Cushing's disease presenting as amenorrhoea with hyperprolactinaemia: report of two cases

Two patients with Cushing's disease first presented with amenorrhoea, hyperprolactinaemia, and normal tomograms of the sella turcica. Both women underwent trans-sphenoidal removal of a pituitary microadenoma resulting in a decreased serum prolactin concentration in both, and cessation of galactorrhoea and return of menses in one of them. One woman became ACTH deficient while the other has persistent Cushing's disease. A survey of the literature on Cushing's disease and prolactinomas shows the association to be uncommon. A likely mechanism is secretion of both hormones by the microadenomas. These two patients illustrate the need for screening other pituitary hormone function in patients with hyperprolactinaemia.