BROMOCRIPTINE TREATMENT OF 42 HYPERPROLACTINAEMIC WOMEN WITH SECONDARY AMENORRHOEA

Abstract

ABSTRACT Bromocriptine therapy was given to 42 amenorrhoeic women with hyperprolactinaemia. Radiological signs of a pituitary tumour were seen in 24 women (57 per cent). During treatment the prolactin concentrations rapidly decreased towards normal in all the women and ovulation returned in all but two of the women after 5.5 weeks, on average. One of the non-responders had previously undergone transfrontal hypophysectomy. Defect luteal function was observed during the first ovulatory cycle in 51 per cent of the women, while 90 per cent had a normal luteal phase after the second 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 tumour. None of them was pre-treated with irradiation or surgery. Clinical signs of tumour enlargement during pregnancy were seen in 2 of the 11 women. Visual field defects developed during pregnancy in one woman, but re-institution of bromocriptine improved the visual impairment and the pregnancy could be completed at full term. Another tumour patient, who had an uneventful pregnancy, showed signs of tumour growth at the post-partum sellar X-ray. None of 10 women with normal pituitary radiology showed symptoms or signs of tumour enlargement during pregnancy, but post-partum the pituitary fossa was found to have increased in size and become asymmetric in one woman. Prolonged bromocriptine therapy reversed oestrogen 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 tumours is still an open question. To sum up, bromocriptine is the drug of choice for treatment of amenorrhoea and infertility due to hyperprolactinaemia.