Outcome of Treatment with Bromocriptine in Patients with Hyperprolactinaemia

Abstract

EDITORIAL COMMENT: The results obtained in Ms series of hyperprolac-tinaemic women indicates the efficacy and safety of bromocriptine therapy. Not everyone would agree with the need for routine surgical excision of pituitary macroadenomas nor with the cessation of the medication at 12 to 16 days after the first missed menstruation, since microadenomas may also enlarge in pregnancy.

Summary: Results in 136 hyperprolactinaemic women who presented with infertility, amenorrhoea, menstrual irregularities and/or galactorrhoea are reported. There was radiographic evidence of pituitary microadenoma in 21 (15.4%) patients and 5 (3.7%) had macrodenoma. Four patients were taking antidepressants, 2 an-tihypertensive drugs and 7 had taken oral contraceptives for a period of 6 months to 5 years. The remaining patients had no obvious cause for elevated prolactin levels. Patients with pituitary adenoma had a significantly higher (p<0.001) baseline serum prolactin level (182 ± 4.6 ng/ml) than those with no adenoma (59.2 ± 4.2 ng/ml). All patients in the study were treated with bromocriptine (2.5 — 10 mg) to normalize serum prolactin or to achieve a pregnancy. The patients without an adenoma required a significantly smaller dose of bromocriptine (2.5 - 5.0 mg) (p<0.005) than those with an adenoma. Galactorrhoea disappeared in all 64 patients within 2–4 months of treatment, sixty-six (71%) of the 93 patients who desired pregnancy achieved it within 3 to 8 months of bromocriptine therapy; 32 of these patients received additional treatment with clomiphene and human chorionic gonadotrophins for induction of ovulation. In the remaining 70 patients menstruation became regular and ovulation was evident in 40% of them. There was no significant difference in the pregnancy rate between the patients with or without pituitary adenoma. Similarly, presence of galactorrhoea or a high level of prolactin did not influence the pregnancy rate. No complications were observed during pregnancy related to pituitary adenomas; 8 (12%) pregnancies ended in first trimester abortion. No lethal congenital fetal abnormalities were observed in the patients treated with bromocriptine. It is concluded that hyperprolactinaemia in infertile patients with or without pituitary adenoma can be safely treated with bromocriptine with a high pregnancy rate and resumption of a normal menstrual pattern. All 5 patients with macroadenomas had excision of the tumour performed before bromocriptine therapy.