Metoclopramide test in women with PCO syndrome after ovarian wedge resection

Afternoon serum PRL levels and PRL responsiveness to metoclopramide (MCP) were determined in 36 women, aged 30.5 +/- 4.5, with normoprolactinemic anovulation. All women underwent a bilateral ovarian wedge resection with diagnosis polycystic ovarian disease (PCO) 2.9 +/- 2.0 years ago. After operation only four women had been pregnant. A bolus i.v. dose of 10 mg metoclopramide was given and serum PRL was estimated before, 30 and 60 min. after MCP administration. Diurnal serum PRL levels were approximately 9 ng in all patients. The PCO patients were classified into 2 groups in terms of the responsiveness to metoclopramide test. MCP induces rapid and marked elevation in serum PRL levels in all subjects. The maximum post MCP PRL value in the group I patients (n = 16) was 143.0 +/- 37.7 ng/ml, which was significantly higher than the maximum value in the II group patients (104.3 +/- 32.5 ng/ml) (P less than 0.005). Nine (56.2%) of the I group patients had maximum PRL values higher than 150 ng/ml; the proportion was statistically higher than 10 percent maximum PRL values in the group II (P less than 0.01). This finding suggests that the patients who had enhanced PRL responsiveness to MCP test have latent hyperprolactinemia, which can not be detected by analyzing PRL levels in blood samples taken randomly. This latent hyperprolactinemia presumably might be normalized by dopamine agonist therapy, resulting in resumption of ovulatory cycles in these women.