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Les grandes instances de santé recommandent toutes un allaitement maternel exclusif jusqu'aux six mois des nouveau-nés. Cependant, certaines femmes choisissent de ne pas allaiter pour diverses raisons ou sont parfois contraintes à y renoncer en présence d'une contre-indication à l'allaitement. La bromocriptine était, il y a encore peu de temps, la molécule de référence pour stopper la lactation. Or, une polémique importante concernant les effets indésirables rares mais graves de cette molécule a abouti à une modification de la stratégie thérapeutique dans l'inhibition de la lactation en post-partum. Bien au-delà de la bromocriptine, ce sont tous les dérivés de l'ergot de seigle qui ont été mis en cause. De plus, les méthodes ancestrales, comme par exemple la restriction hydrique, sont elles aussi critiquées. Ainsi, plusieurs pratiques médicales sont désormais en pleine expansion pour ralentir les symptômes liés à l'inhibition de la lactation et pour freiner cette dernière chez les femmes n'allaitant pas leur enfant. Il s'agit de méthodes naturelles de plus en plus plébiscitées dans notre société et que nous allons développer dans ce travail : la phytothérapie et l'aromathérapie, l'homéopathie, l'acupuncture. Enfin, nous évoquerons le rôle de conseil du pharmacien d'officine auprès des jeunes mamans.

L’adénome hypophysaire à prolactine est le plus souvent une tumeur bénigne consécutive à l’expansion d’une lignée cellulaire de l’adénohypophyse : les cellules lactotropes. Ils touchent majoritairement les femmes. Le traitement médicamenteux est le traitement de première intention avec en chef de file la cabergoline dont la sécurité d’utilisation a été remise en question avec la survenue de fibroses valvulaires chez des patients parkinsoniens traités par cette molécule. Des mesures de précaution sont donc à prendre. En ce qui concerne les prolactinomes et le problème de la contraception, celle-ci sera vue au cas par cas, même s’il ne semble pas y avoir d’influence néfaste des oestrogènes sur la tumeur. Pour les femmes désirant une grossesse ou enceintes, la bromocriptine est à privilégier. Pendant la grossesse, le suivi doit être renforcé.

Introduction : En 2013, le taux d'allaitement maternel en France est de 70%, néanmoins il peut êtreprescrit un médicament inhibiteur de la montée de lait chez certaines femmes le nécessitant. Il existeplusieurs types de traitement dont la bromocriptine (Parlodel® 2,5 mg cp) en première intention et ladihydroergocryptine (Vasobral®), utilisée hors AMM, en cas de contre-indication à la bromocriptine.Nous avons souhaité observer l'efficacité (à savoir, l'absence d'écoulement de lait) et les effetsindésirables respectifs de la bromocriptine et de la dihydroergocryptine dans l'inhibition de la lactation,dans le cadre d'une étude descriptive menée à la Maternité Régionale Universitaire de Nancy de marsà juillet 2013 inclus. Résultats/Discussion : Nous avons obtenu deux groupes de patientes : 61traitées par bromocriptine et 11 traitées par dihydroergocryptine. Dans le bras bromocriptine, 55% despatientes n'ont présenté aucun écoulement mammaire sur toute la durée du traitement, contre 30%dans le bras dihydroergocryptine. La douleur mammaire décrit un pic à J14 quel que soit le traitementde même qu'il existe une recrudescence des effets indésirables à J14. Ce pic douloureux peuts'expliquer par des remaniements physiologiques de la glande mammaire. De plus, d'après notreanalyse, la consommation de tabac favoriserait l'apparition d'écoulements, et ainsi, augmenteraitl'inefficacité du traitement. Nous n'avons pas constaté de lien entre l'obésité ou le diabète gestationnelsur l'efficacité du traitement inhibiteur. Les résultats de notre étude révèlent donc une efficacitépartielle de la bromocriptine, ainsi que des effets indésirables fréquents, ayant parfois nécessité l'arrêtdu traitement. En ce qui concerne la dihydroergocryptine, la faible taille de l'échantillon étudié ne nouspermet pas de conclure quant à l'efficacité et la tolérance du traitement. Conclusion : De la mêmemanière que les conclusions 2013 du groupe de travail de l'ANSM montrant un rapport bénéfice-risquedéfavorable pour ces 2 molécules, notre étude démontre qu'il est légitime de s'interroger surl'intérêt de la bromocriptine, de la dihydroergocryptine ainsi que sur la pertinence des alternativesdisponibles dans l'inhibition de la lactation.

