of treatment and the onset of weight gain, accelerated the elimination of mercury from the whole body and prevented the development of severe co-ordination disorders. However, lactation had no detectable effect on the elimination of mercury from the brain. Moreover control and lactating females had the same degree of histological abnormalities both in the granular layer of the cerebellum and in the dorsal root ganglion cells.
BACKGROUND: L-Lactate has been used as a prognostic indicator for ill humans and animals. A portable analyzer that measures L-lactate could help veterinarians decide to proceed with correction of a displaced abomasum. HYPOTHESES: The likelihood of a dairy cow with a displaced abomasum remaining in the herd can be predicted by lactate concentration and other variables. ANIMALS: Thirty-four healthy early-lactation dairy cows, and 131 cows with abomasal displacements (DA) presented to Cornell University, Ithaca, NY. METHODS: Plasma L-lactate was measured using a commercial analyzer (i-STAT). A cow had a positive outcome (PO) if she remained in the herd 30 days after surgical correction of the displaced abomasum and a negative outcome (NO) if she was culled or died in that time. A multivariable model with physical examination and clinicopathologic variables for predicting NO for cows with right-sided abomasal displacements was constructed. RESULTS: The median plasma L-lactate was 0.54 mM/L (interquartile range, 0.42-0.74) in healthy lactating Holstein cows. In cows with right-sided displaced abomasa, median plasma L-lactate concentrations were higher in cows with NO (5.88 mM/L) versus PO (3.23 mM/L) (P = .002). In a multivariable model, which identified chloride, heart rate, and L-lactate as the best fitting variables for cows with right-sided displacements, the probability of NO increased as L-lactate increased. CONCLUSIONS AND CLINICAL IMPORTANCE: Plasma L-lactate concentration might be a useful predictor of productive outcomes in cows with right-sided abomasal disorders.
The amenorrhea-galactorrhea syndrome in prolactin-secreting pituitary tumors is described. The role of prolactin in the development of amenorrhea and galactorrhea is discussed along with the other endocrine abnormalities that overproduction of prolactin may cause. The diagnostic tests that are commonly performed to identify this disease entity are presented with reference to the nurse's role in preparing patients for the diagnostic work-up. Recent advances in transsphenoidal surgery, radiotherapy, and the use of Bromocriptine as therapeutic modalities for this disorder are described. Nursing guidelines that accompany planning care for patients undergoing these treatment regimes are provided.
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Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.
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