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Prolactin secretion was evaluated in 69 patients with pituitary tumors. Among the 47 w h o were seen prior to treatment, hyperprolactinemia was present in 37 (79%). Excluding patients with galactorrhea, hyperprolactinemia was present in 19 (70%) of those seen before treatment. T h e r e was little correlation between tumor size and level of serum prolactin. Both transsphenoidal surgery and radiotherapy greatly reduced the hyperprolactinemia, b u t a more rapid decrease was achieved with microsurgical removal of the secreting adenoma. We have reviewed a series of patients with pituitary tumors in whom serum prolactin was determined in order to find the incidence of prolactin-secreting pituitary tumors and to determine their biological profile. The series contained large tumors causing chiasmal compression as well as small, hypersecreting microadenomas. In addition, we evaluated the clinical response of these patients to a variety of therapeutic modalities. Clinical Material and MethodsProlactin secretion was evaluated in 69 patients with pituitary tumors seen between 1971 and 1975. There were 28 men and 41 women, with ages rangingfrom 16 to 75 (mean, 40.6) years. Visual field defects were present in 33 patients (18 ofwhom had hyperprolactinemia). Five patients also had compromise of the third or sixth cranial nerves or both, indicating lateral extension of the tumor. Galactorrhea was documented by history or clinical examination in 2 1 women; in 2 of them this started in the postpartum period. Nineteen patients with galactorrhea also had amenorrhea, which was of the primary type in 2 of them. In addition, 7 women had amenorrhea without galactorrhea. Two men had galactorrhea and decreased libido. Ten patients had clinical and chemical evidence of acromegaly. The diagnosis of pituitary tumor was confirmed histologically in 50 cases. In the remaining 19 patients the diagnosis was based on the presence of clinical and laboratory evidence of pituitary dysfunction associated with an eniarged sella turcica.Pneumoencephalography, cerebral angiography, or both were performed in all patients to determine the extension of tumor. Prolactin, growth hormone, luteinizing hormone (LH), FSH, thyroxine, and in some cases triiodothyronine were measured by radioimmunoassay. Adrenal function was evaluated by measuring the serum levels of cortisol before and after stimulation with adrenocortico-tropic hormone. The urinary excretion of 17-ketogenic steroids and 17 ketosteroids was also measured. In a few cases response of prolactin to the following agents was assessed: thyrotropin-releasing hormone (TRH), given as a 500 pg bolus intravenously; L-dopa, 500 mg orally; and chlorpromatine, 50 mg intramuscularly. Results Endocrine FindingsProlactin was measured prior to treatment in 47 patients and was elevated in 37 (79%) (normal values: men, 0-20 ng/ml; women, 1-25 ng/ml) (Fig 1). Abnormal Ievels ranging from 2 1 to 10,000 nglml were found in 15 men (79%; mean value, 1,646 ng/ml). Increased prolactin levels were found in 22 women (79%), wi...

HORMONAL REGULATION OF PITUITARY ACTH 165 experiment was conducted during the regular school term it is obvious that these control data cannot represent truly an unstressed level of serum cholesterol. It does seem likely, however, that the periods of observation do coincide with periods of relatively lesser and greater degrees of mental and emotional stress.As one might expect, these individuals vary greatly in their clinical and biochemical responses to stress. It is apparen't that the situational stress of examination week must have different meaning and hence a differing stress value for the subjects. Further investigation is needed to establish whether this increase in serum cholesterol is harmful or simply part of a normal and desirable bodily adjustment to mental and emotional stress.The difference between these results and those of Beischer(6) may be due, as he has suggested, to his use of fewer subjects and of a particularly and relatively transient stress experience. Our data would coincide with changes which Selye(5) has described in connection with the "resistance phase" of the general adaptive response to various forms of systemic stress. Summary. A significant increase in mean value for serum cholesterol is shown to accompany the mental and emotional stress of examination week in a group of 44 apparently healthy, male, medical students. The mean value for serum cholesterol increased to 238 mg %, which represents an 11% increase over the mean control value of 214 mg % ( P < 0.001).