Introduction: following on serious adverse effect noted in databases, the benefice/risk assessment about using Parlobel for the inhibition lactation is currently reassessed. Review: in 70% of the cases, lactation is inhibiting without serious consequences. Currently, the main treatments used are discussed as well as alternative therapies.Material: this study was carried out on 108 patients from Melun and Clermont-Ferrand in order to know their opinion about the management of lactation inhibition... Methods: a descriptive and comparative study achieved by a self-reported. The “homeopathy” group have had systematic information about the treatment unlike the “parlodel” and “none drugs ” groups. Results: there are less breast pain with Parlodel than homeopathy (36% versus 61%). Parlodel® causes typical side effects (about 10-20%). In the “parlodel” and “none” groups, 79% don’t have treatment’s choice and 37% want information. In the “homeopathy” group, 60% of patients would be back to a non-drug treatment where as 50% from the other groups would not know how to choose. Discussion: patients seem likely to prefer less efficacy to avoid potential side effects with drug. An informed choice is very important for accepting the management. Conclusion: the patients’ information must be reintegrated for the take up acceptance. The real Parlodel®’s indication must be respected. Non-drug therapy must be developed.; La bromocriptine, molécule inhibitrice de la lactation a vu son administration controversée suite à des effets indésirables graves retrouvés dans la littérature. Le rapport bénéfice-risque est actuellement réévalué. Rappels : dans 70 % des cas, la lactation est inhibée spontanément sans conséquences graves. Aujourd'hui, le traitement le plus utilisé est le Parlodel®, les méthodes non médicamenteuses étant discutées. Matériel : une étude a été menée auprès de 108 patientes aux CH de Melun et de Clermont-Ferrand, afin de connaître leur avis sur la prise en charge proposée. Méthode : étude descriptive et comparative réalisée par le biais d'un auto-questionnaire. Le groupe "homéopathie" a systématiquement eu une information sur le traitement, contrairement aux groupes "parlodel" et "aucun". Résultats : l'utilisation du Parlodel® implique moins de douleur des seins que l'homéopathie (36 % versus 61 %) mais présente des effets indésirables typiques (10 à 20 %). Dans les groupes "parlodel" et "aucun", 79 % des patientes n'ont pas eu le choix du traitement et 37 % souhaiteraient des informations. Dans le groupe "homéopathie", 60 % des patientes reprendraient un traitement non médicamenteux alors que 50 % des patientes des autres groupes ne sauraient pas quoi choisir. Discussion : les patientes semblent susceptibles de préférer une efficacité thérapeutique moindre pour éviter d'éventuels effets secondaires d'un médicament. Le choix éclairé a un rôle prépondérant dans l'acceptation de cette prise en charge. Conclusion : l'information des patientes doit être replacée au centre de la prise en charge des femmes. L'indication réelle du Parlodel® devrait être respectée et l'utilisation de méthodes naturelles ou homéopathiques devrait être développée pour répondre au mieux à la demande des patientes.

