We report two rare cases of spontaneously regressed Rathke's cleft cyst (RCC). A 52-year-old woman presented with headache. A pituitary hormone study was normal. Brain magnetic resonance imaging (MRI) showed a 0.45-cm³ cystic sellar lesion. The cyst was hyperintense on T1-weighed imaging and hypointense on T2-weighted imaging without rim enhancement, comparable to a RCC. Six months later, brain MRI showed no change in the cyst size. Without any medical treatments, brain MRI 1 year later revealed a spontaneous decrease in cyst volume to 0.05 cm³. A 34-year-old woman presented with headache and galactorrhea lasting 1 week. At the time of the visit, the patient's headache had disappeared. Her initial serum prolactin level was 81.1 ng/mL, and after 1 week without the cold medicine, the serum prolactin level normalized to 11.28 ng/mL. Brain MRI showed a RCC measuring 0.71 cm³. Without further treatments, brain computed tomography 6 months later showed a spontaneous decrease in cyst volume to 0.07 cm³. Another 6 months later, brain MRI revealed that the cyst had remained the same size. Neither patient experienced neurological symptoms, such as headache or visual disturbance, during the period of cyst reduction. The RCCs in both patients underwent spontaneous regression without any medical treatment during a period of 6 months to 1 year. Although spontaneous regression of a RCC is rare, it is still possible and a sufficient follow-up period should be considered.
Adult ; Brain ; Central Nervous System Cysts ; Female ; Follow-Up Studies ; Galactorrhea ; Headache ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Regression, Spontaneous ; Pregnancy ; Prolactin

Galactorrhea, as an adverse effect of psychotropic medications, usually develops due to high dose of antipsychotics. Selective serotonin reuptake inhibitors (SSRIs) have also been reported to be related to galactorrhea. To the best of our knowledge, no previous study reported galactorrhea with methylphenidate (MPH) use. Hereby, we report a case of an adolescent girl who developed galactorrhea after increasing his modifed-release oral MPH to 50 mg/day while under treatment of sertraline and very low dose haloperidol.
Adolescent* ; Antipsychotic Agents ; Female ; Galactorrhea* ; Haloperidol ; Humans ; Methylphenidate* ; Pregnancy ; Serotonin Uptake Inhibitors ; Sertraline

Venlafaxine is a serotonergic and noradrenergic reuptake inhibitor which is used for the treatment of depression. We report a case of galactorrhea in a patient with major depressive disorder after starting treatment with venlafaxine. In particular, we discuss the course of hyper and normoprolactinemic galactorrhea. We managed this side effect initially by dose reduction and further by switching to essitalopram. Physicians should be aware of endocrinologic side effects such as galactorrhea during the serotonin and noradrenaline reuptake inhibitor treatment.
Depression ; Depressive Disorder, Major ; Female ; Galactorrhea* ; Humans ; Norepinephrine ; Pregnancy ; Prolactin ; Serotonin ; Venlafaxine Hydrochloride*

PURPOSE: The purpose of this study was to retrospectively investigate the reliability of breast ultrasound (US) Breast Imaging Reporting and Data System (BI-RADS) final assessment in mammographically negative patients with pathologic nipple discharge, and to determine the clinical and ultrasonographic variables associated with malignancy in this group of patients. METHODS: A total of 65 patients with 67 mammographically negative breast lesions that were pathologically confirmed through US-guided biopsy were included. RESULTS: Of the 53 BI-RADS category 4 and 5 lesions, eight (15.1%) were malignant (six ductal carcinomas in situ, one invasive ductal carcinoma, and one solid papillary carcinoma). There was no malignancy among the remaining 14 category 3 lesions. Malignant lesions more frequently displayed a round or irregular shape (75.0%, 6/8; p=0.030) and nonparallel orientation (33.3%, 4/12; p=0.029) compared to the benign lesions. The increase in the BI-RADS category corresponded with a rise in the malignancy rate (p=0.004). CONCLUSION: The BI-RADS lexicon and final assessment of breast US reliably detect and characterize malignancy in mammographically negative patients with pathologic nipple discharge.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Female ; Galactorrhea ; Humans ; Information Systems ; Mammography ; Nipples* ; Pregnancy ; Retrospective Studies ; Ultrasonography*

While fluoxetine (FXT) is a frequently prescribed selective serotonin reuptake inhibitor (SSRI), with few major side-effects; altered serotonergic transmissions in hypothalamic pathways might lead to a distressing, and often embarrassing, manifestation of galactorrhea by altering prolactin release in those on FXT. We report here a case of FXT-induced hyperprolactinemic galactorrhea developing late into treatment on a stable regimen, who responded well to subsequent replacement with sertraline. Based on present finding, we suggest that while SSRIs may share similar mechanisms of action, there exist individual differences in their effects on prolactin secretion pathways.
Female ; Fluoxetine* ; Galactorrhea* ; Hyperprolactinemia ; Individuality ; Obsessive-Compulsive Disorder* ; Pregnancy ; Prolactin ; Secretory Pathway ; Serotonin ; Serotonin Uptake Inhibitors ; Sertraline

OBJECTIVETo assess the efficacy and safety of Wuji Powder (WP) and a small dose aripiprazole in treatment of antipsychotic drug-induced phlegm dampness type amenorrhea.

METHODSSeventy female schizophrenic patients with antipsychotic drug-induced galactorrhea-amenorrhea syndrome (GAS) were recruited and randomly assigned to the treatment group and the control group, 35 in each group. All patients received antipsychotic drug therapy. Patients in the treatment group additionally took WP, while those in the control group took aripiprazole (at the daily dose of 5 mg, once daily). The therapeutic course for all was 4 weeks. Prolactin levels and obesity indices[body weight, waist aircumstance, body mass index (BMI) and waist-hit ratio (WHR)] were determined before and after treatment. The efficacy was evaluated.

