ergoline and Amenorrhea

Hyperprolactinemia is a condition characterised by an increase of prolactin blood levels (more than 100-200 ng/ml). It is the most common endocrine disorder of the hypothalamic-pituitary axis. The clinical characteristics of the headache-hyperprolactinemia-hypophyseal-adenoma association are discussed, the various diagnostic and treatment possibilities are explored and the etiology of the headache is considered in the light of several pathogenetic possibilities. We present two cases. (1) A 35-year-old woman suffering from chronic tension-type headache interspersed with occasional episodes of migraine without aura (as defined by the International Headache Society criteria). She had also suffered menstrual cycle alterations since the age of 16. At the age of 30 she developed amenorrhea with hyperprolactinemia. Computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a median-left intrasellar mass. Treatment with cabergoline resulted in complete resolution of both types of headache and the menstrual cycle and prolactin levels returned to normal. The therapy also reduced the volume of the tumour. (2) The second case relates to a 47-year-old man who had been suffering from tension-type headaches for almost 3 months. The patient had never previously suffered from headaches. CT and MRI scans showed a large sellar and suprasellar lesion with raised serum prolactin levels. Treatment with cabergoline had significantly reduced the prolactin levels and had also improved the patient's headaches. High-resolution CT, with and without contrast, or MRI is necessary to visualise microprolactinomas (and other sellar lesions) and confirm the diagnosis.

Topics: Adult; Amenorrhea; Antineoplastic Agents; Cabergoline; Ergolines; Female; Humans; Hyperprolactinemia; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Neoplasms; Prolactin; Tension-Type Headache; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adrenergic alpha-Antagonists; Adrenocorticotropic Hormone; Amenorrhea; Antineoplastic Agents; Bromocriptine; Cyproheptadine; Ergolines; Estrogens; Female; Galactorrhea; Growth Hormone; Humans; Hypothalamus; Levodopa; Pituitary Gland; Pituitary Neoplasms; Pregnancy; Prolactin

Topics: Adrenocorticotropic Hormone; Amenorrhea; Blood Glucose; Cushing Syndrome; Erectile Dysfunction; Ergolines; Female; Galactorrhea; Gonadotropins; Growth Hormone; Hormones; Humans; Lactation; Luteinizing Hormone; Male; Metergoline; Pancreatic Hormones; Pimozide; Pituitary Gland; Postpartum Period; Pregnancy; Prolactin; Receptors, Dopamine; Serotonin Antagonists; Thyrotropin

Cabergoline (CAB) is a long-acting dopamine agonist. In the first national study with CAB--as part of an international multicentric study--39 adult and adolescent females (16 to 44 years old) with hyperprolactinemic amenorrhea (18 microadenomas and 21 idiopathic hyperprolactinemias) were evaluated. CAB or bromocriptine (BEC) was administered for 24 weeks: over 8 weeks, treatment was given under double-blind conditions, and over the remaining 16 weeks (open period) 18 patients received CAB and 21 received BEC as a result of a random distribution. Maximum dosage: CAB = 1.5 mg in 2 or 3 weekly doses; BEC = up to 10 mg in 2 daily doses. Prolactin was measured at base line and 2, 4, 6, 8, 12, 14, 16, 20 and 24 weeks after the initiation of treatment. When vaginal bleeding was restored, progesterone was measured as an ovulation sign. The 4 adolescents continued with CAB treatment for 1 more year. Prolactin was statistically evaluated according to Man Whitney Test (general population) or Wilcoxon Test (adolescents). There were no significant differences between basal levels of prolactin (ng/ml) in patients treated with BEC or CAB: (173.86 +/- 28.23 and 152.11 +/- 14.06 respectively); at the fourth week of treatment the decrease was smaller (p = 0.005) in patients treated with BEC (36.36 +/- 5.71) than in those treated with CAB (14.06 +/- 3.60) and at 24 weeks differences disappeared: BEC = 19.88 +/- 4.48 and CAB = 9.63 +/- 2.62 (p = NS). The adolescents showed a marked decrease in prolactin with no significant differences between BEC and CAB: basal levels = 168.17 +/- 75.47 and 213 +/- 96.99 (p = NS); 4 weeks = 48.00 +/- 8.72 and 35.00 +/- 12.58 (p = NS); 24 weeks = 34.33 +/- 10.17 and 21.75 +/- 7.23 respectively. At 48 weeks (23.25 +/- 11.23) levels remained the same as those of week 24 (p = NS). Some patients treated with BEC had nausea, vomits and epigastralgia; these symptoms were not observed with CAB. All patients resumed menstrual cycles, except one treated with BEC; 6 patients treated with CAB became pregnant, and the 5 patients who continued under our control gave birth to healthy infants. It is concluded that CAB is a useful therapy. This is specially true for adolescents (an age group difficult to manage) because of its easy administration and the almost complete absence of side effects.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Cabergoline; Dopamine Agonists; Double-Blind Method; Drug Tolerance; Ergolines; Female; Humans; Hyperprolactinemia; Prolactin; Treatment Outcome

Cabergoline is a new, long-acting D2 agonist, highly effective in suppressing prolactin and restoring gonadal function in hyperprolactinaemic amenorrhoea. This study compares its efficacity and safety with that of the reference compound, bromocriptine.. A prospective study involved 21 French Centres and 120 women, with hyperprolactinaemic amenorrhoea, randomized to either cabergoline (CAB 0.5-1 mg twice weekly) or bromocriptine (BRC 2.5-5 mg twice daily). Treatment is given under double-blind conditions for the first 8 weeks, and subsequently in open conditions in further 16 weeks with dose adjustments according to response. Patients were assessed for biochemical and clinical efficacy and drug safety (adverse symptoms and biology).. Normoprolactinaemia was achieved in 56/60 (93.3%) taking CAB and 27/58 (48.2%) taking BRC (p < 0.0001). Ovulatory cycles or pregnancy were recorded in 71.6% and 48.2% of patients (p = 0.001). Prolactin suppression to below 50% of the baseline value was observed in 1.6% and 15.5% (p = 0.007). Adverse symptoms were recorded in 31/60 (51.6%) and 40/58 (69.2%) patients respectively in the double-blind period, and 53.3% versus 65.5% for the full course of the study. There were significantly fewer gastro-intestinal symptoms in the CAB group, 36.6% versus 84.5% (p < 0.0001).. Cabergoline is a new prolactin-lowering drug, more effective and better tolerated with fewer gastrointestinal symptoms than the reference compound, bromocriptine.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Cabergoline; Dopamine Agonists; Double-Blind Method; Ergolines; Female; France; Humans; Hyperprolactinemia; Middle Aged; Prolactin; Prospective Studies

Cabergoline is a long-acting dopamine-agonist drug that suppresses prolactin secretion and restores gonadal function in women with hyperprolactinemic amenorrhea. We designed a study to compare its safety and efficacy with those of bromocriptine, which has been the standard therapy.. A total of 459 women with hyperprolactinemic amenorrhea were treated with either cabergoline (0.5 to 1.0 mg twice weekly) or bromocriptine (2.5 to 5.0 mg twice daily), administered in a double-blind fashion for 8 weeks and subsequently in an open fashion for 16 weeks, during which adjustments in the dose were made according to the response. Of the 459 women, 279 had microprolactinomas, 3 had macroprolactinomas, 1 had a craniopharyngioma, 167 had idiopathic hyperprolactinemia, and the remainder had an empty sella. Clinical and biochemical status was assessed at 2-week intervals for 8 weeks and monthly thereafter for a total of 6 months, with an additional assessment at 14 weeks.. Stable normoprolactinemia was achieved in 186 of the 223 women treated with cabergoline (83 percent) and 138 of the 236 women treated with bromocriptine (59 percent, P < 0.001). Seventy-two percent of the women treated with cabergoline and 52 percent of those treated with bromocriptine had ovulatory cycles or became pregnant during treatment (P < 0.001). Amenorrhea persisted in 7 percent of the cabergoline-treated women and 16 percent of the bromocriptine-treated women. Adverse effects were recorded in 68 percent of the women taking cabergoline and 78 percent of those taking bromocriptine (P = 0.03); 3 percent discontinued taking cabergoline, and 12 percent stopped taking bromocriptine (P < 0.001) because of drug intolerance. Gastrointestinal symptoms were significantly less frequent, less severe, and shorter-lived in the women treated with cabergoline.. Cabergoline is more effective and better tolerated than bromocriptine in women with hyperprolactinemic amenorrhea.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Cabergoline; Dopamine Agents; Double-Blind Method; Ergolines; Female; Humans; Hyperprolactinemia; Middle Aged; Prolactin

