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PubMed1977

Current concepts of prolacting physiology in normal and abnormal conditions.

Currently the physiology and pathophysiology of pituitary prolactin secretion are under intensive investigation. Development of sensitive, specific radioimmunoassays for hPRL and improved roentgenographic techniques have increased the diagnostic acumen for incipient pituitary microadenomas. Several modalities of treatment are available at the present time which can result in improvement in the clinical symptoms of the amenorrheagalactorrhea syndromes. Eponymic classification of amenorrhea-galactorrhea syndromes should be discarded and appropriate diagnostic studies initiated to determine the etiology of the inappropriate breast secretion and/or elevated serum hPRL level.

Adenoma↗
PubMed1977

Treatment of functional amenorrhea-galactorrhea with 2-bromoergocryptine.

The present study was undertaken to investigate not only the effectiveness of bromoergocryptine therapy in 13 women with amenorrhea-galactorrhea and hyperprolactinemia without evidence of organic pathology, but also to assess the value of pretreatment evaluation in predicting the response to therapy. Sella turcica tomography, base line serum follicle-stimulating hormone, luteinizing hormone (LH), thyroid-stimulating hormone, T4, plasma cortisol levels, and the growth hormone reserve were normal in all patients. The pretreatment administration of LH-releasing factor (LRF) (100 microng subcutaneously) resulted in either a normal or excessive release of LH. On bromoergocryptine therapy, cyclic menses were reintiated in 10 of the women, while conception occurred prior to reinitiation of menses in the remaining three women. The time required for resumption of menses or conception on therapy correlated well with the magnitude of gonadotropin response to LRF. No correlation was seen with pretreatment prolactin levels nor with the degree of suppression of prolactin during bromoergocryptine therapy. In four women the mean prolactin levels during therapy were above normal, and in one patient prolactin levels approached pretreatment values during therapy. The initiation of cyclic menses despite continued hyperprolactinemia may indicate a possible direct effect of bromoergocryptine on hypothalamic LRF secretion as a partial explanation for its therapeutic action. On discontinuation of bromoergocryptine therapy, serum prolactin levels rapidly returned to pretreatment values or higher in all of the patients studied. In contrast to previous studies in which amenorrhea recurred in all patients after discontinuation of therapy, three of our patients maintained cyclic menses despite continued hyperprolactinemia. The recurrence of hyperprolactinemia after discontinuation of bromoergocryptine would indicate a persistent autonomy of the mechanisms involved. Periodic endocrine evaluation will be necessary to substantiate the presence or absence of pituitary microadenoma in these women.

Adult↗
PubMed1977

Clinical response to CB-154 and the pituitary response to thyrotropin-releasing hormone-gonadotropin-releasing hormone in patients with galactorrhea-amenorrhea.

Ten patients with galactorrhea and amenorrhea were treated with 2-bromo-alpha-ergocryptine (CB-154). All patients had normal anteroposterior and lateral x-rays of the sella turcica and normal or low gonadotropin levels. Before treatment, serum prolactin (PRL) levels were between 80 and 1575 ng/ml. Prior to initiating therapy, six patients were further evaluated by the intravenous administration of thyrotropin-releasing of a pituitary etiology in all patients. During treatment, PRL levels were measured at monthly intervals. After 1 month, serum PRL concentrations were reduced between 13% and 99%. In eight subjects there was complete cessation of galactorrhea. During treatment, nine patients resumed ovulatory menstrual cycles and three patients conceived. After discontinuing therapy, five of seven subjects had a recurrence of galactorrhea, amenorrhea, and hyperprolactinemia.

Adult↗
PubMed1977

Treatment of hyperprolactinemia-anovulation syndrome.

Twelve patients with amenorrhea-galactorrhea and hyperprolactinemia are presented. The mean serum prolactin level was 175 ng/ml (range, 37 to 575 ng/ml). Basal gonadotropin levels were normal in all patients. Serum estradiol levels were normal in three women and reduced in nine. The response to luteinizing hormone-releasing hormone was normal in 10 patients and the response to clomiphene citrate was reduced in all women. Radiologic evaluations of the sella turcica and neurologic examinations were performed in all cases. Patients were treated with bromocryptine (2-bromo-alpha-ergocryptine, CB-154), 2.5 to 10 mg/day, for 5 to 35 weeks. In 10 patients normalization of the menstrual cycle was restored, and 9 patients were ovulatory. The galactorrhea ceased or was improved in all cases. Four patients who were treated for infertility became pregnant after one to three treatment cycles. In all cases prolactin levels were normalized (mean level, 10 ng/ml). Side effects were slight and were experienced only on initiation of therapy. The role of prolactin and the significance of normalization of plasma prolactin levels are discussed. Lowering prolactin secretion with bromocryptine allows resumption of normal gonadal function.

Adult↗
PubMed1978

Current management of the amenorrhea-galactorrhea syndrome.

