ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77379.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Hyperprolactinaemia is a common cause of ovarian dysfunction: infertility, amenorrhoea, oligomenorrhoea, menorrhagia, or regular menstruation with anovulation or a deficient luteal phase. Galactorrhoea occurs only in the minority of these patients, and its incidence depends upon the enthusiasm with which it is searched for by medical practitioners. On average, it appears to occur in between 20% and 30% of hyperprolactinaemic patients and, of all the patients with secondary amenorrhoea, some 30% appear to have hyperprolactinaemia. Bromocriptine, a dopamine receptor agonist, acts as a functional analogue of the prolactininhibiting factor of the hypothalamus directly on the pituitary cells to lower prolactin secretion, returning circulating prolactin levels to normal. Normalization of prolactin levels is associated with a prompt return of gonadal function to normal. Normal ovulatory menstruation returns rapidly, usually within two months of commencement of therapy, though occasionally longer intervals of up to seven months may be required. Responsiveness to clomiphene also returns. Clinical hypogonadism usually recurs if the drug therapy is stopped. Women with hyperprolactinaemic infertility are highly fertile while being treated with bromocriptine, but there is a danger of rapid enlargement of any pre–existing pituitary tumour when such patients become pregnant. Consideration must be given to primary therapy directed at any existing pituitary tumour before conception occurs. Bromocriptine is not teratogenic and, in the doses required to treat hyperprolactinaemia, side effects are usually encountered only at the start of treatment. Such initial side effects may be avoided by starting the therapy with low dosage and increasing it slowly to the usually effective dosage of from 5 mg/day to 7.5 mg/day, although higher doses may be required. In men, hyperprolactinaemia is usually associated with relative or absolute impotence, and only rarely with accompanying galactorrhoea. As in women, these symptoms disappear rapidly on lowering the prolactin levels with bromocriptine. The introduction of bromocriptine has heralded a major change in the management of the hyperprolactinaemia –hypogonadism syndromes and resulted in safer and easier treatment of many cases of infertility, menstrual disorders and, to a lesser extent, of impotence. Gonadotrophin therapy is now rarely indicated, and only when the pituitary gonadotrophin reserve is demonstrably reduced in the presence of normal or low circulating prolactin levels. At present, bromocriptine therapy is the treatment of choice for hyperprolactinaemia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77380.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Abnormal secretion of prolactin is amongst the many disorders of hormone secretion which have been proposed as potential causes for the common syndrome of premenstrual tension. Eight women suffering from this disorder participated in a five–month double–blind crossover trial of bromocriptine (5 mg per day) given in the luteal phase of the cycle. Significant improvement in most symptoms occurred during active as opposed to placebo therapy, together with objective evidence of a decrease in premenstrual weight gain and breast enlargement. This corresponds with the results of other studies which used bromocriptine in this dosage. The effect may be mediated by suppression of prolactin secretion, but could equally be a direct effect of bromocriptine.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77381.x

出版商:Wiley    

年代:1978

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77382.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Lactation occurs when the fully developed breast is released from the inhibitory influence which oestrogen and progesterone exert upon the action of prolactin. The use of oestrogens to suppress lactation depends on a continuation of the peripheral, that is, mammary, inhibition of prolactin. Androgens are also believed to act by inhibition of the action of prolactin on the mammary gland epithelium. Bromocriptine, when compared in a double–blind trial with orally administered methyl testosterone and placebo, gave almost complete relief of breast discomfort and congestion, though a small amount of milk production was seen. Methyl testosterone, in the dosage used in this study, was quite ineffective in suppressing lactation or breast symptoms.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77383.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

The response of Parkinsonism to three ergot derivatives which modify dopaminergic transmission was studied. cf 25‐397 behaved more as an antagonist than an agonist. Lergotrile was an agonist with therapeutic properties marred by prominent hepatotoxicity. Bromocriptine is an effective anti–Parkinsonian agent, particularly useful in patients with prominent dyskinesia or “on–off” reactions to levodopa; in most patients optimal results have been obtained by combining from 40 to 90 mg of bromocriptine daily with approximately 60% of the previous maximal dose of levodopa. Unfortunately, only some 50% of patients tolerate long–term bromocriptine therapy, but all adverse reactions have been dose dependent and reversible.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77384.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Twenty–two patients entered a double–blind trial to test the efficacy of bromocriptine therapy in patients with Parkinson's disease who were already stabilized on conventional L–Dopa therapy. Of these, three patients who were receiving placebo withdrew when no improvement occurred and control became complicated. Another four patients taking active drug withdrew because of side effects, but only in one case was the symptom (nausea and vomiting) thought to be a true effect of the drug. Of the 15 patients who completed the trial, nine were taking active drug and six took placebo. Although more than half the patients in each group were subjectively improved, measurement scales of functional disability and physical examination revealed no significant change in either group. Side effects encountered included nausea, dyskinesia, and hallucinations. It was concluded that bromocriptine does not offer any additional benefit to patients with Parkinson's disease who are stabilized on L–Dopa therapy, but may have a place in those patients who encounter side effects due to fluctuations in serum and tissue levels of L–Dopa.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77385.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Thirteen patients with Parkinson's disease, whose disability was increasing on long–term levodopa therapy (both with and without carbidopa), had the levodopa fully replaced by bromocriptine. At three months, eight of the 13 patients (62%) were less disabled on bromocriptine and none became worse. The present indications for the use of bromocriptine are discussed.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77386.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Eighty–seven patients with active acromegaly were treated with bromocriptine for periods of up to 42 months. On treatment. 82 of these patients noted a rapid alleviation of one or more symptoms of their disease. In 67 patients, the mean growth hormone level of four values taken through the day fell by 14 mu/L or more, or became undetectable. Eighty patients have been treated for over 12 months and this suppression was maintained. Improvement in abnormal glucose tolerance occurred in 25 out of 29 diabetics and tolerance became normal in 19. Bromocriptine is of great value in cases in which surgery or radiotherapy has not been completely effective or as interim treatment until the full effect of other therapy has taken place. However, the long–term effect of high doses of bromocriptine is not yet known.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77387.x

出版商:Wiley    

年代:1978

数据来源: WILEY

摘要:

Ten acromegalics, 6 females and 4 males, aged 24 to 75, have been treated with bromocriptine (CB). Six patients responded clinically to CB: two subsequently escaped control, three have been treated continuously for from 14 to 32 months, and one withdrew because of side effects. Four patients failed to respond: one at 60 mg/day, two at only 20 mg/day and the fourth at 5 mg/day when treatment was ceased because of side effects. Three patients had severe illnesses during treatment, and four patients were troubled by side effects. CB is useful in the treatment of acromegaly where other modalities are unsuitable.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1978.tb77388.x

出版商:Wiley    

年代:1978

数据来源: WILEY