Abstract

PIP: Bromocriptine therapy was given to 42 amenorrheic women with hyperprolactinemia. Radiological signs of a pituitary tumor were seen in 24 women (57%). During treatment, the prolactin concentrations rapidly decreased towards normal in all the women and ovulation returned in all but 2 of the women after 5.5 weeks, on the average. 1 of the nonresponders had previously undergone transfrontal hypophysectomy. Defect luteal function was observed during the 1st ovulatory cycle in 51% of the women, while 90% had a normal luteal phase after the 2nd ovulation. 21 of 22 women who attempted to become pregnant conceived and experienced a total of 27 pregnancies, of which 6 ended in abortion. 11 of the 22 infertile women had radiological signs of a pituitary tumor. None of them was pretreated with irradiation or surgery. Clinical signs of tumor enlargement during pregnancy were seen in 2 of 11 women. Visual field defects developed during pregnancy in 1 woman, but reinstitution of bromocriptine improved the visual impairment and the pregnancy went to full term. Another tumor patient, who had an uneventful pregnancy, showed signs of tumor growth at the postpartum sellar x-ray. None of 10 women with normal pituitary radiology showed symptoms or signs of tumor enlargement during pregnancy, but postpartum, the pituitary fossa was found to have increased in size and become asymmetric in 1 woman. Prolonged bromocriptine therapy reversed estrogen deficiency symptoms in the nonfertile women by restoring normal gonadal function and improved libido and general well-being. Whether longterm bromocriptine therapy inhibits further growth or even causes regression of prolactin secreting pituitary tumors is still an open question. To sum up, bromocriptine is the drug of choice for treatment of amenorrhea and infertility due to hyperprolactinemia.