Title: Medical treatment of hyperprolactinemic states.

POPLINE Document Number: 017095

Author(s):

Ferrari C
Mattei A
Benco R
Barattini G
Caldara R
Vergadoro F
Rampini P
Reschini E
Crosignani PG

Source citation:

In: Crosignani PG, Rubin BL, ed. Endocrinology of human infertility: new aspects. London, England, Academic Press; New York, Grune and Stratton, 1981. :139-59. (Proceedings of the Serono Clinical Colloquia on Reproduction No. 2)

Abstract:

Current experience with bromocriptine and metergoline treatment of tumorous and idiopathic hyperprolactinemic disorders is reported in an effort to resolve some of the identified problems. Independently of the mechanisms that mediate the effects of the different prolactin (PRL) lowering drugs currently available, unresolved clinical problems in the medical treatment of hyperprolactinemic states include: choice of the drug and dose; risks of drug induced pregnancy; effects of drug treatment of PRL secretory dynamics; and effects of long term drug treatment on the disease process. 133 hyperprolactinemic women were studied and treated with PRL lowering drugs. The clinical presentation was secondary amenorrhea, with or without galactorrhea, in 108 cases, primary amenorrhea in 2, anovulation in 18, and isolated galactorrhea in 5. 2 patients also had acromegaly. Thyroid and adrenal function were normal in all subjects. After the initial evaluation, the patients were treated for 2-30 months with either bromocriptine or metergoline. 39 subjects were given separate courses of each drug. Treatment effectiveness was evaluated on clincial grounds and by measuring serum PRL concentrations at monthly intervals and serum progesterone in the presumed luteal phase whenever possible. The following were among the study findings: drug treatment reduced serum PRL levels toward the normal range and restored gonadal function in most hyperprolactinemic patients; bromocriptine appeared to be the most uniformly effective drug; metergoline was an excellent alternative which may sometimes be preferred for its lower incidence of side effects; the relatively lower success rate of metergoline may be dose related rather than drug related; the drug dose must be individualized because some patients are resistant to the PRL lowering action of the conventional doses; drug induced pregnancy carried little risk to either mother or fetus except for patients with pituitary macroadenomas; PRL secretory dynamics remained abnormal during PRL lowering treatment in most cases despite normalized basal levels; after drug withdrawal, cyclic menses and sometimes ovulation may persist for several months, but PRL levels rebound toward pretreatment values in the great majority of patients within 2 months; and as yet no signs of tumor shrinkage have been observed in patients treated for up to 2 years with either bromocriptine or metergoline.

Keywords:

Clinical Research
Italy
Prolactin
Treatment
Drugs
Amenorrhea
Menstruation Disorders
Gonadotropins, Pituitary
Gonadotropins
Ovarian Effects
Pregnancy
Research Methodology
Europe, Southern
Europe
Developed Countries
Pituitary Hormones
Hormones
Endocrine System
Physiology
Biology
Diseases
Ovary
Genitalia, Female
Genitalia
Urogenital System
Reproduction