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Prolactinoma
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Management depends on the size of adenoma:Microadenoma (<1 cm): Consider stopping dopamine agonist in pregnancy, especially if normal pre-pregnancy prolactin and stable microadenoma >2 years. During the pregnancy, the woman should be asked about headaches and changes in vision at each visit (at least every three months). The decision to treat with dopamine agonist is based on symptoms (e.g., headache) and signs (e.g., abnormal visual field examination) only. Prolactin levels should not be checked since they physiologically (10-fold) increase in pregnancy.Macroadenoma (≥1 cm): Dopamine agonist should be continued. Other experts suggest consideration for stopping dopamine agonist with macroadenoma within the sellar boundaries. Monitoring as per microadenoma, plus formal visual field testing every 3 months. Transsphenoidal surgery suggested usually only if maximal dopamine agonist therapy is ineffective.
Network Meta-Analysis
Published in Ding-Geng (Din) Chen, Karl E. Peace, Applied Meta-Analysis with R and Stata, 2021
The second study is a meta-analysis review of seven clinical trials, which investigated four dopamine agonists compared with a placebo group as adjunct therapy for treating Parkinson’s diseases. The four dopamine agonists are Ropinirole, Pramipexole, Bromocriptine, and Cabergoline. Each clinical trial in the meta-analysis compared any two dopamine agonists or any one dopamine agonist and the placebo group. The outcome measured in all seven clinical trials is mean “off-time” reduction among Parkinson’s disease patients. “Off-time” is the term used for the days when a medication for treating Parkinson’s disease is not working well.
Pharmacological Management of Parkinson’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Newman Osafo, Samuel Obeng, David D. Obiri, Oduro K. Yeboah, Leslie B. Essel
The most significant adverse effects seen with apomorphine therapy are nausea and vomiting (almost 73% of patients), which can be attenuated by administration of domperidone before apomorphine therapy. Neuropsychiatric adverse effects, however, are associated with long-term use, but with a lower incidence than with other dopamine agonists (Frankel et al., 1990). Long term use have been associated with significant increase, about 67%, in the mean daily duration of dyskinesia compared with placebo (Ostergaard et al., 1995).
Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome?
Published in Gynecological Endocrinology, 2023
Nafiye Yilmaz, Pinar Gulsen Coban, Saynur Yilmaz, Hasan Ali Inal, Hakan Timur, Hacer Haltas
According to the American Society for Reproductive Medicine, there is good evidence that dopamine agonist administration starting at the time of hCG trigger reduces the incidence of OHSS [21]. However, in the majority of important human clinical studies assessing the effect of cabergoline, the reported evidence was not of high quality in terms of implantation rates, pregnancy rates or miscarriage rates. A review study of 858 women undergoing ART postulated that cabergoline was unlikely to affect clinical pregnancy, although the evidence was low-quality (RR 1.02, 95% CI 0.78–1.34, p = 0.86) [22]. In a Cochrane data analysis involving 16 randomized controlled trials, clinical pregnancy rates were comparable between placebo and intervention groups, the evidence being of moderate quality, although that analysis included not only cabergoline but also other two types of dopamine agonist (bromocriptine and quinagolide) (OR 0.81, 95% CI 0.54 to 1.22) [23].
Recent advances in treatment of spatial neglect: networks and neuropsychology
Published in Expert Review of Neurotherapeutics, 2023
Finally, the evidence for pharmacological neuromodulation suggests that some patients might benefit from a dopamine agonist given alone or in combination with their activity-based therapy. Neurology has a long history of using numerous medications in an off-label manner safely and successfully. In addition, for medications already long in use, a new indication for the amelioration of SN seems highly unlikely. Therefore, the use of a dopamine agonist should be considered with the understanding that some patients may have an adverse reaction not unlike the development of a cough in response to initiating lisinopril or a myopathy in response to a statin. Appropriate monitoring remains a standard part of all good clinical care. Regarding the cholinergic and serotonergic axes, it will be important to systematically assess their impact on neglect measures in prospective studies or in retrospective chart reviews of large numbers of patients.
Pituitary apoplexy of a giant prolactinoma during pregnancy
Published in Gynecological Endocrinology, 2021
Safa Khaldi, Ghada Saad, Hamza Elfekih, Asma Ben Abdelkrim, Taieb Ach, Maha Kacem, Molka Chaieb, Amel Maaroufi, Yosra Hasni, Koussay Ach
Prolactinomas are the most frequent type of pituitary adenoma in women and they represent a common cause of anovulation and female infertility [1]. Giant prolactinomas are a subset of macroadenomas, accounting for only 2–3% of prolactinomas [2]. They are defined as prolactinomas greater than 4 cm in size [2]. They are associated with prolactin (PRL) levels >1000 ng/mL and typically result in clinical symptoms such as galactorrhea or mass effects [3]. Although prolactinomas are benign, giant ones are often locally aggressive, invading surrounding structures [3]. These tumors are extremely rare in women with a male: female ratio of 9:1 [4]. This is usually attributed to early detection of the disease, easily identified by endocrine symptoms in women [3]. Cabergoline is currently the treatment of choice for symptomatic prolactinomas since it has higher efficacy in normalizing PRL levels and in decreasing tumor size [5]. Restoration of gonadal function and the occurrence of pregnancy raise two questions: What will be the effect of pregnancy on tumor growth? What will be the effect of dopamine agonists on fetal development and pregnancy outcomes? The answers are few given the limited number of cases reported in the literature. Our clinical case of a young woman with a giant prolactinoma, confirmed histologically, with restoration of fertility is the fourth case reported in the literature to the best of our knowledge [6–8].