Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called “hook effect”. Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience

Contamination des eaux souterraines et des sois par tes fluorures et leur impact à proximité des mines et d'usines d'exploitation des phosphates (Maroc)

Cette étude est une contribution à la connaissance hydrochimique du système aquifère existant à proximité des mines et d'usines d'exploitation des phosphates (Province de Khouribga, Maroc). Elle a pour objectif de mettre en évidence la pollution des eaux souterraines par les fluorures d'origine phosphatière. L'étude hydrochimique des eaux souterraines de la zone d'étude a permis d'apprécier la qualité des eaux souterraines et de mettre en évidence la contamination de ces eaux par les fluorures. La majorité des puits exploitant la nappe superficielle dépassent largement les normes de potadilité et ils sont à utiliser avec précaution en agriculture. La caractérisation physico-chimique des sols, montre que les teneurs en fluorures sont beaucoup plus importantes que celles existant dans l'eau, ceci est dû à l'accumulation des poussières fluorées. d'origine phosphatière, d'une année à l'autre. Les produits agricoles dans ces zones risquent d'être contaminés ce qui explique le développement de la fluorose, dans ces régions, malgré les faibles teneurs de fluorure dans les eaux d'alimentation. L'analyse statistique nous a permis de mettre en évidence les nuisances causées par les fluorures à l'environnement

Impacts négatifs d'une zone industrielle sur les eaux souterraines et sur le cheptel (Cas du Jorf Lasfar, Maroc) : approches pluridisciplinaires

International audienceDans la région étudiée, second pôle industriel du Maroc, les eaux souterraines représentent les seules ressources en eau pour l'alimentation quotidienne de la population rurale et pour l'abreuvement du cheptel. Les résultats des analyses physico-chimiques des eaux montrent que la majorité des puits suivis dépassent les normes de l'OMS relatives à la qualité de l'eau. En effet, la concentration des fluorures dans l'eau de ces villages varie de 0,24 à 4,3 mg/l, ce qui semble être à l'origine de la fluorose dentaire observée chez le bétail de cette région. Les résultats de l'enquête épidémiologique réalisée sur le cheptel montrent une forte contamination par les fluorures générés, en grande partie, par les industries des phosphates. Plusieurs facteurs sont déterminants dans cette contamination, à savoir : approvisionnement en eau, durée d'exposition, approvisionnement en aliments, proximité des industries,

Characterization of a flying ash stemming from the combustion of the coal

In this study, we were interested in the physic - chemical characterization (SEM, BET, X-ray, DTA-TG, and IR) of the flying ashes stemming of the combustion of the coal in the thermal power station of JORF-LASFAR in EL Jadida (Morocco). On the one hand, we deduce from this study that these flying ashes are belonging to the class F Fly ash (according to ASTM standards). The X-ray diffraction shows that the ashes are mainly constituted by the aluminosilicate and the quartz. The thermal analysis (DTA-TG), the IR, and SEM proves the presence of the carbonates of the calcium. On the other hand, after washing the ashes, with the distilled water, an equilibrium of adsorption - desorption of the carbonates was reached after 30 minutes

True Agonadism: Report Of A Case Analyzed With Y-specific Dna Probes.

We report on a 5-year-old girl with a male karyotype (46,XY), severe psychomotor and physical retardation, minor anomalies, and female external genitalia with a blindly ending vagina. She has normal adrenal function, prepubertal serum gonadotropin and testosterone levels, which did not rise after hCG stimulation. On abdominal exploration no gonads were found, and only mesonephric and Müllerian remnants. She was HY positive, and no deletion was detected in the Y chromosome using 5 different probes. Although a genetic defect is not excluded, pregnancy complications suggest an environmental insult to the developing testes.41444-

A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas

To evaluate the maternal–fetal outcomes of CAB-induced pregnancies in patients with prolactinoma in a large cohort.The prevalence of tumor growth, miscarriage, preterm, low birth weight, congenital malformations and impairment in neuropsychological development in children among women treated with CAB were assessed in a Brazilian multicentre retrospective observational study. We included 194 women with a mean age of 31 (17–45) years, 43.6% presenting microadenomas and 56.4% macroadenomas, at prolactinoma diagnosis. In 233 pregnancies, CAB was withdrawn in 89%, after pregnancy confirmation. Symptoms related to tumor growth occurred in 25 cases, more frequently in macroadenomas. The overall miscarriage rate was 11%, although higher in the subgroup of patients with CAB maintainance after pregnancy confirmation (38% vs. 7.5%). Amongst the live-birth deliveries, preterm occurred in 12%, low birth weight in 6% and congenital malformations in 4.3%. Neuropsychological development impairment was reported in 7% of cases. Our findings confirm previous results of safety in maternal and fetal outcomes in CAB-induced pregnancies; nevertheless, CAB maintenance after pregnancy confirmation was associated with higher miscarriage rate; result that must be further confirmed2312012

Controversial issues in the management of hyperprolactinemia and prolactinomas – An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called “hook effect”. Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience