136 research outputs found
Current treatment issues in female hyperprolactinaemia
No full textHigh prolactin levels can occur as a physiological condition in females who are pregnant or lactating. As a pathological condition, hyperprolactinaemia is associated with gonadal dysfunction, infertility and an increased risk of long-term complications including osteoporosis. The most frequent cause of persistent hyperprolactinaemia is the presence of a micro- (<10 mm diameter) or macroprolactinoma (≥10 mm). These pituitary tumours may produce an excessive amount of prolactin or disrupt the normal delivery of dopamine from the hypothalamus to the pituitary; prolactin secretion from the pituitary is inhibited by dopamine released from neurones in the hypothalamus. Medications including anti-psychotics can induce hyperprolactinaemia, while idiopathic hyperprolactinaemia accounts for 30–40% of cases. The prevalence of hyperprolactinaemia is difficult to establish as not all sufferers are symptomatic or concerned by their symptoms and may remain undiagnosed. Symptoms of hyperprolactinaemia include signs of hypogonadism, with oligomenorrhoea, amenorrhoea and galactorrhoea frequently observed. Pharmacological intervention should be considered the first line therapy and involves the use of dopamine agonists to reduce tumour size and prolactin levels. Bromocriptine has the longest history of use and is a well-established, inexpensive, safe and effective therapy option. However, bromocriptine requires multiple daily dosing and some patients are resistant or intolerant to this therapy. The two newer dopamine agonists, quinagolide and cabergoline, provide more effective and better tolerated treatments compared with bromocriptine and may offer effective therapies for bromocriptine-resistant or intolerant patients. Quinagolide can be used until pregnancy is confirmed and may result in improved compliance in females wishing to become pregnant. For patients with hyperprolactinaemia, pregnancy is safe and can frequently be beneficial, inducing a decrease in prolactin levels. There does not appear to be any increased risk of abortion, malformations or multiple births in pregnancies achieved with bromocriptine and this dopamine agonist can be used safely during pregnancy. Surgery should be considered only in certain circumstances, and for the majority of patients, dopamine agonists will be sufficient to alleviate symptoms and restore normal prolactin levels
Conservative surgery for severe endometriosis: should laparotomy be abandoned definitively?
No full textAccording to current opinion, surgery at laparotomy for conservative treatment of endometriosis is obsolete. The debate on the indications, modalities and results of surgical treatment for the most severe forms has recently been rekindled. Although some expert endoscopists propose advanced techniques to deal with the most problematic pelvic lesions, various authors wonder if such interventions have been demonstrated as efficacious and safe enough to justify abandoning the standard reference treatment. We have reviewed the data, comments and proposals recently published on the topic. The available scientific evidence appears insufficient to recommend laparoscopy instead of surgery at laparotomy, even for the most severe forms of endometriosis. Intestinal, vesical, periureteral, retroperitoneal, and vaginal lesions and large endometriomas associated with extensive dense adhesions may still benefit from classical surgery at laparotomy. However, the lack of comparative studies prevents a correct comparison of the methods in terms of pregnancy rate, resolution of pain and incidence of recurrences
Should endometriomas be treated before IVF-ICSI cycles?
No full textThe laparoscopic excision of ovarian endometriomas appears to increase the chances of spontaneous conception, but
the value of this treatment in women selected for IVF–ICSI cycles is debated. Studies recruiting women with unilateral
disease and comparing ovarian responsiveness in the affected and contralateral intact gonads indicate that excision
of endometriomas is associated with a quantitative damage to ovarian reserve. There are no randomized trials
comparing laparoscopic excision to expectant management before IVF–ICSI cycles. The idea that surgery increases
IVF pregnancy rates is not supported by the available evidence. However, the chance of conception is not the only
issue that has to be considered. Some potential drawbacks are associated with both therapeutical strategies. Specifically,
costs and hazard of surgical complications support expectant management whereas oocyte retrieval risks, the
possibility of missing occult malignancy and endometriosis progression due to ovarian stimulation would favour surgical
treatment. Alternative therapeutical options include medical treatment and ultrasound-guided aspiration.
Whereas prolonged GnRH agonist down-regulation may be beneficial, data on ultrasound aspiration are more
controversial
Mutations in the coding region of the FOXL2 gene are not a major cause of idiopathic premature ovarian failure
No full textPremature ovarian failure (POF) is a heterogeneous disorder whose aetiology is
still unknown. Recently, the autosomal FOXL2 gene, highly expressed in the adult
ovary, has been correlated with the disorder. FOXL2 mutations, causing a
truncation of the FOXL2 protein in the forkhead domain or in the poly-Ala tract
lead to blepharophimosis-ptosis-epicanthus-inversus syndrome associated with POF
(BPES I). Interestingly, in two out of 70 idiopathic POF patients, a 30 bp
deletion (898-927del) and a missense mutation (1009T-->A) were identified. To
further evaluate the correlation between POF and FOXL2 mutations, 120
phenotypically normal women affected by POF were analysed by direct sequencing
of the FOXL2 coding region. The analysis did not reveal any mutation in the 240
analysed chromosomes, indicating that mutations in the FOXL2 coding region are
rarely associated with non-syndromic PO
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