RESULTSThe treatment course was completed in 95.71% of patients. The total effective rate of the 33 patients of the treatment group was 93.94% (31/33), while it was 91.18% (31/34) in the 34 patients of the control group. There was no difference in the total effective rate between the two groups (P > 0.05). Prolactin levels in both group after treatment were significantly lower than those of the baseline (P < 0.01). There was no significant difference in prolactin levels between the two groups after treatment (P > 0.05). Compared with before treatment, body weight, BMI, waist circumstance, and waist-hip ratio obviously decreased after treatment, showing significant difference when compared with the control group (P < 0.05). There was no significant difference in body weight, BMI, waist circumstance, and waist-hip ratio in the control group between before and after treatment (P > 0.05).

CONCLUSIONSBoth WP and aripiprazole could lower high prolactin levels of schizophrenics with phlegm dampness type amenorrhea. They showed equivalent efficacy. But WP showed more obvious effect in reducing obesity indices.

Aged ; Amenorrhea ; drug therapy ; Antipsychotic Agents ; administration & dosage ; adverse effects ; therapeutic use ; Aripiprazole ; Body Mass Index ; Body Weight ; Drug Therapy, Combination ; methods ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Galactorrhea ; drug therapy ; Humans ; Obesity ; Piperazines ; administration & dosage ; adverse effects ; therapeutic use ; Quinolones ; administration & dosage ; adverse effects ; therapeutic use ; Waist-Hip Ratio

PURPOSE: To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-five patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. RESULTS: Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing's disease). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing's disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation. CONCLUSION: EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.
Academic Medical Centers ; Acromegaly ; Adenoma ; Amenorrhea ; Cavernous Sinus ; Cranial Nerves ; Dementia ; Dizziness ; Female ; Follow-Up Studies ; Galactorrhea ; Gynecomastia ; Headache ; Humans ; Hypopituitarism ; Korea ; Libido ; Magnetic Resonance Imaging ; Male ; Medical Records ; Menstruation ; Multivariate Analysis ; Pituitary Neoplasms ; Pregnancy ; Protons ; Radiosurgery ; Recurrence ; Retrospective Studies ; Stroke ; Unconsciousness ; Vision Disorders

Although selective serotonin reuptake inhibitors (SSRIs) have been widely used in both psychiatry and other medicine, few cases have been reported SSRI-related hyperprolactinemia and/or galactorrhea. We experienced one case which showed both galactorrhea and hyperprolactinemia following treatment with paroxetine. In the case, a 37-year-old multiparous woman reported galactorrhea after 8-weeks paroxetine treatment for her depression. After 1 month prescription of bromocriptine, dopamine agonist, as well as switching medication from paroxetine to venlafaxine, serotonin-norepinephrine reuptake inhibitor, both galactorrhea and hyperprolactinemia were disappeared. Both hyperprolactinemia and galactorrhea have not been observed even after the cessation of bromocriptine prescription.
Adult ; Bromocriptine ; Cyclohexanols ; Depression ; Dopamine Agonists ; Female ; Galactorrhea ; Humans ; Hyperprolactinemia ; Paroxetine ; Pregnancy ; Prescriptions ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride

Escitalopram is one of the most popular selective serotonin reuptake inhibitors (SSRIs) in current use as a first-line treatment for depression. Escitalopram is well-tolerated and rarely associated with serious side effects. Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is very rarely mentioned among SSRI-related side effects. Serotonin-enhancing antidepressants may result in a rise in prolactin levels through suppression of dopamine neurotransmission. In the present study, we report a case of hyperprolactinemic galactorrhea associated with escitalopram. A 36-year-old woman developed galactorrhea after initiation of escitalopram for depression and was found to have an elevated prolactin level. Escitalopram was discontinued with resolution of the patient's galactorrhea and normalization of her prolactin level.
Adult ; Antidepressive Agents ; Citalopram ; Depression ; Dopamine ; Female ; Galactorrhea ; Humans ; Pregnancy ; Prolactin ; Serotonin Uptake Inhibitors ; Synaptic Transmission

Many antipsychotics have the potential to increase plasma prolactin levels, leading to a range of short-term and long-term adverse effects. In addition to short-term adverse effects such as galactorrhea, gynecomastia, menstrual irregularities, and sexual dysfunction, a number of important and potentially serious long-term adverse effects have been reported, including loss of bone mineral density, weight gain, pituitary tumor, breast cancer, and prostate cancer. Short-term adverse effects may negatively impact medication compliance, and long-term effects have the potential for serious health consequences. However, to a large degree, hyperprolactinemia has been neglected in clinical practice and research, compared with other potential adverse effects. Balancing the benefits of treatment with antipsychotics against their potential adverse effects is clinically important. Effective management of hyperprolactinemia begins with taking a careful patient history to determine the presence of any relevant signs and symptoms. If a mild elevation of plasma prolactin levels is detected (< 0 ng/mL), then it may be reasonable to continue to monitor the levels. If the elevation is persistent and > 0 ng/mL, then the clinician should consider switching to a drug with a lower potential to elevate prolactin. In any patient with a prolactin elevation greater than 150 ng/mL, a prolactinoma should be considered
Antipsychotic Agents ; Bone Density ; Breast Neoplasms ; Female ; Galactorrhea ; Gynecomastia ; Humans ; Hyperprolactinemia ; Male ; Medication Adherence ; Organothiophosphorus Compounds ; Pituitary Neoplasms ; Plasma ; Pregnancy ; Prolactin ; Prolactinoma ; Prostatic Neoplasms ; Weight Gain