Objective : To compare the efficacy and safety of a single dose of cabergoline 1mg with that of 2,5mg of bromocriptine, twice daily, during 21 days. Methods and subjects: A prospective, comparative study on 2 parallel groups (Bromocriptine 52 women vs Cabergoline 47 women). The 99 women, not wishing to lactate, had to fill out 2 questionnaires. One during their hospital stay and the other 21 days after the beginning of the treatment. Main outcomes: A higher rate of adverse events was reported within the bromocriptine's group (36%,19/52) compared to the cabergoline group (17%,8/47), . Complete success was achieved in 78% of the women treated by bromocriptine and in 85% with those under cabergoline (p=0,2). 13 women, out of the 52, (25%) stopped taking their treatment, because of intolerance and adverse events. After 21 days of treatments, rebound breasts symptomatology occurred in both groups in 4%. Conclusions: A single dose of cabergoline is at leasat as effective as bromocriptine 2,5mg twice daily for 21 days in preventing puerperal lactation. Because of the considerably lower rate of adverse events and a higher rate of success, cabergoline should be the drug of choice for lactation inhibition. Nevertheless, dopamine agonists, should be prescribe with great care, because of possible dangerous events.; Objectifs : Comparer l'efficacité et la tolérance, de la bromocriptine (2,5mg*2/jour pendant 21 jours) avec la cabergoline (1mg dose unique), dans le cas de l'inhibition de la montée laiteuse. Matériel et méthodes : Il s'agit d'une étude comparative, prospective, menée à Necker et Port-Royal auprès de 99 patientes réparties en 2 groupes : 52 patientes sous Parlodel vs 47 patientes sous Dostinex. Les femmes ont dû remplir 2 questionnaires : l'un en suites de couches puis l'autre 21 jours après. Résultats : 36% (19/52) des patientes sous bromocriptine se sont plaintes d'effets indésirables contre 17% (8/47) dans le groupe cabergoline (en particulier lors de l'installation du traitement on a recensé des sensations de vertiges, nausées, céphalées...). 25% (13 sur 52) des patientes traitées par Parlodel 2,5mg ont interrompu leur traitement dans les 3 semaines du post-partum. Le taux de réussite de ces deux agonistes dopaminergiques s'élève à 78% pour la bromocriptine vs 85% pour la cabergoline (p=0,2). Lorsque l'on évalue l'efficacité du traitement 3 semaines après l'accouchement, le taux d'effets rebonds est similaire dans les 2 groupes (4%) à condition que la bromocriptine ait une durée de traitement totale de 21 jours et que la cabergoline soit administrée dans les premières 24 heures suivant l'accouchement. Conclusions : Une dose unique de cabergoline 1mg est au moins aussi efficace que 2,5mg*2/jour de bromocriptine pendant 21 jours de traitement. De par sa simplicité de prise et son meilleur rapport bénéfice-risque, la cabergoline devrait être l'agoniste dopaminergique de première intention dans la prise en charge de l'inhibition de la lactation dans le post-partum immédiat. Néanmoins, avant toute prescription, il faut bien s'assurer de l'absence de contre-indication, car les agonistes dopaminergiques ne sont pas dénués de tout risque.

To provide an overview of ergot derivatives prescription for lactation inhibition in France, either label (bromocriptine 2.5mg and lisuride 0.2mg) or off-label prescription (dihydroergocryptine and cabergoline).Analysis based on a questionnaire sent to all 618 French maternity wards in 2009, and prescription modalities from social security reimbursement data in the Rhône-Alpes region.The mean response rate to the questionnaire was 43% and main characteristics of respondents in this sample were very close to those found at the national level. The use of bromocriptine (89%) was the most frequently proposed. Dihydroergocryptine and cabergoline were mentioned as first or second alternatives in 39 and 24% of cases, respectively. Lisuride, homeopathy and phytotherapy were very rarely mentioned. The analysis of social security reimbursement data in the Rhône-Alpes region between 2008 and 2009 evidenced an increase in the rate of dihydroergocryptine prescriptions (from 37 to 46%), which were more frequent in women also treated with cardiovascular or psychotropic drugs, while that of bromocriptine decreased.This study shows that, in France, the main alternative to bromocriptine for lactation inhibition is the off-label use of dihydroergocryptine followed by cabergoline, which seems to be safer.

We report the case of a 21-year-old pregnant women (36 WA) presenting intensive headaches and visual disturbances. Those sellar compression symptoms have made us suppose the diagnosis of autoimmune hypophysitis. MRI has confirmed the typical aspect of symmetric enlargement of the pituitary gland with a strong and homogenous enhancement after gadolinium. This pathology associated to a high morbidity and mortality due to partial or complete deficit of the anterior pituitary hormones, shall be reminded more often.

