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During one year we studied the acid-base state in the milking cows trying to solve the relationship between the secretion disorders and feeding. THe results confirm that exist a link between the acid-base state and the disorders. These disorders are connected to problems of alimentation. In our experiments it had been possible to observe a change in pH of blood versus alkalosis.
The authors infused 45 control subjects with sodium lactate. Eight of 10 subjects with lactate-induced panic attacks and 26 of 35 without panic attacks were interviewed. An investigator, blind to the outcome of the infusion study, obtained family histories of 160 relatives. There was a high prevalence of anxiety disorders among first-degree relatives of subjects with panic attacks. There was no significant difference in the prevalence of mood disorders and substance abuse between first-degree relatives of subjects with (N = 45) and without (N = 115) panic attacks. The results suggest that individuals with a family history of anxiety disorders may be vulnerable to lactate-induced panic attacks.
Using spectral analysis of the continuous time series signal before and during lactate and placebo infusions, the authors studied heart rate variability in six patients with panic disorder and nine normal comparison subjects. The decrease in high-frequency (0.20-0.50 Hz) power and the increase in sympathovagal ratios (mid-frequency [0.07-0.15 Hz] to high-frequency powers) after the administration of intravenous sodium lactate were significantly greater in the patients than in the normal subjects after correction of the values for the amount of lactate infused. This result suggests an exaggerated cardiac vagal withdrawal in patients with panic disorder during lactate infusions.
Function of the hypothalamo-hypophyseal-adrenal system was investigated in 23 patients with different types of the lactorrhea-amenorrhea syndrome. The basal levels and "stress secretion" of ACTH, cortisol and cyclic nucleotides, the circadian rhythm of ACTH and cortisol levels were determined by RIA. Noticeable disorders in the central and peripheral factors of this system and changes in the blood levels of cyclic nucleotides were observed in patients with the lactorrhea-amenorrhea syndrome.
In 8 patients aged from 17 to 48 years (average age 32,6 years) with normoprolactinemic galactorrhea a stimulation test with GnRH-TRH or arginine-GnRH-TRH was performed. The basal and stimulated serum levels of LH, FSH, PRL, TSH, HGH and total thyroxine (T4), the thyroxine binding capacity (TBC) and the free thyroxine index (FT4-I) were determined. -In a few cases there were disturbances of both the basal and the stimulated serum levels of the hormones. -Both the menstrual disorders which were seen in all patients with galactorrhea and the hormonal disturbances are discussed in context of an hypothetical increase of the PRL receptor sensibility in face of normal PRL serum levels or as a hint at a transient hyperprolactinemia.
A case of galactorrhea immediately following a reduction mammaplasty is presented. Prolactin levels were elevated postoperatively and could be reduced to normal by a prolactin inhibitor. No other disease or disorder could be found. Based on a review of the literature, it seems that various factors have to contribute to galactorrhea, including stress-related prolactin secretion, rebound phenomenon after discontinuation of birth control pills, and hypersensitivity to prolactin receptors. Their coincidental occurrence, resulting in abundant milk production after surgery, is discussed.
Idiopathic PRL deficiency was detected in a parturient woman with otherwise normal pituitary function. This PRL disorder first became manifest postpartum when she had no milk production, and oral metoclopramide failed to raise her serum PRL levels. Her second pregnancy occurred spontaneously after 3 yr of attempts to conceive. During the pregnancy, her serum PRL concentration was very low, varying from 4.5-7.8 ng/ml, and the puerperium was again characterized by alactogenesis. During normal menstrual cycles and after iv GnRH, TRH, metoclopramide, and insulin tolerance tests, serum PRL was only rarely detectable by RIA, at very low concentrations. Bioassay results confirmed the PRL deficiency. The results confirm that PRL is necessary for puerperal lactation and suggest that it is needed for normal ovarian function. The present data also suggest that the maternal pituitary is the main source of serum PRL during pregnancy, and the decidua has only a minor contribution in this respect.
A 19-year-old woman presented with a unique constellation of endocrinopathies, including Cushing's disease, post-partum galactorrhea, hypothalamic hypothyroidism and hypothalamic amenorrhea. There was no evidence of granulomatous or neoplastic disease in pituitary or hypothalamus. The potential role of excess glucocorticoids and disturbances in normal hypothalamic regulation of anterior pituitary function in the pathophysiology of this syndrome is discussed.
Prolactin levels were measured by radioimmunoassay in paired breast milk and plasma samples of 11 hyperprolactinemic women with galactorrhea and various menstrual disorders (amenorrhea, n = 8; oligomenorrhea, n = 2; luteal phase defect, n = 1) before and during treatment with bromocriptine (Parlodel, Sandoz). Pretreatment levels of prolactin in the milk and plasma were 80 +/- 13 ng/mL (mean +/- SEM) and 47 +/- 7 ng/mL (P less than 0.05), respectively. While on treatment, the concentration gradient for prolactin remained in favour of the milk, with values for milk and plasma 59 +/- 11 and 29 +/- 3 ng/mL (P less than 0.01), respectively. Thus, bromocriptine lowered the prolactin concentrations in both breast milk and plasma. Since prolactin in milk is biologically active, these findings may be relevant to the initiation and maintenance of lactation in women with abnormal lactogenesis.
