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Hyperprolactinemic anovulatory syndrome

H G Bohnet, H G Dahlén, W Wuttke

    The Journal of Clinical Endocrinology and Metabolism
    |January 1, 1976
    PubMed
    Summary
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    Hyperprolactinemia, often linked to anovulation, can occur without galactorrhea in women with amenorrhea. Early screening for elevated prolactin is crucial for diagnosing and managing this reproductive disorder.

    Area of Science:

    • Reproductive Endocrinology
    • Clinical Investigation

    Background:

    • Anovulatory disease affects numerous women, impacting fertility.
    • The hypothalamo-pituitary-gonadal (HPG) axis plays a critical role in the menstrual cycle.
    • Understanding the functional status of the HPG axis is key to diagnosing anovulatory disorders.

    Purpose of the Study:

    • To investigate the functional status of the HPG axis in women with anovulatory disease.
    • To identify the prevalence and characteristics of hyperprolactinemia in this population.
    • To determine the clinical and hormonal features of the hyperprolactinemic anovulatory syndrome.

    Main Methods:

    • Assessed 127 women with anovulatory disease.
    • Measured serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin via radioimmunoassay (RIA).

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  • Evaluated hypothalamic-pituitary function using clomiphene challenge tests, LH pulsatility, LRH tests, and ovarian function via E2 and progesterone levels, and gestagen withdrawal tests.

    • Main Results:

    • 13.4% of patients (17/127) had hyperprolactinemia, with or without galactorrhea.
    • Hyperprolactinemic patients were consistently clomiphene non-responders and showed no LH secretory episodes (non-spikers).
    • These patients exhibited LH-hypogonadotropism, normal FSH levels, subnormal to normal estradiol (E2) levels, and gestagen withdrawal bleeding.

    Conclusions:

    • Hyperprolactinemic anovulatory syndrome can occur without galactorrhea.
    • Hyperprolactinemia should be screened in all amenorrhea cases, as it is frequently associated with anovulation.
    • Key features include gestagen withdrawal bleeding, normal FSH, low LH, and impaired response to clomiphene.