Management of patients with hyperprolactinemia and normal or abnormal tomograms

Abstract

Forty women with hyperprolactinemia with and without radiologic evidence of prolactin-secreting pituitary adenoma were prospectively treated with bromocriptine. On the basis of tomographic studies, the patients were divided into either a microadenoma group (N = 19) or no adenoma group (N = 21). Both groups had similar distributions as to obstetric history, menstrual abnormalities, levels of baseline serum luteinizing hormone, follicle-stimulating hormone, and thyrotropin. Patients in the adenoma group had significantly higher (p < 0.001) baseline serum prolactin levels (173 ± 4.4 ng/ml) than those of patients without adenoma (61.1 ± 4.5 ng/ml). Patients without an adenoma required significantly less bromocriptine (5 to 7.5 mg) (p < 0.005) to normalize serum prolactin or establish a pregnancy than did those who had an adenoma (5 to 20 mg). Similarly, patients with adenoma resumed ovulatory cycles (8.7 ± 1.2 versus 5.7 ± 0.06 weeks), had their galactorrhea disappear (11.3 ± 2.1 versus 5.6 ± 1.1 weeks), and become pregnant (16.2 ± 2.5 versus 9.8 ± 1.5 weeks) in a significantly longer time (p < 0.01) than did those who had no adenomas. There was no significant difference in the pregnancy rate between the groups, and the overall rate was 86% of 28 patients desiring pregnancy. No complications were observed during pregnancy. The conclusion is that both patients with and those without radiologic evidence of a prolactin-secreting pituitary adenoma can be safely treated with bromocriptine. In addition, the resumption of ovulatory cycles is more important than the absolute normalization of serum prolactin.