ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, July 2011, p. 3624–3626 Copyright © 2011, American Society for Microbiology. All Rights Reserved. Valacyclovir for Herpes Simplex Encephalitis䌤 Thomas Pouplin,1* Julie Nguyen Pouplin,1 Pham Van Toi,1 Niklas Lindegardh,4 H. Rogier van Doorn,1 Tran Tinh Hien,1 Jeremy Farrar,1 M. Este ¨k,3 and Tran Thi Hong Chau1,2 Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit,1 and Hospital for Tropical Diseases,2
Endolri.org.ukthe Pituitary Foundation inFormation leaFlets
Monday - Friday 9:00am – 5:00pm Email: [email protected]
0845 450 0375
Endocrine Nurse HelpLine
available scheduled hours The Pituitary Foundation publishes a library
0845 450 0377
of leaflets on pituitary conditions, treatments and wel -being issues. For more information please visit our website, or call our HelpLine.
The Pituitary Foundation
P.O. Box 1944
HelpLine: 0845 450 0375
Administration Line: 0845 450 0376
Company Limited by GuaranteeRegistered in England and WalesNo. 3253584 Registered Office:86 Colston Street Registered Charity No. 1058968 2010 The Pituitary Foundation Working to support pituitary patients,
Working to support
This material may not be stored or reproduced in any form or pituitary patients,
their carers & families
by any means without the permission of The Pituitary Foundation.
their carers & families
DISCLAIMER All information is general. If you or your carer, have any concern about your treatment or any side effects please read the
series : conditions
Patient Information leaflet enclosed with your medication or consult your GP or endocrinologist The Pituitary Foundation
The Pituitary Foundation is a charity working in the United Kingdom and Republic of Ireland supporting patients with pituitary conditions, their carers, family and friends. An ExPlAnAtion of HormonEs
Our aims are to offer support through the pituitary journey, provide information to the - where they are secreted from and what they do
community, and act as the patient voice to raise awareness and improve services.
The PiTuiTary Gland
About this leaflet
The pituitary gland produces a number of hormones, The Pituitary & Hypothalamus
The aim of this leaflet is to provide information and understanding about hyperprolactinaemia (raised levels of the including: prolactin, follicle stimulating hormone hormone prolactin in the blood stream) and prolactinoma (a prolactin secreting growth on the pituitary gland).
(FSH) and luteinizing hormone (LH). Prolactin is sometimes known as the ‘milk hormone' because it Everyone is individual and not all the information will apply to you but hopeful y you will gain some understanding of your condition and perhaps answer some questions you may have with regards to your diagnosis/condition.
stimulates milk production after childbirth, but it is also produced in men, although in smal er amounts. FSH and LH control sex and reproduction. In women they cause release of the sex hormone oestrogen and stimulate the ovaries to produce eggs; these hormones An Explanation of Hormones are essential for a normal menstrual cycle. In men, they cause the release of testosterone and stimulate What causes the Prolactin Level to be Raised? production of sperm from the testicles.
What is a Prolactinoma? Brain Stem
Signs & Symptons presenting in Women Signs & Symptons presenting in Men he endocrine SySTem
Diagnosis & what Tests are carried out? How is a Prolactinoma Treated? Medication Treatment Surgical Treatment Prolactinoma Aftercare How will a Prolactinoma affect my Lifestyle? Membership & Donation Information What causes the Prolactin Level to be raised?
Signs and Symptons of a Prolactinoma
Common CAusEs of rAisEd ProlACtin
signs And symPtons PrEsEnting in WomEn
Most women with prolactinomas are likely to have microprolactinomas. Your first symptoms may relate to loss of • Nipple stimulation and suckling
periods (amenorrhoea) as excessive prolactin interferes with the pituitary's production of the hormones FSH and • Stress
LH which control the menstrual cycle. You may have reduced interest in sex (low libido) and experience vaginal dryness and discomfort during intercourse. You may also be infertile because of impaired egg release by the ovaries • Certain medications such as:
- as we shall see later, there is usual y effective treatment for this problem. You may also develop excess breast » Anti sickness medications e.g. Metoclopramide, Stemitil, Domperidone, milk production (cal ed galactorrhoea), which may leak spontaneously. This is due simply to the biological action also acid reducing medication like Omeprazole can raise your prolactin level.
of prolactin and is not a sign of breast disease, particularly breast cancer. » Certain antidepressants and tranquil isers used to treat mental health il ness can raise prolactin: Women with prolactinomas do not have any increased risk of examples include Amytriptyline and Fluoxetine (Prozac) and Respiridone.