To further evaluate the potency and time course of the PRL-lowering effect of single oral doses of cabergoline, two doses of the drug were given to 51 hyperprolactinemic patients who also received 2.5 mg bromocriptine according to a randomized cross-over design. One group (n = 26) received 0.3 mg, and the other (n = 25) received 0.6 mg. Both cabergoline doses induced a significant fall in serum PRL levels, which lasted, on the average, from 3 h to 5 days after 0.3 mg and from 3 h to 14 days after 0.6 mg; the mean maximum decrease after 0.3 mg was -65 +/-4% (+/- SEM), significantly (P less than 0.05) less than that after bromocriptine (group mean, -73 +/- 4%), and it was -76 +/- 3% after 0.6 mg, not significantly different from that induced by bromocriptine (group mean, -71 +/- 4%). The effect of 0.6 mg cabergoline was significantly greater than that of 0.3 mg (P less than 0.01). In a second study designed to evaluate the possible therapeutic use of the new drug, 0.3 or 0.6 mg cabergoline was administered orally once weekly for 9 weeks to 2 groups of 15 and 16 hyperprolactinemic patients, respectively. Serum PRL levels fell significantly by the first week and reached a plateau after 2 doses in the 0.6 mg cabergoline-treated group and after 5 doses in the 0.3 mg-treated group; the absolute PRL decrease was greater in the former. Ten patients in each group achieved normal serum PRL levels, and a marked decrease (greater than 50% of pretreatment values) occurred in all patients treated with 0.6 mg and in 13 treated with 0.3 mg weekly. Resumption of menses occurred during the treatment period in 15 of the 17 premenopausal women with amenorrhea. Six patients who had poor responses had better responses when given higher drug doses for 4 weeks, and serum PRL levels became normal in the 3 receiving 0.6 mg twice weekly. These data confirm that cabergoline is a long-acting oral dopaminergic drug and suggest that it may be a useful agent for the treatment of patients with hyperprolactinemia.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Cabergoline; Clinical Trials as Topic; Ergolines; Female; Humans; Hyperprolactinemia; Kinetics; Male; Middle Aged; Prolactin

In a multicentric study, the effect of the antiserotoninergic agent metergoline was evaluated in the management of patients with idiopathic normoprolactinemic secondary amenorrhea (NSA). The awareness that psychological factors might lead to a spontaneous reappearance of menses was also taken into account, and all the patients, after physical, gynecological and laboratory examinations, and the performance of the progesterone withdrawal bleeding test (100 mg i.m.) and the clomiphene citrate test (100 mg p.o./day for 5 days), were treated for 60 days with placebo; only patients showing no menses during placebo administration were later treated with metergoline. 108 patients entered the trial: of these, 48 experienced menses on admission or during placebo administration, and were withdrawn. Of the 60 patients not responding to placebo, 50 were treated for 90 days with metergoline (4 mg t.i.d.), and 23 had menses, ovulatory in 68.4% of cases. A new placebo treatment was accompanied, in the majority of cases, by recurrence of amenorrhea. These results indicate that many patients with NSA may experience a spontaneous disappearance of the disease: in cases more seriously affected metergoline might be a useful therapeutic agent.

Topics: Amenorrhea; Clinical Trials as Topic; Ergolines; Female; Humans; Metergoline; Prolactin; Serotonin Antagonists

The results of this study offer further evidence that metergoline is a valuable alternative to bromocriptine in the suppression of excessive prolactin secretion. Forty-nine hyperprolactinaemic and 44 normoprolactinaemic women with amenorrhoea took part in a double-blind trial to compare the efficacy of metergoline 12 mg/day and bromocriptine 7.5 mg/day in restoring menstruation and ovulation. All the women had normal results on conventional tomography of the sella turcica, normal gonadotrophin levels and normal androgen levels. In the hyperprolactinaemic group, metergoline and bromocriptine were equally effective, with 84 and 75% respectively achieving menstruation, and 76 and 67% respectively achieving ovulation, within 4 months. In the normoprolactinaemic group, 47% menstruated and 40% ovulated on metergoline, against comparative figures of 36 and 21% for bromocriptine and 20 and 13% for placebo, but the differences were not statistically significant. Side effects were not a major problem.

Topics: Adult; Amenorrhea; Bromocriptine; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Ergolines; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menstruation; Metergoline; Ovulation; Progesterone; Prolactin; Random Allocation; Time Factors

Thirty-one patients with hyperprolactinemia were admitted for protocol study. Twenty-one of these patients had no findings of prolactinoma by computerized axial tomography (CAT) scanning; 10 had documented tumor by CAT scan. The patients were assigned to either Parlodel or Pergolide treatment on the basis of random numbers tables. They were treated for 6 months continuously and followed during this time with radiologic survey, hormonal evaluation, and blood chemistry determinations. Patients in both groups showed a decrease in prolactin levels, whether they were treated with Parlodel or Pergolide. The response was similar whether patients had hyperplasia or pituitary tumors. Patients with pituitary tumors tended to have a diminution in the size of their lesions regardless of the dopamine agonist used. The types of side effects experienced by various groups were similar regardless of the treatment. It is concluded that both Pergolide and Parlodel are useful in the treatment of hyperprolactinemic syndromes, although neither one appears to be superior to the other.

Topics: Adolescent; Adult; Aged; Amenorrhea; Bromocriptine; Clinical Trials as Topic; Dopamine; Ergolines; Female; Galactorrhea; Humans; Middle Aged; Pergolide; Pituitary Neoplasms; Pregnancy; Prolactin; Random Allocation

84 patients with elevated serum PRL levels, ranging from 25 to 253 ng/ml, were treated with an antiserotonin agent, metergoline, at the dose of 12 mg/day for 90 days. The clinical complaint was of amenorrhea in 70 cases (plus galactorrhea in 44 cases) and of anovulation in 14 cases (plus galactorrhea in 6 cases). Hyperprolactinemia was due to a pituitary adenoma in 18 cases; in 53 cases it was of unknown origin, while in 7 cases it followed treatment with neuroleptics or with oral contraceptives and in 6 cases it followed a puerperium. In patients with amenorrhea, metergoline induced the appearance of menses in 61 cases (94%), and of ovulation in 46 cases (82%). In 13 of the 14 patients with anovulation, ovulation was restored. Galactorrhea disappeared in 40 out of 50 patients. Metergoline normalized serum PRL levels (less than 20 ng/ml) in 46 cases and significantly reduced serum PRL levels in all but 3 of the remaining patients. In spite of suggested nonhormonal contraceptive measures, 14 patients became pregnant; 2 had abortions and the remaining 12 patients completed by vaginal delivery, uneventful pregnancies. These results indicate metergoline as a safe and effective drug in the management of hyperprolactinemic amenorrhea and anovulation. 49 patients were followed for 2 additional months, receiving no treatment (24 cases) or metergoline at a reduced daily dosage (8 mg/day, 25 cases). Within 60 days, 60% of the first group had relapse of the clinical condition and a rebound elevation of serum PRL levels while only 20% of the second group experienced relapse of amenorrhea and rebound elevation of serum PRL levels (p less than 0.01).

Topics: Amenorrhea; Anovulation; Clinical Trials as Topic; Ergolines; Female; Galactorrhea; Humans; Metergoline; Pregnancy; Prolactin

To examine the monitoring, management, and outcomes of pituitary tumors in pregnancy.. A national, prospective, observational, population-based case series study was conducted in all U.K. consultant-led obstetric units over 3 years using the U.K. Obstetric Surveillance System. To evaluate rates of adverse pregnancy outcomes, women with a macroprolactinoma (10 mm or greater) or nonfunctioning pituitary adenoma, diagnosed before or during pregnancy, were compared with two comparison groups: 1) a U.K. Obstetric Surveillance System cohort with singleton (n=2,205) or twin (n=27) pregnancy; and 2) data from the Office of National Statistics (n=2,703,102). Main outcome measures were the incidence, management, and frequency of adverse maternal and offspring outcomes of pituitary tumors in pregnancy.. There were 71 confirmed cases of pituitary tumors in pregnancy (49 macrolactinoma, 16 nonfunctioning adenomas, three acromegaly, three Cushing's disease). The women with pituitary tumors were 4 years older than comparison women (P<.001). None of the nine women treated with surgery or radiotherapy before pregnancy had symptomatic tumor expansion. This occurred in 6 of 40 women with macroprolactinomas and one of seven nonfunctioning adenomas diagnosed before conception and in three of five women with nonfunctioning adenomas diagnosed in pregnancy. Two women had pituitary apoplexy, both of whom also had symptoms of expansion of tumor or surrounding pituitary tissue. To within the level of accuracy possible, there was no evidence that pituitary tumors were associated with adverse pregnancy outcomes (pregnancy-induced hypertension, preeclampsia, preterm labor, stillbirth). Women with nonfunctioning adenomas were more likely to have cesarean delivery compared with women in a control group (relative risk 2.06, confidence interval 1.26-3.36, P=.035).. The majority of women with macroprolactinomas and nonfunctioning adenomas have good pregnancy outcomes. Nonfunctioning pituitary adenomas occur more commonly in pregnancy than previously thought and can present de novo with symptoms of pituitary expansion in pregnancy.

