Galactorrhea-Amenorrhea Syndrome: Follow-up of Forty-Five Patients After Pituitary Tumor Removal

Abstract

Forty-five patients with galactorrhea-amenorrhea were followed during a period of 1 to 8 years (mean 3.1) after transsphenoidal prolactinoma removal. The ratios of patients who appear to be cured to the total numbers treated were 20 patients of 27 with grade I tumors; six of 10 with grade II; two of five with grade III; and none with grade IV tumors. Six patients with normal prolactin levels one week postoperatively had relapse later, as did three with normal prolactin levels 2 months postoperatively. A normal prolactin level 6 months postoperatively predicted ultimate cure. The 19 pregnancies that occurred in 15 patients, four with high prolactin levels, were uneventful. Prolactin rose normally with pregnancy and returned to prepregnancy level in all but one patient. Prolactin responses to stimulation tests were blunted for 6 months after successful tumor removal. By 1 year, responses to thyrotropin releasing hormone and metoclopramide tests were returning to normal, although responses to chlorpromazine and hypoglycemia remained blunted. The postoperative inhibition of normal lactotropes for 6 months is suggested. Ultimate cure cannot be determined before 6 months and conception should be deferred until then.

Extrasellar Prolactinomas: Successful Management of 24 Patients Using Bromocriptine

“…By comparison, surgery has less than a 15% chance of normalising the serum prolac tin level when pretreatmenl values are more than 500 ng/ml [3,6,15] and although visual defects may be corrected, there is a consid erable risk of permanent hypopituitarism which increases with tumour size [16], Fur thermore, visual abnormalities may be pre cipitated by surgery [16], All these complica tions were observed in this study. Medical treatment entails none of these serious risks [3,6,15] and may in fact completely reverse the hypogonad state.…”

“…Medical treatment entails none of these serious risks [3,6,15] and may in fact completely reverse the hypogonad state. The latter occurrence has so far been observed in half the patients and of the seven desiring pregnancy, four have already conceived.…”

“…Hypoadrenalism or hypothyroidism was a com plication of surgery in 3 patients (No. 1,5,6). External irradiation to the pituitary fossa, using an 8 MV Model SI 75/10 linear accelerator, was given to 4 patients before, and 2 during treatment.…”

“…As they may remain static for years, they can be observed without therapy or, if necessary, treated with bromocriptine, transsphenoidal microadenomectomy or external irradiation [1][2][3][4][5]. Surgical cures occur less frequently as the tumours get larger and are unusual if the prolactin level exceeds 500 ng/ml [3,6,7]. The initial management of extrasellar prolac tinomas is controversial.…”

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

“…Although surgical resection of the adenomaoffers a potential for cure, in fact cure was later found to be achieved in a minority of patients with large tumors and was associated with a risk of recurrence in all patients. Hyperprolactinemia recurs one to five years after surgery in 10 to 50%of patients with microprolactinomas and in 20 to 91% of patients with macroprolactinomas (3,(4)(5)(6)(7)(8)(9). Radiotherapy rarely results in the restoration of normal serum prolactin concentrations and therefore is generally not considered as a primary treatment for prolactinomas.…”