Apathy is defined as reduced goal-directed behavior due to lack of motivation. Traumatic brain injury is a frequent cause. Drugs activating the dopaminergic system provide variable benefit. A 30-year-old patient was the victim of a severe head injury with frontal bruise at the age of 15. At the request of his family, he consulted for a 7-year history that included a lack of initiative and the inability to generate behavior spontaneously, contrasting with the ability to execute behaviors on command. He also presented indifference, major emotional disruption without sadness, pessimism, and other depressive signs. The examination found a severe apathetic syndrome confirmed by specific scales with a mild impairment of executive functions and without depressive syndrome. Encephalic MRI showed atrophy of the whole prefrontal cerebral cortex. The patient was treated with bromocriptine, which he did not tolerate, then with Selegiline at 15 mg per day, which dramatically improved his symptoms. Apathy occurs frequently after traumatic brain injury, in 23-71% of patients according to the authors. The pathophysiology of apathy has been described in anatomical terms as related to disruption of frontal-subcortical pathways. The biochemical hypothesis postulates a disruption in dopaminergic activity. The use of dopaminergic agents usually improves cases similar to our patient. Apathy is frequent following head injury, warranting a search for systematic causes. Since it increases dopaminergic activity, Selegiline is well worth trying in these patients.

Bromocriptin has been associated with stroke and myocardial infarction in the postpartum period. We report on the case of a patient who developed digital ischemia while receiving this drug.Mrs D, 28 years old presented with digital ischemia occurring five days after the introduction of bromocriptin. Magnetic resonance imaging also displayed stroke in the area of the right posterior cerebellar artery. The course was favourable after discontinuation of the drug.Bromocriptin is an ergot derivative with dopaminergic agonist properties. A paradoxical vasoconstriction is rarely associated with vascular ischemic complications, including digital ischemia.

The association of Parkinson's disease and pregnancy is very rare. Some thirty cases are found in the literature. We report the case of a pregnancy in a 30-year-old patient with juvenile Parkinson's disease. During this pregnancy treated by levodopa and bromocriptine, no aggravation of the symptoms was been observed. However, the pregnancy was complicated by a premature delivery at 31 weeks of amenorrhoea.

The postpartum period is a high-risk period for occurrence of mood disorders (depression, mania) particularly for women with a history of bipolar disorder. We report the case of a woman with a postpartum mania episode with psychotic features induced by bromocriptine. This case report highlights the need to systematically explore the personal history of pregnant women in search of mood disorder which may proscribe use of bromocriptine.

Postpartum is known to be an important risk factor for stroke. Bromocriptine may induce cerebral angiopathy.We report the case of a 26-year-old postpartum woman who presented with headaches, seizures, hypertension and acute renal failure eight days after the beginning of a treatment with bromocriptine prescribed for lactation suppression. Brain MRI and MR angiogram excluded cortical vein thrombosis and revealed multiple abnormal areas of increased signal in the cortex with segmental arterial narrowings of intracranial vasculitis. The patient completely recovered within one week after drug withdrawal. Biological and radiological abnormalities were also reversible. Following the chronology bromocriptine was most likely responsible for this adverse cerebral and systemic event.Clinicians should be aware of bromocripine-related postpartum cerebral angiopathy, a rarely described but serious complication of bromocriptine used to prevent postpartum breast engorgement.