Topics: Adenoma; Adult; Amenorrhea; Antineoplastic Agents; Bromocriptine; Cabergoline; Case-Control Studies; Cesarean Section; Dopamine Agonists; Ergolines; Female; Galactorrhea; Humans; Incidence; Pituitary Neoplasms; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Complications, Neoplastic; Premature Birth; Prolactinoma; Prospective Studies; Stillbirth; United Kingdom; Vision Disorders; Young Adult

We report clinical presentation, response to medical treatment, and long-term follow-up of 39 children and adolescents with prolactinoma (F:M; 30:9) (30 macro and 9 microadenoma) diagnosed at the age of 9-20 years. Mean duration of follow up was 56 months. All patients were treated with bromocriptine (BC) at doses ranging from 2.5 to 20 mg/day or by cabergoline at doses ranging from 0.5 to 2 mg/week orally. Two patients received external conventional radiotherapy after surgery. In patients with macroprolactinoma (F:M; 21:9), headache and/or visual defects were the first symptoms. All females had primary or secondary amenorrhea. Growth arrest was not observed in any patient and pubertal development was appropriate for their age. Spontaneous or provocative galactorrhea was observed in 23 patients (all females) and none of male patient had gynecomastia. Mean serum prolactin (PRL) concentration at the time of diagnosis was 322.50 ng/ml in patients with microadenoma, 522.38 ng/ml in patients with macroadenoma and 2,294.86 ng/ml in patients with macroadenoma with suprasellar extension. In 25 patients, BC normalized PRL levels and caused variable, but significant, tumor shrinkage. Cabergoline normalized PRL concentrations in 14 patients. Pregnancy occurred in 6 patients while on treatment. Pregnancies were uncomplicated, and the patients delivered normal newborns at term. Impairment of other pituitary hormone secretion was documented at the time of diagnosis in only one patient. Postoperatively six patients had other pituitary hormone deficiencies. In conclusion, the medical treatment with dopaminergic compounds is effective and safe in patients with prolactinoma with onset in childhood, allowing preservation of the anterior pituitary function.

Topics: Adolescent; Amenorrhea; Bromocriptine; Cabergoline; Child; Dopamine Agonists; Ergolines; Female; Galactorrhea; Humans; Male; Pregnancy; Prolactin; Prolactinoma; Retrospective Studies; Treatment Outcome; Young Adult

Headache is a common problem in patients with pituitary tumours. Small pituitary lesions can cause debilitating headache, suggesting that the size of the pituitary tumour may not be the only causal factor in pituitary-related headache. We present two cases of prolactinoma-associated headache. The first case has a clinical diagnosis of short-lasting unilateral headache attacks with conjunctival injection and tearing (SUNCT). The second case has a clinical diagnosis of hemicrania continua and idiopathic stabbing headache. In each case, the administration of dopamine agonists has led to an exacerbation of symptoms. We review the relevant literature to understand the pathophysiological implications of these cases.

Topics: Adult; Amenorrhea; Anti-Inflammatory Agents, Non-Steroidal; Bromocriptine; Cabergoline; Dopamine Agonists; Ergolines; Female; Headache; Humans; Indomethacin; Magnetic Resonance Imaging; Pituitary Neoplasms; Prolactin; Prolactinoma; Radiography

Pituitary adenomas in childhood and adolescence constitute 2-6% of all operated pituitary adenomas. We report the clinical features, treatment and follow-up of 10 pediatric patients affected by pituitary adenomas. All patients underwent clinical evaluation, endocrine tests, magnetic resonance imaging and visual field assessment. Follow-up ranged from 8 to 132 months (median 52.6). All patients were older than 10 years of age; 60% were males. In 50% the initial complaints were headache and/or visual impairment, all except one had clear evidence of endocrine dysfunction. Ninety percent were macroadenomas. According to hormone measurements and immunostaining 50% were prolactinomas, 20% were pure GH-secreting and 30% were non-functioning adenomas. Prolactinomas in two females were successfully treated with cabergoline. The other patients underwent surgery: three prolactinomas are still being treated with dopamine agonists and a GH-secreting adenoma is being treated with octreotide LAR and cabergoline. Two patients were also treated with conventional radiotherapy. Treatments were completely successful in 50% of patients: these have normal hormone secretion, full pubertal development, no significant tumor mass and normal visual field. Hypersecretion of prolactin persists in two cases; partial or complete hypopituitarism is present in four, relevant tumor remnant in another four and impairment of visual field is present in two cases. In conclusion, pediatric adenomas occur mostly in pubertal age, are prevalently macroadenomas and clinically functioning. Medical therapy should be preferred for secreting adenomas, but in some cases, notably prolactinomas in males, surgery and eventual radiotherapy may be needed.

Topics: Acromegaly; Adenoma; Adolescent; Amenorrhea; Bromocriptine; Cabergoline; Child; Ergolines; Female; Headache; Human Growth Hormone; Humans; Male; Neoplasm Recurrence, Local; Octreotide; Pituitary Neoplasms; Prolactinoma; Puberty, Delayed; Radiotherapy; Treatment Outcome; Vision Disorders; Visual Fields

Topics: Amenorrhea; Bromocriptine; Cabergoline; Dopamine Agents; Ergolines; Female; Humans; Hyperprolactinemia

Dopaminergic drugs have been reported to be effective in the treatment of FSH-secreting adenomas. We describe the case of a young woman suffering from amenorrhea with radiologic signs of pituitary macroadenoma. The enlargement of both ovaries with hemorrhagic and serous cysts suggest that FSH was active biologically. The short-term (13 weeks) chronic treatment with 0.5 mg cabergoline one time per week, a dopaminergic drug with long-lasting effect, was effective in reducing FSH and PRL hypersecretion and restoring the function of the pituitary ovarian axis, as confirmed by the occurrence of pregnancy.

Topics: Adenoma; Adult; Amenorrhea; Cabergoline; Dopamine Agonists; Ergolines; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Pituitary Neoplasms; Pregnancy; Prolactin

Thirteen women with hyperprolactinemic amenorrhea were treated with lisuride (Dopergin, Schering AG, Germany). The dosage of lisuride was started with 0.1 mg per day and increased to 0.2 mg per day after one week of treatment. Further increment of the drug depended on clinical and laboratory responses of the patients. One patient dropped out from the study due to marked nausea and dizziness. In ten out of twelve patients serum prolactin decreased to normal. Most patients received lisuride 0.2-0.4 mg per day. Only one got more than 0.4 mg per day. Two patients whose serum prolactin levels did not decrease to normal range had uterine bleeding, quite regularly. Menstrual cycle resumed within 23 to 141 days. All galactorrhea disappeared during treatment. Two of five patients who desired pregnancy became pregnant during the treatment. The course and outcome of pregnancies were normal. Common side effects of lisuride treatment were nausea and dizziness. In conclusion, this study demonstrated that lisuride is another effective prolactin inhibiting agent even at low dose. This drug provides an alternative treatment to bromocriptine.

Topics: Adult; Amenorrhea; Ergolines; Female; Humans; Hyperprolactinemia; Lisuride; Prolactin

Cabergoline (CAB) is a new oral dopaminergic compound showing a very long-lasting PRL-lowering activity and reported to be well tolerated. The efficacy and tolerability of chronic treatment with CAB in 30 female hyperprolactinemic patients, aged 18-52 yr (6 microadenomas, 3 macroadenomas, and 21 functional hyperprolactinemias), were studied. In a group of 10 patients who received CAB (0.8 mg once weekly or 0.4 mg twice weekly) for 8 weeks PRL levels normalized while on treatment and remained normal (8 patients) or greatly reduced (1 patient) for 1-2 months after discontinuation of the drug. Twenty-six patients underwent chronic treatment (6-12 months) with an initial dose of 0.5 mg once weekly, subsequently increased to 1-2 mg in 10 patients and decreased in the other 2. Due to severe side-effects CAB was discontinued in 3 patients, in 1, 8, and 12 weeks. A significant reduction of PRL levels was already observed after the first week of treatment (mean +/- SEM basal values, 90.1 +/- 13.3 vs. 29.5 +/- 6.3 micrograms/L; P less than 0.001). Twenty-two patients had normal PRL levels in 1-36 weeks (mean, 6 weeks) with 0.5-2 mg CAB. Twenty-two patients resumed regular menses; 2 patients became pregnant after 3-11 months of treatment. Thirteen patients complained of side-effects (nausea, hypotension, headache, gastric pain, dizziness, and weakness) that disappeared with time in 10 of them. The comparison with a previous bromocriptine treatment regimen in 20 patients had shown that the number of patients requiring discontinuation of the latter drug was significantly higher (7 vs. 3 patients; P less than 0.001). However, 2 patients who needed to discontinue CAB were able to tolerate bromocriptine therapy. A computed tomographic scan performed after 12 months of therapy in 7 patients showed a significant reduction (50%) of the adenoma in 5. In conclusion, our results show that CAB is a well tolerated new dopamine agonist with long-lasting activity that represents an advance in chronic medical treatment of hyperprolactinemic conditions.

Topics: Adenoma; Adult; Amenorrhea; Bromocriptine; Cabergoline; Dopamine Agents; Ergolines; Female; Humans; Hyperprolactinemia; Pituitary Neoplasms; Prolactin

The ergoline derivative, Metergoline, in a dosage of 4 to 24 mg/day, was administered for one to eight months to 42 patients with hyperprolactinemic amenorrhea. Mean serum prolactin (PRL) concentrations before treatment were 91.2 ng/mL in the patients with functional hyperprolactinemia (N = 29) and 256.9 ng/mL in the patients with pituitary tumor (N = 13). Within four weeks, Metergoline treatment reduced these PRL concentrations to 39.5 ng/mL and 82.9 ng/mL, respectively. In this study Metergoline treatment resulted in restoration of menstruation in a total of 37 patients; 28 patients ovulated, and eight became pregnant. It is considerably more effective in functional hyperprolactinemia than in hyperprolactinemia caused by adenoma.

