Impaired prolactin responsiveness to dopamine antagonists in acromegaly

Prolactin (PRL) and growth hormone (GH) secretion have been evaluated in 17 acromegalic patients following acute administration of two dopamine (DA) receptor antagonists, i.e. sulpiride (SULP) and domperidone (DOM). Six patients had persistent hyperprolactinemia. In 8 normoprolactinemic patients, i.m. injection of 100 mg SULP elicited only a slight rise iN plasma PRL, which was strikingly lower than that SULP induced in control subjects. Likewise, an i.v. bolus injection of DOM (4 mg) was barely effective to raise plasma PRL in the 11 normoprolactinemic and the 6 hyperprolactinemic patients. DOM was instead capable of inducing a clear-cut rise in plasma PRL in normoprolactinemic controls and in a group of subjects with puerperal hyperprolactinemia. Neither drug affected GH secretion in acromegalic patients. It is proposed that a defective tuberoinfundibular DA function or, alternatively, a diminished PRL reserve due to a decrease pituitary lactotroph mass may be responsible for the blunted PRL responsiveness of acromegalics. However, standing the paucity of present knowledge on the pituitary PRL secretory pool in acromegalics, neither hypothesis seems capable to account satisfactory for the reported results.