The response to bromocriptine therapy of 12 infertile women with ovulatory dysfunction and euprolactinemic galactorrhea was studied. Four of the subjects had anovulation, four had oligo-ovulation, and four had delayed ovulation. Serum PRL levels in all 12 subjects were less than 20 ng/ml. Normal ovulation occurred at least once in all of the patients on bromocriptine therapy and in 38 of 41 (92%) of the cycles. Seven patients (58%) conceived promptly with bromocriptine therapy, and all subjects had cessation of galactorrhea within 1 month of the onset of therapy. The seven pregnancies included five normal term vaginal deliveries, one premature vaginal delivery, and one tubal pregnancy. The results of this study should be considered preliminary but suggest that the presence of euprolactinemic galactorrhea in patients with ovulatory dysfunction may still represent a covert disorder of PRL physiologic factors. The prompt correction of these ovulation disturbances gives supporting evidence for this hypothesis and suggests that a short trial of bromocriptine therapy may be warranted after minimal blood sampling. The differential outcome between our group of patients produces further evidence that variable mechanisms may be operative.
When caffeine (1,3,7-trimethylxanthine) was introduced into the diet of rats throughout pregnancy and lactation at levels of consumption of 10 mg/kg/day, offspring of successive pregnancies showed growth reductions. This finding was not accompanied by teratogenic effects. However, following four pregnancies severely reduced offspring growth and neonatal mortality was demonstrated. The birthweights of these offspring were 72.5% of control. This study mimicked the mode of intake and quantities of caffeine consumed in many societies.
The therapeutic activity of bromocriptine mesilate (CB 154) was studied in a coooperative trial over a period of three months and using the same protocol in eleven different centres. 126 women and 9 men were studied. All had hyperprolactinaemia associated either with gonadal insufficiency-amenorrhoea/galactorrhoea syndrome (102 cases), isolated amenorrhoea (8 cases), impotence (6 cases), or to galactorrhoea with in certain men gynaecomastia. 32 patients had previously undergone removal of a pituitary adenoma, but had a normal response to the administration of LH-RH. Of the 106 untreated patients, only 36 had tumour-like deformities of the sella turcica. Under the effects of treatment, blood prolactin levels fell in all cases exception 4 and returned to normal in 66% of patients. The average value fell from 197 +/- 19 to 36.8 +/- 3.4 ng/ml (p less than 0.001). Spontaneous and provoked galactorrhoea regressed in 100% and 75% of cases respectively. Ovarian function reappeared in 89.4% of cases, with 32 pregnancies occurring during the 3 months period. Gynaecomastia and impotence responded in approximately half the men. The effectiveness of treatment was independent of the duration of the disorder (ranging from a few months to five years), the initial prolactin level and the radiological state of the sella turcica. Tolerance was satisfactory apart from transient problems (essentially digestive) occurring during the first days of treatment. In case of pregnancy, careful repeated studies of the sella turcica and visual fields are needed in order to detect possible growth of underlying pituitary adenomas or micro-adenomas.
Three adolescent males presented with nipple discharge. In two boys, the expressed secretion was clinically consistent with galactorrhea. Galactorrhea/breast discharge is a rare complaint in males of any age. Although galactorrhea is commonly associated with a neuroendocrine disorder or drug ingestion, the work-up in each, including basal prolactin level, was normal. Reluctantly, each by admitted to breast self-manipulation to reduce gynecomastia. When the behavior was discontinued, the galactorrhea/breast secretion ceased. Clinicians should be aware of this heretofore undescribed and apparently benign phenomenon. If basal hyperprolactinemia is absent in a male with a breast discharge and a history of breast manipulation, then an extensive work-up is not usually indicated.
The nonspecific systems of the brain and their role in neuroendocrine regulation were studied and the nature of some neuroendocrine and metabolic disorders was specified. Examination of 41 women with the hypothalamic syndrome showed that they had ergotrophic insufficiency expressed both in the specific hypothalamus-pituitary system (hyperprolactinemia) and in nonspecific systems (deficiency of the activation systems of the brain sympathetic activity at the periphery and the emotional syndrome), which suggests the deficit of dopamine not only in the tuberoinfundibular but also in mesolimbic systems.