Topics: Adenoma; Adult; Amenorrhea; Ergolines; Female; Humans; Hyperprolactinemia; Metergoline; Metoclopramide; Nausea; Ovulation; Pituitary Neoplasms; Progesterone; Prolactin; Tomography, X-Ray Computed

The effects of single oral doses of 0.1 mg lisuride hydrogen maleate (lisuride), a semisynthetic ergot derivative given at 09.00 h, on the serum levels of prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), thyroid-stimulating hormone (TSH), oestradiol and cortisol were studied in six normally cycling women and six patients with hyperprolactinaemic amenorrhoea. The same subjects received placebo and the results were compared with those of lisuride. Within 1 h after oral administration of lisuride, PRL levels decreased significantly (P less than 0.05) and reached the lowest level at 4 h after ingestion and stayed low until 8 h in both normal women and hyperprolactinaemic patients. LH levels slightly but not significantly decreased after lisuride administration in hyperprolactinaemic patients. Serum cortisol levels increased at 13.00 h, probably due to the effect of meal. No significant differences between the lisuride group and placebo group were observed in GH, TSH, FSH and oestradiol levels. These results suggest that lisuride acts as a long-acting prolactin suppressor and that it has little effects on the secretion of other pituitary hormones. Therefore, this drug could be useful for treatment of hyperprolactinaemic patients.

Topics: Adult; Amenorrhea; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Hydrocortisone; Lisuride; Luteinizing Hormone; Pituitary Hormones, Anterior; Prolactin; Thyrotropin

Serum prolactin (PRL) was estimated for up to 2 months after discontinuation of therapy with either bromocriptine (n = 33; 15 with idiopathic disease, 12 with pituitary microadenoma, and six with macroadenoma) or metergoline (n = 23; 11 with idiopathic disease, and 12 with microadenoma) that had been administered for 8-30 months. Only five patients treated with bromocriptine and two treated with metergoline had PRL levels that remained normal or below 50% of pretreatment values. Among the patients followed-up for up to 12 months, four showed a fall in PRL at 3-4 months, but this was followed by a rise in one patient. Five patients showing persistently lower or normal PRL after drug withdrawal were retested with thyrotrophin-releasing hormone; the two responsive women also had a normal response before treatment. Of 10 patients followed for 9 months, three had persistently normal PRL levels. Amenorrhoea and anovulation recurred, with some delay, in all the patients showing PRL rebound except one. Medical treatment of hyperprolactinaemia only rarely results in permanent benefit.

Topics: Adenoma; Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Metergoline; Ovulation; Pituitary Neoplasms; Progesterone; Prolactin; Prospective Studies; Recurrence

Eighteen hyperprolactinaemic patients were orally treated for up to 16 months with pergolide mesylate, a new potent long-lasting dopaminergic ergot derivative. In all cases, Prl normalization (less than 25 ng/ml) was achieved at a once-a-day dose of 50-300 micrograms. All women recovered and/or exhibited normal menstrual function. Among the 6 women wishing to become pregnant, 4 of them conceived within 4 months; there were other causes for infertility than hyperprolactinaemia in the 2 other couples. A macroprolactinoma man experienced important improvement in well-being as well as objective regression of his visual fields defect. This suggests a shrinkage effect of pergolide on the tumoural process. Another man regained normal potency and normal testosterone within 2 weeks. While 10 patients were completely free of any side effect, 7 experienced transiently mild gastro-intestinal side effects or postural hypotension. Only one patient discontinued her treatment because of dizziness. The present study demonstrates the high potency, the good tolerance and the excellent efficacy of pergolide in the treatment of hyperprolactinaemia.

Topics: Adolescent; Adult; Amenorrhea; Dose-Response Relationship, Drug; Ergolines; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Middle Aged; Oligomenorrhea; Pergolide; Pituitary Neoplasms; Prolactin; Time Factors

59 patients affected by amenorrhea or anovulation, 37 of whom also with galactorrhea, and with hyperprolactinemia of unknown origin (idiopathic hyperprolactinemia, 24 patients) or due to a pituitary microadenoma (tumoral hyperprolactinemia, 35 patients) were treated with metergoline (4-12 mg/day) or with bromocriptine (2.5 to 10 mg/day) for 90 days. The effectiveness of the two treatments was assessed on clinical grounds and by evaluating at monthly intervals serum progesterone levels, during the presumed luteal phase, and serum prolactin levels. The success rate with the two drugs was superimposable in terms of disappearance of galactorrhea and return of menses, normalization of prolactin levels and induction of ovulation. Also the number of pregnancies obtained (7 with metergoline, 9 with bromocriptine) was similar. With both drugs, the majority of patients responded to the treatment within the first month.

Topics: Adenoma; Adult; Amenorrhea; Anovulation; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Metergoline; Middle Aged; Pituitary Neoplasms; Pregnancy; Prolactin

20 puerperal women who did not wish to breast feed their infants were treated with the serotonin antagonist metergoline. In 19 cases effective suppression of puerperal lactation was achieved by the administration of metergoline without the side effects or signs of intolerance. Of 9 women with hyperprolactinaemic amenorrhoea treated with metergoline the raised prolactin level was lowered, followed by menstruation in 7 patients. Ovulation even occurred in 5 of these women. One patient had to discontinue therapy due to intolerance. in normoprolactinaemic amenorrhoea regular menstruation reappeared in 4 out of 5 women; 2 patients even ovulated.

Topics: Adolescent; Adult; Amenorrhea; Ergolines; Female; Humans; Hypotension; Lactation; Metergoline; Pregnancy; Prolactin; Vomiting

One hundred ninety-one hyperprolactinemic patients (78 women and 13 men; 54 with pituitary macroadenoma, 53 with microadenoma, and 84 with idiopathic disease) were treated for 2 to 48 months with one or two of the following prolactin (PRL)-lowering drugs: bromocriptine, metergoline, and lisuride. All of the three drugs used were highly effective in lowering PRL levels and restoring gonadal function both in females and in males in the majority of patients with either idiopathic or tumorous disease. In poorly responsive patients, increasing the drug doses resulted in further PRL lowering for all the three drugs. Mild side effects were frequently encountered with initiation of drug treatment but spontaneously subsided in most cases; severe side effects, necessitating stopping of the treatment, occurred in only 12 instances, but changing of the drug allowed PRL-lowering treatment to be continued in 11 of them.

Topics: Adenoma; Adolescent; Adult; Amenorrhea; Bromocriptine; Erectile Dysfunction; Ergolines; Female; Galactorrhea; Humans; Lisuride; Male; Metergoline; Middle Aged; Ovarian Function Tests; Pituitary Neoplasms; Pregnancy; Prolactin; Visual Fields

Topics: Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pregnancy; Risk; Surveys and Questionnaires

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Hyperprolactinemia; Infertility, Female; Lisuride; Menstruation; Prolactin

Topics: Adenoma; Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Hyperprolactinemia; Lisuride; Pituitary Neoplasms; Pregnancy; Prolactin

Topics: Adult; Amenorrhea; Drug Evaluation; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Luteinizing Hormone; Pergolide; Pregnancy; Prolactin

Topics: Adolescent; Adult; Amenorrhea; Ergolines; Female; Humans; Metergoline; Prolactin

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Infertility, Female; Lisuride; Pregnancy; Prolactin

Twenty-five patients, aged 23-39, with amenorrhea of 18 to 168 months' duration, galactorrhea, hyperprolactinemia (prolactin levels of 45 to 370 ng/ml), and radiologic evidence of a pituitary microadenoma, were treated with bromocriptine or lergotrile, 7.5 mg daily for 2 to 16 weeks until conception occurred. All conceived and were delivered of infants. Follow-up during pregnancy included frequent office visits and monthly visual field examinations from the sixth month until delivery. All the pregnancies resulted in single infants and uneventful and no neurological or visual symptoms developed. All infants born were normal. Twelve patients breast-fed while the others did not by choice. Menstrual function resumed in two patients after delivery and one of them subsequently conceived spontaneously. We believe that the presence of a pituitary microadenoma without neurological or visual symptoms should not be a contraindication to ovulation induction and pregnancy. Most of such pregnancies are uneventful. If symptoms arise during pregnancy, they can be treated medically or, in extreme emergencies, surgically.

