Diagnostic and therapeutic modalities in women with galactorrhea

Prolactin response to various pharmacologic agents was tested and hypocycloidal polytomograms of pituitary sellae were performed in 77 women with galactorrhea. Polytomographic findings of pituitary sellae and the results of hypothalamic-pituitary tests were analyzed retrospectively in 18 patients with pituitary adenoma. Of the patients with pituitary tumor, 94% had abnormal polytomograms of sellae turcica, 89% had serum prolactin levels greater than 160 ng/ml (range, 170 to 264 ng/ml), and 78% showed abnormal response to thyrotropin-releasing hormone (TRH) stimulation test. Transsphenoidal excision of the tumor was complete in all 14 patients with microadenoma (10 mm or less in diameter) but was incomplete in 4 patients with macroadenoma and evidence of extrasellar extension. Galactorrhea ceased and normal ovulatory menses resumed after surgery in all patients with microadenoma. Twenty-five patients received bromocriptine. Twenty-three of them had hyperprolactinemia and 21 had normal sellar polytomograms. Galactorrhea ceased and normal menses occurred in 18; 6 patients conceived. Two patients with abnormal polytomography and euprolactinemia responded to bromocriptine treatment and 1 of them conceived. The findings suggest that serial prolactin levels and hypocycloidal polytomography of sella turcica are helpful in diagnosis of pituitary prolactinomas. The TRH stimulation test is also useful in evaluating these patients. Because the natural course of the prolactinomas and the long-term results of the surgical and pharmacologic treatments are unknown, ideal management has yet to be established.