Mature, healthy lactating dairy cattle were sampled on two farms in the southwestern United States to examine the effects of heat stress (Experiment I) and stage of lactation (Experiment II) on the fecal shedding of E. coli O157:H7 and Salmonella. To examine the effects of heat stress, fecal samples were collected from 45 cows at 7:00 AM (coolest part of the day) and 5:00 PM (hottest part of the day) in August 2002 on a 250 cow dairy. The study was replicated one month later (n = 170 total samples). A temperature-heat index (THI) was calculated for each sampling time. In Experiment II, stage of lactation was examined by sampling lactating dairy cattle early [< 60 days in milk (DIM)] and late (> 150 DIM) in the lactation cycle in the summer of 2001. The study was replicated the following summer (60 cows/group/replicate; n = 240 total samples). For Experiment I, THI averaged 75 and 82 for the AM and PM samplings, respectively, indicating the cows were beginning to experience heat stress in the morning and by afternoon were in severe heat stress. The shedding of E. coli O157:H7 tended to be higher (p = 0.09) in the afternoon sampling of the first replicate, however was not different in the second replicate or when both replicates were pooled (p > 0.10). Salmonella shedding was not different (p > 0.10) at any sampling time with nearly 100% of the cows positive. Stage of lactation had no effect on the number of cows shedding E. coli O157:H7 (p > 0.10). Salmonella shedding tended to be higher (p = 0.09) in early lactation cows in the first replicate, while in the second replicate more late lactation cows were shedding Salmonella (p < 0.05); however, there were no differences due to stage of lactation when replicates were pooled (p > 0.10). While further research is needed, results of this research highlight the variability in pathogen shedding in healthy dairy cattle and indicate that environmental factors and/or production demands may influence shedding patterns of E. coli O157:H7 and Salmonella.
A TRH-test was performed in 305 normoprolactinemic patients with gynecological disorders in order to appreciate the possible relationship between luteal defect, anovulation, galactorrhea and prolactin. The basal prolactin mean values of each group (normal cycle, pure luteal defect, luteal defect with persistent estrogenic influence, anovulation: with or without galactorrhea) were not different. However, some patients with luteal defect with persistent estrogenic influence and galactorrhea had an exaggerated response to TRH, and women with oligomenorrhea or amenorrhea had a low one. Unapparent hyperprolactinemia appears infrequent in normoprolactinemic patients.
Nonpuerperal alactorrhea and amenorrhea have been reported following the use of oral contraceptives. Treatment of this condition with ergot alkaloids has proved to be of great therapeutic value. Pretreatment plasma hLH and hFSH concentrations in 13 women with postqill galactorrhea-amenorrhea (PPGA) were 6.6 plus or minus 0.6 (SE.) and 5.0 plus or minus 0.8 mlU/ml, respectively. The mean prolactin concentration was 80.7 plus or minus 13.2 ng/ml. After complete evaluation in which diagnostic evidence of pituitary tumor was absent, the patients were treated with ergocryptine (CB-154). The mean hPRL concentration at 14 days of therapy was 7.8 p;us or minus 1.9 ng/ml. Cyclic gonadotropin secretion resumed in all but one instance; ovulation was confirmed on the basis of a biphasic temperature chart and in 5 cases, endometrial biopsy. Measurement of serum dopamine-beta-hydroxylase (DBH) activity indicated a significant decline at the end of 8 weeks of CB-154 therapy. The fall in hPRL was not necessarily associated with a fall in DBH. The majority of women in this study exhibited a consistent personality suggesting varying degrees of anxiety unrelated to the PPGA and usually antedating the use of oral contraceptives. PPGA was found in women without hyperprolactinemia, but altered hPRL secretion was evident in all instances. The data suggest that the disorder of cyclic gonadotropin secretion is related to altered hPRL secretion, but the mechanism is possibly related to a catecholamine abnormality. The data support the presence of an inherent cyclic mechanism for the secretion of gonadotropins. CB-154 therapy does not affect conception, and no teratogenic effects were observed in 2 infants born to women who had received CB-154 during the first 40 days of gestation.
The degree of autonomy in prolactin secreting pituitary adenomas and also prolactin secretory reserve in cases with suspected functional galactorrhea syndrome was evaluated with the use of metoclopramide, TRH and L-DOPA. It was found that in patients with pituitary adenoma the basal prolactin (PRL) level often exceeded 150 micrograms/l and the response to stimulation with TRH and/or metoclopramide was markedly diminished or even nonexistent, while the response to L-DOPA was usually retained. In patients with galactorrhoea and/or amenorrhoea, with normal skull X-ray the basal PRL level was either normal or moderately raised but the response to stimulation was various; mostly it was excessive, it was sometimes normal, but in some other cases it was markedly diminished as in patients with adenoma. In the author's opinion the so-called "functional disorder" of prolactin secretion is mainly hyperresponsiveness to stimulation, whereas the basal PRL level in those cases is usually normal or only intermittently raised. In the cases with a moderate hyperprolactinaemia, especially if it appears to be constant, and the response to stimulation is diminished or none at all, we suspect a pituitary microadenoma. Finally, there are rare cases of galactorrhoea with normal basal PRL and normal response to stimulation, in which the sensitivity of the mammary PRL receptor is probably increased. We suggest therefore that the above mentioned PRL stimulation tests may help in distinguishing between tumoural and functional hyperprolactinaemia.