Vitex agnus castus might enrich the pharmacological armamentarium for medical treatment of prolactinoma

Vitex agnus castus effects on hyperprolactinaemia

Background

Vitex agnus castus (VAC), also known as chaste tree, is a plant from the Mediterranean area, Crimea, and central Asia. Its fruit has been used for more than 2500 years as phytotherapic agent. In the last century, VAC has been mostly used for the treatment of premenstrual syndrome (PMS), menstrual irregularities, fertility disorders, and symptoms of menopause. Since some degree of hyperprolactinaemia may be observed in patients with such disorders, VAC effects on hyperprolactinaemia have been assessed in a small number of studies and in some patient series or single case reports. It has been postulated that the diterpenes contained in VAC extract may interact with dopamine D2 receptors (D2R) and inhibit prolactin release via dopamine D2R activation in the anterior pituitary. Most of the published papers focus on the use of VAC for the management of PMS or infertility. However, due to its action on D2R, VAC could have a role in the treatment of mild hyperprolactinaemia, including patients with idiopathic hyperprolactinaemia, microprolactinoma, drug-induced hyperprolactinaemia, or polycystic ovary syndrome.

Methods

We have reviewed and analysed the data from the literature concerning the use of VAC extracts in patients with hyperprolactinaemia.

Results

Some evidence suggests a possible role of VAC for the management of hyperprolactinaemia in selected patients, though in an inhomogeneous way. However, there are not any large randomized controlled trials supporting the same and the precise pharmacological aspects of VAC extract in such a clinical setting still remain obscure.

Conclusion

It appears that VAC may represent a potentially useful and safe phytotherapic option for the management of selected patients with mild hyperprolactinaemia who wish to be treated with phytotherapy. However, larger studies of high quality are needed to corroborate it.

How to manage intolerance to dopamine agonist in patients with prolactinoma

PURPOSE

Dopamine agonists (DA) are the gold-standard for prolactinoma and hyperprolactinemia treatment. Intolerance to DA leading to drug drop out occurs in 3 to 12% of cases. We provide here a review of published data about DA intolerance and present a case report concerning the use of intravaginal cabergoline.

METHODS

We review the literature on the definition, the pathogenesis, frequency and management of DA intolerance. In addition, the review provides strategies to enhance tolerability and avoid precocious clinical treatment withdrawal.

RESULTS

Cabergoline is often cited as the most tolerable DA and its side effects tend to ameliorate within days to weeks. Restarting the same drug at a lower dose or switching to another DA can be used in cases of intolerance. The vaginal route can be tried specifically if there are gastrointestinal side effects in the oral administration. Symptomatic treatment could be attempted, although mainly based on a strategy used in other diseases.

CONCLUSIONS

Due to limited data, no guidelines have been developed for the management of intolerance in DA treatment. The most frequent management is to perform transsphenoidal surgery. Nevertheless, this manuscript provides data derived from published literature and expert opinion, suggesting new approaches to this clinical issue.

Vitamin, Trace Element, and Fatty Acid Levels ofVitex agnus-castusL.,Juniperus oxycedrusL., andPapaver somniferumL. Plant Seeds

The levels of fat-soluble vitamin, trace element and fatty acid ofVitex agnus-castusL.,Juniperus oxycedrusL., andPapaver somniferumL. seeds in Turkey were determined by using HPLC, ICP-OES, and GC, respectively. In theVitex agnus-castusL.,Juniperus oxycedrusL., andPapaver somniferumL. seeds, linoleic acid (18 : 2) was determined with the highest level rates (%54.11, %28.03, and %72.14, resp.). In theVitex agnus-castusL. seeds, R-tocopherol,α-tocopherol, and K1levels were determined as 9.70 μg/g, 18.20 μg/g, and 24.79 μg/g, respectively; In theJuniperus oxycedrusL. seeds, R-tocopherol,α-tocopherol, and K1were determined as 18.50 μg/g, 0.84 μg/g, and 5.00 μg/g, respectively, and in thePapaver somniferumL. seeds, R-tocopherol,α-tocopherol, K1, and D2levels were determined as 43.25 μg/g, 122.05 μg/g, 12.01 μg/g, and 0.62 μg/g, respectively. In theVitex agnus-castusL.,Juniperus oxycedrusL., andPapaver somniferumL. seeds, nickel (Ni), zinc (Zn), and iron (Fe) were determined with the trace element level rates (4.42 mg/kg, 10.43 mg/kg, 3.71 mg/kg for Ni, 7.00 mg/kg, 7.70 mg/kg, and 24 mg/kg for Zn and 93.73 mg/kg, 187.95 mg/kg, and 149.64 mg/kg for Fe, resp.). These parameters in seeds are very important for human life.