Topics: Adenoma; Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Infant, Newborn; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prolactin

A 19-year-old girl with primary amenorrhea, galactorrhea, and hyperprolactinemia is described. Her high serum prolactin levels (95 ng/ml) did not increase after thyrotropin-releasing hormone and sulpiride, but markedly decreased after acute bromocriptine and metergoline administration. The results of other pituitary function tests were normal. Tomography of the sella turcica and CT scan of the skull were also normal. The patient was treated with metergoline, a prolactin-lowering drug which is believed to act as a serotonin antagonist, for 30 months. Serum prolactin rapidly decreased after institution of treatment, with actual normalization (less than 20 ng/ml) by the 3rd month. At this time the low serum luteinizing hormone levels began to rise and fluctuate in the normal follicular range. Galactorrhea disappeared, and menarche occurred during the 15th month of treatment. 15 further menstrual bleedings ensued over the following 15 months, albeit at irregular time intervals; ovulation was suggested by finding elevated serum progesterone levels in the presumed luteal phase by about 1 year following the menarche. The available data on 38 patients with primary amenorrhea and hyperprolactinemia reported in the literature are reviewed. 15 of them were treated with bromocriptine, and either pregnancy or cyclic menses occurred in 11. Hyperprolactinemic primary amenorrhea may be more common than previously recognized, and it may probably be successfully treated by prolactin-lowering drugs or by surgical ablation of a pituitary adenoma in a high percentage of cases.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Lactation Disorders; Luteinizing Hormone; Metergoline; Pregnancy; Progesterone; Prolactin; Sulpiride; Thyrotropin-Releasing Hormone

This is a report about 20 sterile women in whom the amenorrhoea or oligomenorrhoea was accompanied by hyperprolactinaemia. Parlodel, Lysenyl, and Deprenon were used for treatment. The therapy was followed by pregnancy of 70 per cent of the women.

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Infertility, Female; Lisuride; Oligomenorrhea; Pregnancy; Prolactin

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Kidney Function Tests; Liver Function Tests; Menstruation; Metergoline; Ovulation Induction; Pregnancy; Prolactin; Sella Turcica

Topics: Adenoma; Adult; Amenorrhea; Bromocriptine; Dopamine; Ergolines; Female; Humans; Metergoline; Pituitary Gland; Pituitary Neoplasms; Prolactin; Sulpiride

10 amenorrhea-patients and 5 galactorrhea-amenorrhea-patients were treated wi2-Br-alpha-ergocryptine (CB 154) as a specific prolactin inhibitor. Side-effects, such as headaches, dizziness, and nausea could be reduced to a minimum by delivering the drug with the meal at night. Before and under the treatment hormone levels were determined in plasma and 24-hour-urine. In the beginning all 15 patients showed a hyperprolactinaemia with a nearly always simultaneously existing hypogonadotropinaemia and the absence of LH-peaks. Also the estrogen- and progesterone-concentrations were on the lower normal level or extremely suppressed. In all patients CB 154 therapy led to a quick decrease of the prolactin levels, to a regaining of typical LH- and FSH-episodes, as well as to a regeneration of ovarian function. 5 women reacted with an ovulation, 3 became pregnant. The galactorrhea diminished significantly and stopped finally after a treatment of one week to 6 months. Discontinuation of CB 154-therapy, however, often provoked the galactorrhea-amenorrhea-syndrome again. For women with normoprolactinaemic amenorrhea a gestagen- and estrogen-test were carried out in order to classify the amenorrhea-type and it was tried to induce an ovulation with Dyneric. For patients with a strong desire for children and without any organic cause for their sterility, in cases of ovarian insufficiency grade I and II a HMG-HCG-treatment was often indicated. In spite of a precise control in order to avoid an overstimulation of the ovaries about 1% of the Dyneric-treated and even 30% of the HMG-HCG-treated patients developed ovarian cysts. In spite of high doses of gonadotropins only 32,5% of our sterility-patients (group I and II) became pregnant, whereas about 60% of the hyperprolactinaemic amenorrhea-patients (group VI) conceived under CB 154 treatment.

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Gonadotropins; Humans; Lactation Disorders; Luteinizing Hormone; Ovulation; Pregnancy; Prolactin; Syndrome

Studies of prolactin secretion in humans have confirmed the concept, derived originally from animal investigations, that prolactin is predominantly controlled by tonic inhibition from the hypothalamus. The locus of action of dopamine and dopaminergic agents such as the ergot alkaloids inhibiting prolactin secretion appears to be primarily at the pituitary level, though a hypothalamic action to increase secretion of prolactin inhibitory factor may also contribute. Prolactin hypersecretion, through any of several possible mechanisms, is frequently but not always found in patients with galactorrhea. Recent studies have shown that hyperprolactinemia is considerably more common than was previously appreciated among patients without galactorrhea. It is present in at least two-thirds of all patients with pituitary tumors and in a significant minority of patients with secondary amenorrhea. Its clinical measurement in these conditions is therefore of considerable diagnostic importance. Whatever the pathophysiology of its production, hyperprolactinemia of all forms is responsive to treatment with the newer ergot alkaloids. The potential use of these agents for therapeutic purposes, particularly in the treatment of infertility, appears to be wider than was originally anticipated.

Topics: Acetonitriles; Amenorrhea; Bromocriptine; Dopamine; Ergolines; Ergot Alkaloids; Female; Galactorrhea; Humans; Levodopa; Pituitary Neoplasms; Pregnancy; Prolactin; Prolactin Release-Inhibiting Factors

Eleven women with secondary amenorrhoea and hyperprolactinaemia were treated with lisuride, a new semisynthetic ergot derivative. Acute administration of lisuride (100 microgram orally) significantly suppressed serum prolactin (PRL) levels in nine out of eleven subjects. In these nine patients, prolonged treatment with lisuride (50--200 microgram daily) lowered PRL levels into the normal range, menstrual cycles were resumed and eight patients ovulated. Two patients, in whom lisuride failed to lower PRL levels into the normal range, did not resume normal menstruation. These data demonstrate that lisuride may be used clinically to lower PRL levels and to restore cyclic gonadotrophin secretion and ovulation in amenorrhoeic patients with hyperprolactinaemia.

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Lisuride; Ovulation; Pregnancy; Prolactin; Syndrome; Thyrotropin-Releasing Hormone

Lergotrile mesylate is an ergot alkaloid derivative modified to eliminate the vasoconstrictive properties of the parent compound while preserving the properties that inhibit pituitary secretion. Administration of the drug to women with amenorrhea-galactorrhea resulted in the lowering of serum prolactin concentrations. The duration of action was short, so that prolactin levels were near base line 6 to 8 hours after a 2.0-mg dose and morning prolactin concentrations were not persistently suppressed. Initial therapy was accompanied by the development of postural hypotension. Tolerance to this side effect of the drug developed after several days of treatment with gradually increasing doses. In one patient, long-term treatment resulted in reduction of breast secretions, resumption of menses, and conception.

Topics: Acetonitriles; Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Hypotension, Orthostatic; Lactation Disorders; Pregnancy; Prolactin

Forty women with secondary amenorrhea and galactorrhea, thirty-six of whom had associated hyperprolactinemia, were studied prior to therapy with ergocryptine. Abnormal sella tomographic findings were present in 23. The findings on sellar tomography, basal serum prolactin concentrations, and pharmacologic stimulation/suppression of the serum prolactin failed to predict subsequent responders and nonresponders to ergocryptine. Pituitary stimulation for hormone responsiveness did differentiate subsequent responders to ergocryptine from nonresponders. The serum growth hormone response to hypoglycemia was the most definitive predictor. Return of apparently ovulatory function occurred in 29 patients, 11 of whom conceived and have delivered healthy infants.

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pituitary Function Tests; Pregnancy; Prognosis; Prolactin; Sella Turcica

A patient with amenorrhea due to a prolactin-secreting pituitary microadenoma was treated with the antiserotoninergic drug metergoline for 8 months. The first menstruation occurred after 1 month of therapy, and it was followed by regular menses by the 3rd month. Presumptive evidence of ovulation was obtained in at least some instances by serum progesterone and gonadotropin determination. Serum prolactin was only slightly lowered by treatment. The patient had menses and possibly ovulation in the 2 months following drug withdrawal. Metergoline might restore ovarian function in hyperprolactinemic amenorrhea either by prolactin suppression or perhaps by direct stimulation of gonadotropin release.

Topics: Adenoma; Adult; Amenorrhea; Ergolines; Female; Humans; Menstruation; Metergoline; Ovary; Pituitary Neoplasms; Prolactin

19 women with anovulation after discontinuing oral contraceptive agents and with normal plasma-prolactin concentrations were treated with bromocriptine. Ovulation and menstruation were restored in 9 of the 13 amenorrhoeic and 5 of the 6 oligomenorrhoeic patients. The success-rate (74%) indicates that bromocriptine is an effective treatment for post-pill anovulation in normoprolactinaemic women.. The therapeutic efficacy of bromocriptine in the treatment of anovulation was assessed in 19 women who failed to return to fertility following discontinuation of oral contraceptive (OC) use. Plasma concentrations of prolactin were normal. Treatment with bromocriptine restored ovulation and menstruation in 9 of the 13 amenorrheic patients and in 5 of 6 oligomenorrheic women. Given the high success rate (74%), it is concluded that bromocriptine is an effective treatment for postpill anovulation in women with normal prolactin levels.

Topics: Adolescent; Adult; Amenorrhea; Anovulation; Bromocriptine; Contraceptives, Oral; Drug Evaluation; Ergolines; Female; Follow-Up Studies; Humans; Menstruation Disturbances; Oligomenorrhea; Prolactin

The development of homologous prolactin assays, multiple pituitary stimulation, tomography, and computerised axial tomography permit more detailed investigation of patients with secondary amenorrhoea than was formerly possible. 39% of 90 patients with secondary amenorrhoea had hyperprolactinaemia. 10 patients (11% of total) had pituitary tumours. 8 of these women had galactorrhoea (27% of those with galactorrhoea). For patients with hyperprolactinaemia but no tumour, bromocriptine is the treatment of first choice rather than clomiphene or human gonadotrophins. The best treatment for patients with detectable tumour is controversial, particularly when the tumour is confined to the sella turcica. Whether or not these tumors are true neoplasms remains to be determined. Clinically, a history of secondary anemorrhoea with or without galactorrhoea following withdrawal of oral contraceptives remains the commonest presenting syndrome.