Bromocriptin, member of the class of ergolines, is commonly prescribed as treatment of Parkinson's disease. Apart from vascular, digestif, neurologic and psychic disorders, the authors report cases of retroperitoneal fibrosis and pleural effusion, as adverse reactions related to the bromocriptin.About 40 cases of skin, pleural, lung and retroperitoneal attacks were described after long term and high doses of bromocriptin. More ten years ago, the first case of constrictive pericarditis was cited in the medical literature, and the bromocriptin was incriminated as responsible. Since then, two other cases were cited. Our observation is a constrictive pericarditis, found in a 72 years old patient treated with bromocriptin for Parkinson's disease since five years (cumulative dose intake 73 grams). Investigations aimed to establish etiology were negative. Bromocriptin is suspected and the treatment is discontinued. As in the three other cases, cardiac and neurologic conditions markedly improved after bromocriptin's withdrawal. A pericardic thickening persists at the echography.The responsibility of bromocriptin in the etiology of constrictive pericarditis is seldom discussed, because it remains an exclusion diagnosis. Periodic chest X-ray and echocardiography should be considered in patients with long-term bromocriptin treatment.

To review the literature about the indications, efficacy, limits and tolerance problems of drugs used with the aim of improving recovery of consciousness after a traumatic coma.Query using Medline, Embase, Neurosciences and Pascal databases. Thirty-two references were selected, including:articles proposing a synthesis of recent knowledge concerning neurotransmitters involved in vigilance, the pathophysiological mechanisms of impairment and the related pharmacology;clinical studies examining the efficacy of large categories of pharmacological agents (dopaminergic drugs, psychostimulants, tricyclic antidepressants and others) on vigilance and on alteration of consciousness following brain lesions.The synthesis provides evidence about the theoretical actions and efficacy of the available pharmacological agents. The clinical studies are less convincing: indications and therapeutic choices are empirical. Studies report often single cases. Randomised studies are rare, often heterogeneous concerning the aetiology of the brain lesions. The evaluation scales are varied and too wide. In this context, amantadin, amphetamine, methylphenidate and bromocryptin showed some positive effects. Despite a pessimist general feeling, some cases of unexpected recovery as well as relapses during breaks in treatment were arguments in favour of the drug that was administered.This review suggests that drug treatments for awakening might become a useful and perhaps even indispensable, complement in case management. It is therefore urgent to design multicentre studies in order to set rational indications and to develop realistic therapeutic protocols.

The occurrence of a pathological gambling behavior in a 61-year-old patient with idiopathic Parkinson's disease treated with dopaminergic drugs is reported. This is the first case reported with bromocriptine. The main characteristics and the mechanism of this recently described and a unexpected, adverse drug reaction are discussed.

Bromocriptine, a derivate of ergot of rye, is employed in high doses for the treatment of Parkinson's disease, and may induct pleuropulmonary affections. We report the case of a 75-years-old patient, on bromocriptin for 5 years, who presented a progressive dyspnea, due to a pleural thickening, and moderate interstitial infiltrate, associated with an inflammatory syndrome. The outcome was favorable with 3 months of bromocriptin cessation. These complications are rarely described, probably underestimated, and justify a respiratory follow-up for these patients, who are difficult to stabilize in their neurologic treatment.

To illustrate that residual normal pituitary gland may show hyperintense signal on T1-weighted image after medical treatment of pituitary prolactinoma.and methods. Three patients treated with bromocriptine for a prolactinoma and showing hyperintense signal of the residual normal pituitary tissue on T1-weighted images were studied. In all patients, measurements of the anterior pituitary gland signal (APGS) and the temporal lobe white matter signal (TLWMS) were obtained by a "region of interest" (ROI) on coronal T1-weighted images. The APGS/TLWMS ratios were calculated and compared to those of a control group of 30 normal subjects.In the three patients, the measurements obtained by ROI confirmed the visual impression of high signal of the residual normal pituitary tissue. Ratios were ranging from 1.15 to 1.21, while they were ranging, in the control group from 0.92 to 1.09.In patients with prolactin-secreting adenoma seen after medical treatment, high signal of the residual normal pituitary tissue can be observed, probably due to cellular hyperactivity as it can be noticed during some physiological states. This pattern has to be differentiated from other pituitary abnormalities demonstrating T1 hyperintensity such as hemorrhagic changes of a prolactinoma.

