Hyperprolactinemia in anovulatory women. Incidence and endocrine features.

Abstract

This retrospective study covers 496 cases of primary amenorrhea (n = 60), secondary amenorrhea (n = 298), and anovulatory oligomenorrhea (n = 138). The test system for these patients included the determination of basal plasma PRL values, the TRH-test (200 μg TRH i v ), LHRH-test (25 jtig LHRH i v ), antero-posterior and lateral X-ray of the sella, tomography in cases of suspected pituitary tumor and exclusion of other endocrine dysfunctions. In primary amenorrhea, PRL was found generally low at concentrations of 10.6 ± 5.8 ng/ml (mean ± SD) with two exceptions. 230 women with secondary amenorrhea showed normal basal PRL levels (10 ± 5.7 ng/ml), hyperprolactinemia was found in 68 women (23%). From this group, 25 patients (37%) had radiological indications of a pituitary tumor. In these patients, basal PRL levels (mean = 366 ng/ml) were significantly higher than in patients with normal sella findings (mean=92.5 ng/ml, p < 0.005). Hyperprolactinemia was detected in 26 women (19%) with anovulatory oligomenorrhea, but in a significantly lower range than in amenorrhea (p < 0.001). Galactorrhea was found in thirteen women (50%) with milk-leakage in two of them. The TRH-induced PRL release was not discriminative for the diagnosis of prolactinoma. The gonadotropic response after LHRH stimulation evaluated either by comparison to early follicular phase conditions or by the standardized Human-Pituitary-Gonadotropin (HPG)-lndex score showed a significantly higher frequency of “impaired” responses and R 0, R 1 respectively in cases of pituitary tumors and when PRL exceeded 200 ng/ml.