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Title of Thesis

Nadeem Ahmed Arshad Qureshi
Institute/University/Department Details
Department of Biological Sciences/ Quaid-i-Azam University Islamabad
Biological Sciences
Number of Pages
Keywords (Extracted from title, table of contents and abstract of thesis)
hyperprolactinaemia, nonlactating women, oligomenorrhea, amenorrhea, galactorrhea, infertility, livebirths, idiopathic hyperprolactinaemia patients

A prospective study was conducted from July 1995 to February 2002 in gynaecology clinics of various teaching hospitals in Islamabad and Lahore. Patients presenting with symptoms suggestive of hyperprolactinaemia such as oligomenorrhea, amenorrhea, galactorrhea and infertility were screened for their prolactin levels, after recording their histories and relevant examinations. Those with prolactin levels more than 25 ng/ml were included in the study, and an informed consent was taken. Their blood samples were taken for a hormone profile including FSH, progesterone, estradiol, as well as prolactin, and were subsequently repeated. Radiography for the pituitary fossa and perimetry for the field of vision (hemianopsia) were done in all the patients. Patients with prolactin levels more than 200ng/ml had high resolution MR imaging of their pituitary fossa. It was done selectively in the patients with mild and moderately elevated prolactin levels. Statistical analysis of the data was done. Results of the study demonstrate that 19,266 gynaecological patients were examined and n=830; 4.31% subjects were diagnosed with hyperprolactinaemia. All of the patients were of reproductive age ranging from 16 to 49 years. Hyperprolactinaemia is significantly more prevalent among unmarried patients than in married patients (P<0.001) when compared at age class 21years to 35 years. The positive history of spontaneous abortion was present in n=296; 35.66% subjects. There is a highly significant negative correlation (P<0.02) between prolactin levels and incidence of abortion. The predominant symptoms were oligomenorrhea / amenorrhea, (n=748; 90.12%), infertility (n=266; 32.05%) and galactorrhea (n=248; 29.88%). Number of hyperprolactinemic patients with primary infertility is significantly (P=0.0354) higher than those with secondary infertility of up to 2 years duration. Married hyperprolactinemic patients with livebirths have the highest incidence of galactorrhea. The number of galactorrhea patients is significantly high in married patients with livebirths when compared to unmarried patients (P<0.001). Among married patients galactorrhea is significantly associated with those who had livebirths compared to patients with no live births (P=0.0143). Married hyperprolactinemic patients with galactorrhea are significantly higher in number compared to unmarried patients when distributed in relation to unilateral and bilateral involvement of the breast (P=0.0020). The symptoms manifesting due to hypoestrogenaemia among hyperprolactinemic patients were vulvovaginal atrophy symptoms in n=392; 47.23% and decreased libido in n=202; 24.34% subjects. Prolactin levels were (25-100ng/ml) mildly elevated in n=576; 69.40%, moderately elevated (101-200ng/ml) in n=185; 22.29% and high (>201 ng/ml) in n=69; 8.31 % patients. Causes of hyperprolactinaemia were idiopathic, (n=398; 47.95%) secondary (n=254; 30.60%) and prolactinomas (n=178; 21.45%). Of these prolactinoma patients, n=110; 13.25% had microadenomas and n=68; 8.19% were macroadenomas. A strong association of microadenoma with mild and moderately elevated prolactin and that of macroadenoma with higher levels of prolactin were observed (P<0.001). Among macroadenoma patients (n=5; 0.60%) had supra seller expansion causing partial or complete hemianopsia. Serum progesterone was decreased in n=782; 94.20% patients, estradiol in n=716; 86.27% patients and FSH was low in n=726; 87.47% patients. However none of the patients had raised concentration of any of these hormones. In conclusion incidence of hyperprolactinaemia is 43/1000 in the studied population and it causes significant morbidity among gynaecological patients. Though this incidence is higher, symptoms are similar to the studies done in other populations in other parts of the world. A highly significant negative correlation between prolactin levels and number of abortions is observed. Serum prolactin levels >200ng/ml are strongly associated with macroadenoma and <200ng/ml with microadenoma. If MRI could be employed more frequently in patients with moderately elevated prolactin concentration some more microadenomas are likely to be diagnosed among idiopathic hyperprolactinaemia patients.

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S. No. Chapter Title of the Chapters Page Size (KB)
1 0 Contents
821.7 KB
2 1 Introduction 4
1326.65 KB
3 2 Materials And Methods 14
749.56 KB
4 3 Results 21
1686.63 KB
5 4 Discussion 55
936.24 KB
6 5 References 62
1616.69 KB