After levodopa, dopaminergic agonists are the most powerful agents in idiopathic Parkinson's disease treatment. Used in monotherapy or rather in early combination with levodopa, they allow a dramatic reduction of long-term motor side effects of the latter: onset and peak-dose dyskinesias, early morning dystonias. Their gastro-intestinal (nauseas) and moreover psychiatric (confusion and hallucinations) side effects limit their use, notably in geriatric populations. Superiority of so-called "second generation" agonists (ropinirole, pramipexole) on "first generation" agonists (bromocriptine, pergolide) remains to be proved.

Prolactinoma usually occurs a small intrasellar tumor in women or as a large tumor in men. To determine whether the predominance of macroprolactinomas in men is due to a delay in diagnosis as has been suggested, or whether there is a sex-related difference in growth rate we conducted a retrospective study in 45 men and 51 women with prolactinomas. Preoperative prolactin level (PRL) was 2,789 573 ng/ml and mean tumor size was 26 2 mm. Prolactin levels and tumor size were significantly higher in women (292 74 ng/ml and 10 1 mm; p0.01). There was no correlation with age at diagnosis or duration of symptoms. Giant tumors were only observed in men (n=8). Frequency of resistance to bromocriptine (30% vs 5%, p0.01) and invasive tumors (52% vs 27%, p0.001) were significantly higher in men than in women. Likewise, proliferation rate was higher for the prolactinomas in men (Ki-67: 2.6 1.1% positive nuclei vs 0.4 0.2%; p=0.08; PCNA: 5.0 2.3% vs 3.7 1.1%). In conclusion, prolactinomas in men are more aggressive than in women. They grow rapidly, often invade the cavernous sinus and are resistant to bromocriptine; proliferation rates can be increased.

We analysed the epidemiological, clinical, biological, morphological and therapeutic characteristics of 36 cases of pituitary prolactinomas in Yaoundé, Cameroun. Diagnosis was made on the basis of neuro-ophthalmological, gynaecological and sexual symptoms associated with quantity determinations of prolactinemia, total testosterone and blood oestrogen, folliculo stimulating hormone and luteining hormone. Expected levels of prolactinemia are above 150 micrograms/l. Cerebral tomodensitometry and, where possible, magnetic resonance imaging were used. Among the 24 patients on whom a tomodensitometry was performed, 4 male patients presented macroprolactinomas; the remaining 20 patients--mostly female--had microprolactinomas. Macroprolactinomas were found in male patients only, leading to an acute ophthalmological emergency for 2 of them who were operated in Paris-France. All the patients were put on bromocriptine; this molecule has antisecretory and antiproliferative properties, which are very useful in Africa, since surgery is very expensive. Cases of resistance to the molecule exist and new dopaminergic agonists are not yet being used in Cameroon.

Two cases of obstructive hydrocephalus who suffered multiple shunt failures and shunt revisions are presented. The patients developed after the neurochirurgical treatment a clinical syndrome of akinetic mutism followed by a Progressive Supranuclear Palsy-like (PSP) syndrome. The akinetic mutism and the PSP-like syndrome were remarkably improved with bromocriptine.

The authors report the case of a 28 year old woman who developed antero-septoapical myocardial infarction in the post-partum period. This was detected by surface ECG and echocardiography performed after a systemic embolism. The infarction followed treatment with Parlodel for inhibition of lactation. Coronary angiography, performed one month post-partum, was normal and the methergin test was negative. The physiopathological mechanism of myocardial infarction resulted from the association of an iatrogenic spastic phenomenon favourised by the patient restarting to smoke and the physiological arterial hyperactivity of the post-partum period. This mechanism raises the question of preventive measures in cases of inhibition of lactation in the post-partum period, notably stopping smoking.

