1981 Volume 21 Issue 11 Pages 1113-1121
The authors report on 16 women with prolactin-secreting pituitary adenomas and discuss the indication of surgery and bromocriptine treatment. Cases were classified into four groups according to Hardy's classification. Grade I patients were 5, Grade II: 3, Grade III: 6, and Grade IV: 2. Thirteen patients sustained amenorrhea with galactorrhea and three patients sustained only amenorrhea. Four women complained of visual disturbances.
Operations were performed on five patients. Of these patients, one had a microadenoma (Grade I) and four had suprasellarly extending macroadenomas (Grade II, III and IV). Results of the operations were satisfactory in patients of Grades I and II, but unsatisfactory in patients of Grades III and IV. Grade I and II patients reached a normal prolactin level and resumed regular menstruation after the operation, but in Grade III and IV patients, plasma prolactin remained high and they did not resume menstruation.
Bromocriptine was administered to fourteen patients. Ovulation was restored in 11 patients by bromocriptine treatment only. Of seven patients who desired to be pregnant, four became pregnant. In two cases CT scan demonstrated tumor reduction after bromocriptine treatment. Thus results of bromocriptine treatment were satisfactory in hyperprolactinemic patients with prolactinomas, but there are some problems with bromocriptine treatment. These include the rise of plasma prolactin after discontinuance of bromocriptine treatment, increased risk of tumor enlargement during pregnancy, possible teratogenic effects and tolerance to bromocriptine.
From observations of these data the following methods for treatment of female patients with prolactinomas are proposed. Patients with microadenomas should be operated on. There is a good possibility that the removal of the microadenoma will produce a biological cure without significant risk of damaging the normal gland. However, if patients desire to become pregnant, bromocriptine treatment should be applied without surgery after a careful discussion with the patient. If the tumor is not very large and not very invasive, an operation should be performed before bromocriptine treatment. However, if patients desire to become pregnant, bromocriptine treatment should be applied in consideration of postoperative pituitary functions. In such cases, pregnant patients should be carefully monitored for tumor enlargement during pregnancy. For large invasive adenoma, bromocriptine treatment should be given priority over operations.
