BROMOCRIPTINE TREATMENT OF 42 HYPERPROLACTINAEMIC WOMEN WITH SECONDARY AMENORRHOEA

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Abstract
Bromocriptine therapy was given to 42 amenorrhcic 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 wk, on average. One of the non-responders 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. Twenty-one of the 22 women, who attempted to become pregnant, conceived and experienced a total of 27 pregnancies, of which 6 ended in abortion. Eleven of the 22 infertile women had radiological signs of a pituitary tumor. None were pre-treated with irradiation or surgery. Clinical signs of tumor enlargement during pregnancy were seen in 2 of the 11 women. Visual field defects developed during pregnancy in 1 woman, but re-institution of bromocriptine improved the visual impairment and the pregnancy could be completed at full term. Another tumor patient, who had an uneventful pregnancy, showed signs of tumor growth at the post-partum sellar X-ray. None of 10 women with normal pituitary radiology showed symptoms or signs of tumor enlargement during pregnancy, but post-partum the pituitary fossa had increased in size and became asymmetric in 1 woman. Prolonged bromocriptine therapy reversed estrogen deficiency symptoms in the non-infertile women by restoring normal gonadal function and improved libido and general well-being. Whether long-term bromocriptine therapy inhibits further growth or even causes regression of prolactin secreting pituitary tumors is still an open question. Bromocriptine is apparently the drug of choice for treatment of amenorrhea and infertility due to hyperprolactinemia.