Bromocriptine, used in the treatment of acromegaly, hyperprolactinemia and Parkinson's disease, may be responsible in this last case, for pleuro-pulmonary complications in higher doses. Since 1981 about thirty cases were described. It was mostly pleural effusions, pleural thickening and parenchymal lung fibrosis. The prevalence of pleuro-pulmonary diseases is between 2 to 5% after 5 years with bromocriptine that varied in dosage from 20 to 90 mg daily. The patients developed symptoms from nine months to four years. We report a case of a patient treated for one year for Parkinson's disease with daily dose of 105 mg of bromocriptine in whom bilateral pulmonary infiltrate was discovered with a deterioration in the general physical state and dyspnea. There was a favorable clinical and chest roentgenogram outcome following the cessation of treatment, in six months. The hypotheses to explain the pathogenesis of these disorders were always discussed: a vascular theory, an immunological theory or a toxic fibrogenesis induced by the molecule acting on dopaminergic receptors and serotonergic synapses. Now, in our knowledge, these complications justify a clinical and chest roentgenogram follow up for any patients treated with bromocriptine.

Several transactivating factors specifically involved in the differentiation and proliferation of anterior pituitary cell types have been recently identified. Among them Pit-1 a member of the POU-domain transcription factors family is specific of anterior pituitary cells, and was initially identified and cloned as a transactivator of the GH and PRL genes and as a regulator of the TSH beta gene. Pit-1 play a key role during embryogenesis in the differentiation and proliferation of somatotrophs, lactotrophs and thyreotrophs. The importance of Pit-1 as a regulator in the anterior pituitary development has been further demonstrated by naturally occurring mutations or delections in dwarf mouse strains. In the Snell and Jackson dwarf mice, the levels of Pit-1 gene expression are low or undetectable, GH, PRL and TSH beta gene expression are absent and lactotrophs, somatotrophs, and threotrophs fail to proliferate. Furthermore Pit-1 carries out similar functions in humans. This is supported by the fact that children with mutations of the Pit-1 gene present with a congenital combined GH, PRL and TSH deficiency analogous to the phenotype of the Snell and Jackson dwarf mice. In children who were born to healthy consanguinous parents and present such combined deficiencies we recently reported a Pit-1 mutation causing a transition from a Phe to a Cys in a region of the protein known to be involved in DNA binding. Pit-1 transcripts identical in size and sequence to those observed in normal pituitary were described in human GH, PRL and TSH secreting pituitary adenomas. The Pit-1 beta isoform, raised through alternative splicing of exon 2 of the Pit-1 gene, is a more potent inducer of GH transcription than the major Pit-1 form. However no difference in the level of expression of the different Pit-1 isoforms was observed between tumors identified as pure GH or PRL producing tumors. The results support the existence of other transcription factors interacting with Pit-1 to coordinately regulate the activity of the GH and PRL promotors in a cell specific manner. In contrast, variable Pit-1 expression was observed in prolactinomas, according to their sensitivity to bromocriptine treatment. A highly significant correlation was indeed evidenced between the D2 receptors mRNA and the Pit-1 mRNA levels. These results raise the possibility that Pit-1 may either directly or indirectly affect the transcription of the D2 dopaminergic receptor gene. In fact, receptors for other hypothalamic neurohormones such a GHRH and somatostatin are known to be potential Pit-1 target genes. Such mechanisms could be implicated in the differentiation and proliferation of lactotrophs and somatotrophs.

Drug induced pleurisy is often a diagnosis of elimination because the clinical presentation, paraclinical features and anatomicopathological aspect are relatively non-specific. The pleural effusions are typically chronic and somewhat torpid, most often bilateral but may be unilateral. Two types of lesion are found: effusion or thickening and these may be associated. The peculiarity of these pleural diseases are the frequent coexistence of accompanying signs: for example pulmonary, cutaneous, ocular, hepatic, peritoneal, pericardial as well as evidence of inflammation and depending on the medicaments hypereosinophilia, cytolysis, cholestasis or antinuclear antibodies. Anatomicopathogically there is dense fibrosis which is diffuse, pauci-cellular and with little inflammation. The progress is variable according to the drug either going on to complete regression on the cessation of the medication or the persistence of a degree of pleural thickening. The causative drugs are essentially the derivatives of Ergotamine and amongst others bromocryptine and dantrolene.

