Management of patients with hyperprolactinemia and normal or abnormal tomograms

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 less than 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 less than 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 less than 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.