» Some homeopathic and herbal medications. NB: If galactorrhoea is a symptom: it is important to note that self • Another possibility of raised prolactin is an underactive thyroid gland, which can be diagnosed by
examination and expressing of milk acts as stimulation and therefore a simple blood test and which requires treatment with thyroid hormone tablets. Once your doctor reinforces the raised prolactin level, making galactorrhoea persist! has excluded these causes, he or she will consider the possibility of a prolactinoma.
Although it is tempting to look to see if it is still present, you should resist the temptation. Make sure you tell your doctor about all your current prescribed
and any non-prescription medication you are taking.
signs And symPtons PrEsEnting in mEn
Men with prolactinomas usual y have tumours larger than 10mm in diameter (macroprolactinomas). However, What is a Prolactinoma?
a larger size tumour does not rule out an excel ent response to tablet treatment. As in women, excessive prolactin reduces production of FSH and LH by the pituitary gland. This A prolactinoma is a prolactin-producing tumour of the pituitary gland. in turn lowers testosterone levels and may result in a reduced interest in sex (low Please be assured that this is a benign tumour, and not a brain tumour or cancer. libido) and in impotence. You may also have infertility due to a low sperm count. Doctors use the words ‘tumour', ‘adenoma' or ‘growth' which means a swel ing on the pituitary gland. These Milk production by the male breast can occur but is very uncommon even when tumours only grow very slowly and many do not seem to grow at al . We do not know exactly what causes prolactin levels are very high.
prolactinomas, but they are the most common type of hormone-producing pituitary tumour.
Once diagnosed and treatment with medication has been established and the The action and stress of performing a blood test can mildly elevate the prolactin level and for this reason more than abnormal level of prolactin starts to decrease the abnormal y low testosterone level should one level requires to be checked.
in turn start to recover and rise again. This does not happen in all cases and in that instance the An appointment with an endocrinologist is usual y sought by the GP, when there have been repeated raised levels man will go on to have hormone replacement therapy in the form of testosterone.
of prolactin. Following referral to an endocrine department, the initial appointment will probably entail having your prolactin level re-checked.
Prolactinomas come in various sizes, but the vast majority are less than 10mm (3/8 inch) in diameter. These are If you have a large tumour, you may have pressure symptoms such as headache or visual problems. This is because cal ed microprolactinomas. The rarer, large tumours greater than 10 mm in size are cal ed macroprolactinomas. the nerves to your eyes pass over the top of the pituitary gland. In a minority of patients, an increase in pituitary size Prolactinomas can occur in men and women. The symptoms produced by a prolactinoma depend on the sex of the patient and the size of the tumour.
may cause pressure on these nerves and produce visual disturbance. Again, even these prolactinomas can usual y be treated effectively with tablets, rather than surgery.
PRODUCT TECHNICAL DOSSIER TRIBULUS TERRESTRIS EXTRACT 95% SAPONINS Product Code: P20046 Raw Material Full Name: Tribulus Terrestris Extract 95% Saponins Raw Material Full Botanical/Chemical/Latin/Trade Name/Synonyms: Tribulus Terrestris L This material is Food Grade Assay (by UV): Min 95.0% Saponins Ratio of Material: Approx. 10:1 Solubility in Water: 40-50% Soluble in Water Solubility in Alcohol: The Solubility of this product in 75-80% Alcohol 80% Particle Size: 100% pass through 80 Mesh Bulk Density: 40g/ml – 60g/ml Loss on Drying: Max 5% Ash: Max 5.0%