Topics: Amenorrhea; Bromocriptine; Contraceptives, Oral; Diagnosis, Differential; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pituitary Function Tests; Pituitary Neoplasms; Pneumoencephalography; Pregnancy; Prolactin; Tomography; Tomography, X-Ray Computed

In a group of 16 females and 2 males with hypogonadism and hyperprolactinemia, bromocriptine was found to suppress prolactin (PRL) high levels within one day without further significant lowering during a 3 weeks longitudinal survey. The usually effective dosage was 5 mg per day. On the contrary, sex hormones did not vary initially and increased secondarily only in those patients resuming gonadal activity. The changes were either cyclical or heterogenous when the first cycle was anovulatory. This latter situation could sometimes but not always be attributed to persistent hyperprolactinemia. Menstruation resumed in 11 patients. Persistance of hypogonadism in the remainder could be explained by incomplete PRL reduction in one case and probability of previous hypothalamo-pituitary damage in six. The latter hypothesis was based in part on impaired gonadotropins responses to LH RH which were not modified by the treatment.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Erectile Dysfunction; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Luteinizing Hormone; Male; Pituitary Gland; Prolactin; Secretory Rate; Testosterone; Time Factors

The present study was undertaken to investigate not only the effectiveness of bromoergocryptine therapy in 13 women with amenorrhea-galactorrhea and hyperprolactinemia without evidence of organic pathology, but also to assess the value of pretreatment evaluation in predicting the response to therapy. Sella turcica tomography, base line serum follicle-stimulating hormone, luteinizing hormone (LH), thyroid-stimulating hormone, T4, plasma cortisol levels, and the growth hormone reserve were normal in all patients. The pretreatment administration of LH-releasing factor (LRF) (100 microng subcutaneously) resulted in either a normal or excessive release of LH. On bromoergocryptine therapy, cyclic menses were reintiated in 10 of the women, while conception occurred prior to reinitiation of menses in the remaining three women. The time required for resumption of menses or conception on therapy correlated well with the magnitude of gonadotropin response to LRF. No correlation was seen with pretreatment prolactin levels nor with the degree of suppression of prolactin during bromoergocryptine therapy. In four women the mean prolactin levels during therapy were above normal, and in one patient prolactin levels approached pretreatment values during therapy. The initiation of cyclic menses despite continued hyperprolactinemia may indicate a possible direct effect of bromoergocryptine on hypothalamic LRF secretion as a partial explanation for its therapeutic action. On discontinuation of bromoergocryptine therapy, serum prolactin levels rapidly returned to pretreatment values or higher in all of the patients studied. In contrast to previous studies in which amenorrhea recurred in all patients after discontinuation of therapy, three of our patients maintained cyclic menses despite continued hyperprolactinemia. The recurrence of hyperprolactinemia after discontinuation of bromoergocryptine would indicate a persistent autonomy of the mechanisms involved. Periodic endocrine evaluation will be necessary to substantiate the presence or absence of pituitary microadenoma in these women.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Evaluation Studies as Topic; Female; Galactorrhea; Gonadotropin-Releasing Hormone; Humans; Lactation Disorders; Pituitary Gland; Pregnancy; Prolactin

Ten patients with galactorrhea and amenorrhea were treated with 2-bromo-alpha-ergocryptine (CB-154). All patients had normal anteroposterior and lateral x-rays of the sella turcica and normal or low gonadotropin levels. Before treatment, serum prolactin (PRL) levels were between 80 and 1575 ng/ml. Prior to initiating therapy, six patients were further evaluated by the intravenous administration of thyrotropin-releasing of a pituitary etiology in all patients. During treatment, PRL levels were measured at monthly intervals. After 1 month, serum PRL concentrations were reduced between 13% and 99%. In eight subjects there was complete cessation of galactorrhea. During treatment, nine patients resumed ovulatory menstrual cycles and three patients conceived. After discontinuing therapy, five of seven subjects had a recurrence of galactorrhea, amenorrhea, and hyperprolactinemia.. Clinical and pituitary effects of 2-bromo-alpha-ergocryptine (CB-154) in 10 patients with galactorrhea-amenorrhea syndrome are reported. Pretreatment testing with hormones suggested a pituitary disorder in all cases. 1 month after treatment with 3 daily doses of CB-154 (2 mg), prolactin concentrations decreased between 13-99%. Galactorrhea was completely suppressed in 8 patients, 9 patients had a return to normal ovulatory menstrual cycles, and 3 conceived. However, once treatment was discontinued, 5 of 7 patients had a recurrence of galactorrhea, amenorrhea, and hyperprolactinemia.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Lactation Disorders; Luteinizing Hormone; Pituitary Gland; Pituitary Hormone-Releasing Hormones; Pregnancy; Prolactin; Thyrotropin-Releasing Hormone

A patient is described with a galactorrhea-amenorrhea syndrome and an enlargement of the sella turcica. Pregnancy occurred after induction of ovulation with bromocriptine (and 2.5 years after pituitary irradiation). Periodic assessment of the visual fields showed an increase in size of the blind spots after 10 weeks and a moderate bitemporal hemianopsia after 22 weeks, which improved spontaneously after 30 weeks of pregnancy. One month after delivery the visual field of the left eye was almost normalized, while that of the right eye showed a definite improvement. Prior radiotherapy need not prevent visual complications from enlargement of pituitary adenomas during pregnancy.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Hemianopsia; Humans; Lactation Disorders; Luteinizing Hormone; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prolactin; Syndrome; Visual Fields

Of 28 patients presenting with amenorrhea-galactorrhea, pituitary tumors were confirmed in eight. Six patients had occult hypothyroidism and the rest had an endocrine profile suggestive of pituitary tumor or of an idiopathic etiology. Treatment with bromocryptine resulted in suppression of the inappropriate lactation and restoration of regular menstrual function. In five cases, however, the galactorrhea was only diminished and in four of these cases, normal ovarian function did not return. Of the 19 patients that were seeking fertility and continued the medication for at least 20 days, nine pregnancies resulted. A similar response to bromocryptine was observed regardless of the underlying cause of the amenorrhea-galactorrhea.. 28 women with amenorrhea-galactorrhea were investigated endocrinologically and treated with bromocryptine 2.5 mg twice daily, ranging from 18 to 150 days. These women were classified into 6 with hypothyroidism, having prolactin (PRL) over 30 ng/ml, thyroid stimulating hormone (TSH) over 8 mcU/ml, luteinizing hormone (LH)6-20 mlU/ml and greater than follicle stimulating hormone (FSH); 8 with radiologically diagnosed pituitary tumors, LH, FSH, and increased PRL; 9 with similar endocrine profiles and suspected pituitary tumors; and 3 with high PRL considered idiopathic. 5 of the hypothyroid group were followed, and achieved ovulation, reduced TSH, PRL, and lactation, and 3 became pregnant. Of the 8 with tumors, 5 menstruated, 4 ovulated, 3 conceived, 3 had reduced lactation, 2 had reduced PRL, and 1 failed to respond clinically; 9 with suspected tumors took bromocryptine for at least 20 days, resulting in 4 pregnancies and 3 with regular menses. The 3 idiopathic cases showed lower PRL and regular ovarian function, 1 pregnancy, yet 1 developed pseudocyesis and recurrent galactorrhea. 2 women had to stop bromocryptine because of vomiting. This drug is longer-acting than L-dopa and safer than estrogen-progestagen combinations in cases of pituitary tumors. Bromocryptine reduces galactorrhea and associated hypothyroidism temporarily.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Hypothyroidism; Lactation Disorders; Luteinizing Hormone; Pituitary Neoplasms; Pregnancy; Prolactin; Thyrotropin

Fifteen female patients with amenorrhea and hyperprolactinemia were studied 1 to 3 times daily during the first 4 days of treatment with bromocriptine (2.5 mg b.i.d). Normal PRL levels were reached within one day in 12 while the mean value for the whole group showed no further significant decrease. Estradiol, LH and FSH levels did not vary significantly at this stage even in those 10 patients who subsequently resumed menstruation.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hyperpituitarism; Luteinizing Hormone; Pituitary Hormones, Anterior; Prolactin

Our demonstration of an inhibitory effect of dopamine on LH release prompted us to examine whether a similar action exists for dopamine agonists, such as L-dopa and 2-bromo-alpha-ergocryptine (CB-154). Following the administration of L-dopa (0.5 g, orally) to 6 normal women in the early follicular phase, a significant fall in mean LH levels after 1 h which lasted for 5 h was observed (P less than 0.00005). This was followed by a significant rebound above basal levels between the 7th and 10th h (P less than 0.00005). The expected fall in mean PRL levels which lasted for 4 h (P less than 0.00001) was followed by a significant rebound above basal levels after the 6th h (P less than 0.00001)). There was no significant change in mean FSH levels. Following the administration of CB-154 (2.5 mg. orally) to 6 women with hyperprolactinemic amenorrhea, there was also a significant fall in LH levels (P less than 0.00001) and in FSH levels (P less than 0.00001) from 5 h until the study ended at 10 h. The anticipated PRL suppression was also observed and persisted for the duration of the 10 h study. The demonstration of an inhibitory effect of L-dopa and CB-154 on LH release adds further support to the role of dopaminergic control of pituitary LH secretion.

