Galactorrhea-Amenorrhea Syndrome (GAS) に関する臨床的研究-特に正Prolactin血性GASについて-

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  • Study on Galactorrhea-Amenorrhea Syndrome (GAS) with Special Reference to Normoprolactinemic GAS

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In order to clarify the mechanism (s) which causes galactorrhea and amenorrhea in patients with Galactorrhea-Amenorrhea Syndrome (GAS) (Group A, n=20), composed of Chiari-Frommel Syndrome (CFS) (Subgroup I, n=3), Argonz-del Castillo Syndrome (ADCS) (Subgroup II, n=5) and Drug-induced Galactorrhea-Amenorrhea (DIG) (Subgroup III, n=12), we analysed basal plasma prolactin (PRL) and gonadotropin levels and their responsiveness to TRH and LH-RH, respectively in GAS patients. In addition, another group of galactorrheic patients without amenorrhea (Group B, n= 29) was selected, and further divided into three subgroups; subgroup I (n=7) with persisting postpartum lactation, subgroup II (n=7) of idiopathic galactorrhea, and subgroup III (n=15) induced by drug administration.<BR>There were found unexpectedly high frequencies of normoprolactinemic patients (<23.7ng/ml) in 40% of GAS (66.7% in CFS, 40% in ADCS, and 33.3% in DIG). The PRL responsiveness to TRH, evaluated by %ΔPRL (peak PRL-basal PRL/basal PRL×100), tended to be high in ADCS and DIG (group after discontinuation of drugs) compared with those of normal subjects (n=12) and patients with primary hypothyroidism (n=21). PRL response was almost normal in CFS or DIG (group during drug administration).<BR>Basal level of plasma gonadotropin in GAS was comparable to that of normal subjects. However, responsiveness of gonadotropin to LH-RH in GAS tended to be high compared with that of normal subjects.<BR>The patients in group B (subgroup demonstrated almost parallel responses of PRL and gonadotropin, respectively, to those of corresponded subgroups in group A.<BR>From the present results, we concluded that; 1) It seems likely that frequency of normoprolactinemic patients in GAS (Group A) is surprisingly high. 2) A still unclarified mechanism (s) for the occurrence of galactorrhea, not explained solely by plasma radioimmunoassayable PRL level and/or hyperresponsiveness of PRL to stimuli, may operate on a considerably large number of group A patients. 3) Decreased gonadotropin secretion at pituitary level seems not to be a main cause of menstrual abnormality in group A patients. 4) The same mechanism (s) as in group A patients may cause galactorrhea in group B patients.

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