Management of the amenorrhea-galactorrhea syndrome has changed considerably in the last 5 years. Better understanding of the neuroendocrine physiology of the central nervous system in general, and of the hypothalamic-pituitary region in particular, have contributed significantly to our understanding of the pathophysiology of this syndrome. Greater awareness by physicians, improved neuroradiologic techniques, and the development of immunoassays for prolactin have markedly improved our diagnostic abilities. Many more patients are being diagnosed as having a pituitary tumor. The recent introduction of microneurosurgical techniques and the new medications (ergolines) are changing the treatment of this syndrome. Women in the childbearing age--who are affected most often--can expect successful treatment in the majority of cases with resumption of normal menstrual function and fertility. However, certain risks are still posed, particularly during pregnancy. In spite of improved diagnosis and treatment, the natural history of prolactin-secreting pituitary tumors and the long-range effects are still not fully appreciated. More experience in time will be needed before the indications for and the efficacy of various treatment regimens are fully known.

Adenoma↗
PubMed1980

Clinical course and outcome of thirty-five pregnancies in infertile hyperprolactinemic women.

Thirty-five pregnancies occurred during a 21-month follow-up period in 68 women (51%) who presented with infertility and hyperprolactinemia. Bromocriptine was used in 33 patients, of whom 25 (76%) conceived. In the remaining 35 patients who did not receive bromocriptine, there were 10 pregnancies (28%). The presence or absence of menses and galactorrhea in infertile hyperprolactinemic women treated with bromocriptine did not affect significantly the pregnancy rate. No pituitary complication occurred during pregnancy in any hyperprolactinemic patient and there was no change in sellar x-ray appearance, even in two patients whom a plain skull x-ray showed a minor sellar abnormality. Of the 35 pregnancies, 25 occurred after bromocriptine therapy, 2 after thyroxine therapy, 2 after clomiphene therapy, and 6 without any treatment. Five pregnancies ended in first-trimester abortion, including four after bromocriptine treatment. It is concluded that hyperprolactinemia is a good prognostic factor in infertility and that the majority of patients become fertile after a course of bromocriptine. No congenital abnormalities were observed in the offspring of patients treated with bromocriptine, but the abortion rate was higher than average.

Abortion, Spontaneous↗
PubMed1982

Restoration of ovarian function by low nocturnal single daily doses of bromocriptine in patients with the galactorrhea-amenorrhea syndrome.

Eighteen hyperprolactinemic patients with either amenorrhea or both galactorrhea and amenorrhea were treated with 2.5 mg of bromocriptine per day supplied at night. Ovulation occurred in 16 patients, and 8 wishing to conceive became pregnant. One of these patients became pregnant for a second time at a bromocriptine dose as low as 1.25 mg/day. Normal ovulatory cycles in four women receiving 2.5 mg of bromocriptine per day could also be maintained at 1.25 mg, despite the differences in the degree of prolactin (PRL) inhibition. Progesterone and luteinizing hormone levels measured for both bromocriptine levels were consistent with ovulatory cycles. The low, single dose of bromocriptine per day supplied at night decreased PRL levels, but normalization of blood levels did not always occur. Eighty percent of the patients ovulated with prolactin values over 25 ng/ml (normal value = less than 20 ng/ml).

Adolescent↗
PubMed1982

Retrospective evaluation of human menopausal gonadotropin and human chorionic gonadotropin induction of ovulation in galactorrheic and hyperprolactinemic women.

A retrospective study on the success of induction of ovulation with human menopausal gonadotropin and human chorionic gonadotropin (hMG/hCG) in 267 women was performed. Galactorrheic women had a higher pregnancy rate (55%) than nongalactorrheic women (22%). Galactorrhea was a far better indicator of the success of the treatment than hyperprolactinemia at present. The results obtained may suggest that in "bromocriptine failure" it is not mandatory to lower prolactin levels prior to induction of ovulation with hMG/hCG, and these women may be treated with menotropins alone.

Adult↗
PubMed1987

Primary amenorrhea associated with hyperprolactinemia: four cases with normal sellar architecture and absence of galactorrhea.

Hyperprolactinemia is an uncommon cause of primary amenorrhea. The diagnosis should be sought even in the absence of galactorrhea and sellar abnormality, particularly when thelarche and pubarche have occurred. Reduction of serum PRL levels followed by menarche can be anticipated within a few months of starting bromocriptine therapy in the majority of cases.

Adolescent↗
PubMed1977

Multiple hypothalamic-pituitary abnormalities in an adolescent girl with galactorrhea.

A patient with multiple hypothalamic abnormalities is presented who had galactorrhea at seven years of age followed ten years later by secretory deficiencies of growth hormone, TSH, and gonadotropins. There was no clinical evidence of a mid-brain tumor. Patients presenting with galactorrhea and amenorrhea associated with hyperprolactinemia may develop additional hypothalamic malfunctions over a period of several years and should be observed carefully for appearance of them as well as for evidence of brain tumors.

Adolescent↗