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Follicle Stimulating Hormone; Humans; Levodopa; Luteinizing Hormone; Prolactin

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Lactation; Pregnancy

A patient with hyperprolactinemia, amenorrhea, and an enlarged sella turcica, but without galactorrhea, was treated with Bromocriptin to effect restoration of ovarian function. The subsequent pregnancy was without problems from an obstetric point of view, but visual field abnormalities developed progressively, leading to termination of the pregnancy in the 39th week. However, within 1 week after delivery, the field defects disappeared and the visual acuity returned to normal.

Topics: Adult; Amenorrhea; Bromocriptine; Cesarean Section; Ergolines; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prolactin; Sella Turcica; Thyrotropin; Tomography, X-Ray; Vision Disorders; Visual Acuity; Visual Fields

Seven women with amenorrhea and galactorrhea, and no evidence of pituitary adenoma, were treated with brom-ergocryptine for two to 24 weeks. All seven patients had the resumption of regular menses within eight weeks, but six patients required 24 weeks of therapy to completely cease lacting. Two of the five women attempting to conceive became pregnant. Four of the five nonpregnant patients had a total recurrence of their symptoms after discontinuing the drug. Brom-ergocryptine appears to be very effective in inhibiting prolactin secretion and thus reestablishing normal ovulatory menstrual cycles and fertility.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pregnancy; Prolactin

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Pituitary Neoplasms; Prolactin

A 33-year-old woman who had had amenorrhoea and galactorrhoea for ten years and had hyperprolactinaemia was treated with metergoline, a serotonin antagonist. There was a marked decrease in plasma prolactin levels. After two months, ovulation and pregnancy occurred. This is the first such report.. A case study of a 33-year-old hyperprolactinemic woman becoming pregnant after treatment with metergoline is reported. The patient had also had amenorrhea and galactorrhea for 10 years. Treatment twice a day with 4 mg metergoline, a serotonin antagonist, markedly decreased plasma prolactin levels. 2 months later the patient became pregnant and delivered a normal, healthy boy. This is the 1st report of ovulation induction by metergoline.

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Humans; Ovulation; Pregnancy; Prolactin

Prolactin interferes with the function of the corpus luteum, as was demonstrated by repeatedly finding a short luteal phase in the ovulatory cycles of two hyperprolactinaemic women after prolactin supression by bromocriptine had been discontinued. In hyperprolactinaemic ovulatory cycles excretion of pregnanediol in urine was less and plasma-progesterone concentrations were lower than in normo-prolactinaemic cycles. When the amenorrhoea-galactorrhoea syndrome recurred the symptoms appeared in the following order: (1) serum-prolactin increased and the luteal phase became shorter; (2) galactorrhoea appeared; (3) ovulation was missed; (4) menstruation was missed. All these abnormalities may be treated by prolactin suppression, but the effect of treatment does not persist for long after bromocriptine administration ceases.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Luteal Phase; Menstruation; Ovulation; Pregnancy; Prolactin; Syndrome; Time Factors

Bromocriptine 2-5 mg twice daily is effective in the treatment of both normoprolactinaemic and hyperprolactinaemic secondary amenorrhoea. This was demonstrated by the restoration of menstrual cycle and/or ovulation in 9 of 18 normoprolactinaemic and in 8 of 14 hyperprolactinaemic patients taking bromocriptine. Serum-prolactin level decreased in both groups of patients, and usually menstruation was recovered within 8 weeks'treatment. Galactorrhoea disappeared in 7 of 9 hyperprolactinaemic patients, and 2 became pregnant. After treatment had ceased spontaneous menstrual activity continued in 4 patients. 16 patients had side-effects the commonest being nausea and vertigo. These usually disappeared with the dosage was reduced, but 5 patients refused to continue. These results point to a new approach in the treatment of secondary amenorrhoea, even in those patients whose clinical findings give no indication of prolactin suppression.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Drug Evaluation; Ergolines; Female; Follow-Up Studies; Galactorrhea; Humans; Menstruation; Ovulation; Pregnancy; Prolactin; Puerperal Disorders

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Ovulation; Prolactin

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Prolactin

Prolactin (PRL) and thyrotropin (TSH) responses to a 200 mug intravenous thyrotropin-releasing hormone (TRH) bolus were measured by radioimmunoassay in 11 women with hyperprolactinemic amenorrhea and 9 with normoprolactinemic amenorrhea. In all cases, the tests were carried out under basal conditions and repeated during bromocriptine treatment. In women whose basal PRL level was normal; TRH caused a maximal PRL increment of 85 +/- 25.2 mug/l (mean +/- SE), while those women whose basal PRL level was raised showed a smaller increase (5.2 +/- 11.9 mug/l) (P=0.02). The peak levels were not significantly different in these two groups (95.0 +/- 26.7 and 134.6 +/- 35.9 mug/l) (P is greater than 0.1). During bromocriptine treatment, the raised PRL levels decreased in all cases, but levels over 30 mug/l remained in 3 patients, one of whom turned out to have a pituitary tumor. Prolactin responses to TRH were markedly inhibited in normoprolactinemic patients by the dose of bromocriptine used. The mean maximal net increase of PRL was 2.0 +/- 0.9 mug/l in normoprolactinemic patients and 11.0 +/- 8.1 mug/l in hyperprolactinemic patients taking bromocriptine. After TRH stimulation during bromocriptine, the peak PRL levels in hyperprolactinemic patients were higher (32.7 +/- 10.5 mug/l) than in normoprolactinemic patients (7.2 +/- 1.5 mug/l). Unlike what has been described for hypothyroid patients, the basal TSH level in euthyroid amenorrhea patients was not affected by bromocriptine, and we found that bromocriptine has no effect on the TRH-TSH response.

Topics: Adult; Amenorrhea; Bromocriptine; Contraceptives, Oral; Ergolines; Female; Humans; Pituitary Gland; Pregnancy; Prolactin; Thyrotropin; Thyrotropin-Releasing Hormone; Time Factors

Fourteen women with amenorrhea-galactorrhea were treated with bromo-ergocryptine. Serum prolactin hPRL, hLH, hFSH, estradiol 17-beta (E2), and progesterone values were determined before and during treatment. No consistent pretreatment hormonal pattern was found. During treatment hPRL levels fell in 13 of 14 patients, and E2 rose in 12 of 14 patients. Levels of hLH became normal, and amounts of hFSH did not change. Galactorrhea lessened in all cases and ceased in 11. Menses resumed in 11 patients and 3 women became pregnant. Cessation of galactorrhea and resumption of menses occurred irrespective of initial hPRL or hLH levels. It is suggested that improvement of galactorrhea and resumption of menses in some patients with normal hPRL values are the result of increased serum E2 levels and may be due to a direct action of bromo-ergocryptine on the ovary. Bromo-ergocryptine may also be effective in treatment of amenorrhea, unassociated with galactorrhea or elevated hPRL levels.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Lactation Disorders; Luteinizing Hormone; Middle Aged; Pregnancy; Prolactin

Fifteen patients with galactorrhea-amenorrhea syndromes were studied before, during, and after treatment with bromergocryptine. Galactorrhea and amenorrhea were noted after pregnancy (6 patients), after oral contraceptive therapy (5 patients), and in association with pituitary adenoma (4 patients). Before treatment prolactin values were elevated ranging from 27 to 125 ng/ml, while luteinizing hormone and progesterone levels failed to show ovulatory peaks or luteal phase progression. Eleven patients had luteinizing hormone-releasing hormone tests before therapy. Response was normal in 8, subnormal in 2 pituitary adenoma, and supranormal in 1 patient with premature ovarian failure. Treatment with bromergocryptine was associated with a lowering of serum prolactin, cessation of lactation in all, and return of ovulatory menses in 14 of 15 patients. All relapsed when therapy was discontinued. Four patients became pregnant while on therapy. Long-term bromergocryptine therapy is effective for all forms of galactorrhea-amenorrhea syndromes studied.

Topics: Adenoma; Amenorrhea; Bromocriptine; Chiari-Frommel Syndrome; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pituitary Function Tests; Pituitary Neoplasms; Pregnancy; Recurrence; Syndrome

In order to elucidate the pituitary regulation of the female testosterone secretion, we studied by radioimmunoassay the circulating prolactin (PRL) and testosterone-dihydrotestosterone (T-dT) levels in 12 hyperprolactinemic and 12 normoprolactinemic patients with secondary amenorrhea. After the basal levels had been recorded, each patient was given bromocriptine for two weeks, 2.5 mg twice daily, and repeat estimations of the PRL and T-dT levels were done. We found no significant difference in the basal T-dT levels between normoprolactinemic and hyperprolactinemic patients, and no significant correlation between the PRL and T-dT levels in either group. Although the PRL levels of the hyperprolactinemic patients were greatly suppressed by bromocriptine, the T-dT levels showed no systematic change. In normoprolactinemic patients, the T-dT concentrations were somewhat lower during bromocriptine treatment, but the difference from basal levels was not statistically significant (0.05 less than P less than 0.1). Our results suggest that in patients with secondary amenorrhea PRL does not interfere directly with T-dT secretion, or vice versa.