Dopamine agonists are able to restore ovulatory cycles in 80-90% of hyperprolactinemic patients and to reduce tumoral volume (often dramatically) in 80% of macroprolactinomas. Their side-effects will be reduced with the use of parenteral forms or new agonists currently in preparation. Somatostatin analogues administered either subcutaneously by three daily injections (octreotide) or intramusculary with a long-acting formulation every 10-15 days (lanreotide) are able to "normalize" GH levels in 70% of acromegalic patients and to shrink tumor in half of the patients. Side effects are generally minor but an increased incidence of gallstones has been reported. These somatostatin analogs are also very effective in the treatment of TSH-secreting adenomas. Medical treatment of other pituitary adenomas is much more disappointing.

High doses of bromocriptine used for treatment of Parkinson's disease may be associated with pleuropulmonary complications. Isolated pleural effusions are a rare manifestation as is lower limbs edema are an exceptionally one. We report the case of a 67-year-old man, treated since five years by a daily dose of 30 mg of bromocriptine for Parkinson's disease, who developed important leg's edema and a few months later an exsudative right pleural effusion. No etiologies were found. Bromocriptine was discontinued. The evolution was characterized by nearly complete resolution of pleural effusion and disparition of lower limbs edema.

We report a case of benign cerebral angiopathy in a 37 year-old woman in the postpartum period occurring after bromocriptine therapy to suppress lactation. She presented with severe headache, hyperthermia and bradycardia. She had partial seizure. Angiography excluded cortical vein thrombosis but revealed multiple narrowing of intracerebral arteries. Bromocriptine was stopped. The patient totally recovered. A second angiography performed 3 months later was normal. Postpartum cerebral angiopathy is considered as rare but the prevalence is probably underestimated. Neurological features of this affection are multiple. Diagnosis is made by angiography performed in emergency and which showed narrowing of intracerebral arteries which are reversible. Prognosis is good. Reversible vasoconstriction may be due to acute arterial hypertension, sometimes triggered by ergot derivatives.

Prolactin radioimmunoassay was carried out before and 15, then 30 min after intravenous infusion of protireline (0.2 mg) in 3 groups of male patients: 7 with reactive arthritis (HLA B27: 6; age: 25 +/- 6.3 yr), 13 with ankylosing spondylitis (HLA B27: 11; age: 33.2 +/- 14.7 yr), 5 with psoriatic arthritis (HLA B27: 1; age: 28.8 +/- 6.3 yr). The same test was carried out in sex-age-body mass index matched controls. Only the patients with reactive arthritis presented dynamic hyperprolactinaemia 15 and 30 min after protireline infusion and none of ankylosing or psoriatic arthritis groups. A complete failure of bromocriptine was observed in reactive arthritis. In 2 cases of psoriatic arthritis, adding bromocriptine to gold salts and nonsteroidal anti-inflammatory drug was followed by a drastic efficacy with spectacular improvement in clinical, biological and occupational status. Because none of the cases had hyperprolactinaemia, bromocriptine acted probably had an intrinic anti-inflammatory effect independent of its antiprolactinic effect.

Non-steroid anti-inflammatory drugs and/or gold salts were unsuccessful alone in providing symptom relief in three men with rheumatoid psoriasis. All three were treated with bromocriptine (5 mg/d in 2 doses) after verification of normal baseline and protirelin-stimulation prolactin levels. There was a beneficial effect in nocturnal pain relief, morning stiffness, the Lee and Ritchie scores and biological markers of inflammation. Two of the patients were able to return to regular work occupation after 15 and 45 days. In the third patient, bromocriptine was discontinued due to nausea and dizziness but was reintroduced successfully in fractionated doses after recurrence of the symptomatology. Treatment was continued without secondary adverse effects for 3 to 9 months providing continued symptom relief. Bromocriptine can be an effective adjuvant for the management of rheumatoid psoriasis.

Use and interest of therapeutic association bromocriptine-neuroleptic in schizophrenia. Twelve schizophrenic patients were treated by bromocriptine (7.5 mg.day) and neuroleptic. After one month, patients on this treatment showed a mean improvement of 29% on the total score of the positive and negative symptom scale. This results suggest that therapeutic association bromocriptine-neuroleptic may be used for schizophrenic patients.