Topics: Adult; Amenorrhea; Bromocriptine; Depression, Chemical; Ergolines; Female; Humans; Prolactin; Testosterone

In a series of 23 patients bromocriptine increased the plasma estradiol-17 beta level from 44.0 +/- 9.5 (mean +/- SE) to 144.1 +/- 31.8 pg/ml after 3 - 5 weeks' treatment (p less than 0.01). In normoprolactinemic patients (N = 12) the level increased from 59.6 +/- 16.3 to 186.5 +/- 50.5 pg/ml (p less than 0.05), and in hyperprolactinemic patients (N = 11) the corresponding values were 27.0 +/- 6.2 and 97.8 +/- 34.6 pg/ml (p less than 0.05). Bromocriptine treatment did not significantly alter the FSH and LH levels. The results suggest that bromocriptine treatment induces endocrine recovery also in patients whose clinical findings give no indication of prolactin suppression.

Topics: Amenorrhea; Bromocriptine; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Prolactin

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pregnancy

Three nulliparous women presented with secondary amenorrhea with no evidence of endocrinopathy and normal skull x-ray. Pulsatile gonadotropin secretion was reduced, but an adequate pituitary gonadotropin reserve was demonstrable with luteinizing hormone-release factor provocation. The administration of bromocryptine was associated with amplification of pulsatile secretion of gonadotropins and was followed, in two of the three, by ovulatory menstruation. It is suggested that bromocryptine should be considered for induction of menstruation in euprolactinemic secondary amenorrhea.

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Menstruation; Ovulation; Prolactin

In ten patients with amenorrhea-galactorrhea who had hyperprolactinemia, ovulation could not be induced clomiphene citrate or exogenous gonadotropins. Treatment with bromocryptine in eight of these patients resulted in suppression of PRL in all, cessation of galactorrhea and ovulation in seven and conception in five.

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Fertility; Galactorrhea; Gonadotropins, Pituitary; Humans; Lactation Disorders; Menotropins; Ovary; Ovulation; Pregnancy; Prolactin; Thyrotropin

A woman developed amenorrhoea and galactorrhoea after partial removal of a pituitary tumor during pregnancy. Hyperprolactinaemia was supressed by therapy with bromocryptine (CB 154, Sandoz) resulting in cessation of galactorrhoea in two months, spontaneous menstruation after eight months, and pregnancy after twelve months.

Topics: Adenoma, Chromophobe; Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Pituitary Neoplasms; Pregnancy; Syndrome

11 patients suffering from amenorrhea-galactorrhea, and 26 puerperas for whom lactation was not indicated were treated with 2-Br-alpha-ergocryptine. The drug led to a regression of galactorrhea, and to normal menstrual cycles in all patients, except in one who was suffering from hypophyseal adenoma. Lactation was effectively inhibited in all 26 puerperas after only a few days of treatment. Results showed that 2-Br-alpha-ergocryptine has a powerful inhibitory action on the hypophyseal secretion of prolactin, both during puerperium and in nonpuerperal conditions.

Topics: Adult; Amenorrhea; Ergolines; Female; Galactorrhea; Gonadotropins, Pituitary; Humans; Lactation; Lactation Disorders; Pituitary Gland; Pituitary Gland, Anterior; Pregnancy; Prolactin; Puerperal Disorders

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Infertility, Female; Lactation Disorders; Ovulation; Pregnancy

Administration of Brom-ergocryptine (CB-154) has a dramatic effect on breast secretion. Inhibition of lactation occurs within three to four weeks in women with amenorrhea and galactorrhea. Resumption of normal ovulatory function was documented by serum progesterone levels, as well as pregnancy, in three of four women attempting to conceive. Serum prolactin levels become normal following initiation of Brom-ergocryptine. Discontinuation of Brom-ergocryptine was found to result in a return of both inappropriate lactation and elevation of serum prolactin in this study. No deleterious side effects of Brom-ergocryptine have been found in any of the volunteers either clinically or on the basis of sequential laboratory studies.

Topics: Adult; Amenorrhea; Breast Feeding; Bromocriptine; Ergolines; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Lactation; Lactation Disorders; Luteinizing Hormone; Pregnancy; Progesterone; Prolactin; Radioimmunoassay

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Galactorrhea; Humans; Infertility; Lactation; Lactation Disorders; Male; Pregnancy; Prolactin

Topics: Amenorrhea; Brain; Bromocriptine; Depression, Chemical; Dopamine; Ergolines; Female; Galactorrhea; Humans; Lactation Disorders; Male; Pregnancy; Prolactin; Receptors, Drug; Syndrome

Four women with the amenorrhoea-galactorrhoea syndrome were treated with 2-Br-a-ergocryptine (CB-154). In 3 patients, lactation was inhibited and ovulation was induced. Furthermore, pregnancy was achieved in one of them. In the remaining case, neither was lactation inhibited nor ovulation induced. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) were measured sequentially in the 4 CB- 154 treated women. They showed high serum PRL levels and acyclic patterns of serum FSH and LH. CB-154 suppressed PRL secretion and stimulated FSH and LH secretion in 3 cases where lactation was inhibited and ovulation was induced. In the one unsuccessful case, serum PRL decreased only slightly and the serum FSH and LH showed no marked changes.

Topics: Adult; Amenorrhea; Bromocriptine; Depression, Chemical; Ergolines; Ergot Alkaloids; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Lactation Disorders; Luteinizing Hormone; Ovulation; Pregnancy; Prolactin; Stimulation, Chemical; Time Factors

2 Bromo-alpha-ergocryptine, a specific prolactin inhibitor, was administered to 9 patients suffering from galactorrhea-amenorrhea syndrome of varying aetiology. Plasma levels of FSH, LH, prolactin, total estrogens and progesterone were measured by radioimmunoassy before and after treatment initiation. Prior to treatment, plasma prolactin levels were in all cases supraphysiological. FSH and LH levels were, with the exception of one patient, in the low cyclic range. One patient had subnormal gonadotropin levels, presumably reflecting hypophyseal insufficiency following surgical removal of a pituitary adenoma. Mean plasma levels of total estrogens were in the lower normal range. Administration of CB 154 led in all cases to a reduction of plasma prolactin levels. In eight cases, galactorrhea was suppressed during the first month of treatment. Eight patients menstruated and seven ovulated as indicated by the basal body temperature (BBT) or plasma progesterone measurement. The postoperative hypophyseal tumor patient did not, with the exception of galactorrhea suppression, respond to treatment, presumably due to hypophyseal insufficiency. 2 patients conceived during the course of treatment. One patient, who developed galactorrhea-amenorrhea syndrome as a result of psychopharmacological drug administration received 7,5 mg/day CB 154. Prolactin secretion, as indicated by plasma levels, was inhibited but the inhibitation was much slower in onset than that exhibited by the other patients and this patient ovulated only after 5 months of treatment. Upon withdrawal of CB 154 therapy after 6 to 7 months, the patients redeveloped galactorrhea-amenorrhea syndrome, so that a definitive cure could not be demonstrated.

Topics: Adult; Amenorrhea; Bromocriptine; Contraceptives, Oral; Ergolines; Estrogens; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Hypophysectomy; Lactation Disorders; Luteinizing Hormone; Pregnancy; Progesterone; Prolactin; Psychotropic Drugs; Radioimmunoassay; Syndrome

Topics: Adult; Amenorrhea; Bromocriptine; Ergolines; Female; Humans; Infertility, Female; Prolactin

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Gonadotropins; Humans; Prolactin

Recent progress in the field of radioimmunology, especially as regards prolactin (PRL) assay, as well as the use of new drugs have opened new perspectives for a better understanding of the "amenorrhoea-galactorrhea syndrome" both from the diagnostic and therapeutic points of view. This syndrome which formerly was considered infrequent, is now observed more and more often, perhaps as a result of the more widespread use of drugs such as phenothiazines, reserpine derivatives, alpha-methyldopa and tricyclic antidepressants, as well as owing to the large-scale use of estrogens and above all of estrogen-progestogen contraceptives. The problems of etiopathogenesis and management of the amenorrhea-galactorrhea syndrome are complicated by the fact that a variety of factors are responsible, as is shown also by the classical nosographic classification with the Forbes-Albright syndrome in the presence of a pituitary tumour, the Chiari-Frommel syndrome of amenorrhea-galactorrhea following pregnancy, and the Argonz-del Castillo-Ahumada syndrome in the absence of lither pregnancy or tumor.

Topics: Adult; Amenorrhea; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Humans; Lactation Disorders; Luteinizing Hormone; Pituitary Hormone Release Inhibiting Hormones; Pregnancy; Progesterone; Prolactin; Radioimmunoassay; Syndrome

Topics: Amenorrhea; Bromine; Ergolines; Female; Gonadotropins, Pituitary; Humans; Lactation; Pregnancy; Prolactin