Hyperprolactinaemic infertility: some considerations on medical management

  • M. O. Thorner
  • M. L. Vance
  • R. M. Macleod


Hyperprolactinaemia is a common cause of infertility in women. The most common cause for hyperprolactinaemia (after excluding ingestion of medications which elevate prolactin) is a pituitary tumour. These tumours can either be small (diameter less than 10 mm) = microadenomas, or, if greater than 10 mm, are termed macroprolacti-nomas. Although this distinction is arbitrary, it is often useful in predicting the outcome of transsphenoidal surgery, although the basal serum prolactin is a better predictor.

Irrespective of the size of the tumour or the pretreatment prolactin level, medical treatment with dopamine agonist drugs (e.g. bromocriptine, lisuride and pergolide) is effective in >80% of cases in lowering prolactin levels and in restoring gonadal function. The large tumours undergo volume reduction under this form of therapy. The potential problem of tumour expansion during pregnancy which is a function of the pre-existing tumour is reviewed. This risk appears extremely small in microadenomas but may be clinically significant in 10–25% of macroadenoma patients. The dilemmas of the management of this controversial problem are discussed.


Dopamine Agonist Prolactin Level Serum Prolactin Fertility Control Serum Prolactin Level 
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  1. 1.
    Franks, S., Murray, M. A. F., Jequier, A. M., Steele, S. J., Nabarro, J. D. N. and Jacobs, H. S. (1975). Incidence and significance of hyperprolactinemia in women with amenorrhea. Clin. Endocrinol, 4, 597CrossRefGoogle Scholar
  2. 2.
    Franks, S., Nabarro, J. D. N. and Jacobs, H. S. (1977). Prevalence and presentation of hyperprolactinemia in patients with ‘functionless’ pituitary tumours. Lancet, 1, 778PubMedCrossRefGoogle Scholar
  3. 3.
    Hardy, J. and Mohr, G. (1981). Le prolactionome aspects chirurgicaux. Neurochirurgie, 27, (Suppl. 1), 41PubMedGoogle Scholar
  4. 4.
    Randall, R. V., Laws, E. R., Abboud, C. F., Ebersold, M. J., Kao, P. C. and Scheithauer, B. W. (1983). Transsphenoidal microsurgical treatment of prolactin-producing pituitary adenomas. Results in 100 patients. Mayo Clin. Proc., 58, 108PubMedGoogle Scholar
  5. 5.
    Tindall, G. T., McLanahan, S. and Christy, J. H. (1978). Transsphenoidal microsurgery for pituitary tumors associated with hyperprolactinemia. J. Neurosurg., 48, 849PubMedCrossRefGoogle Scholar
  6. 6.
    Kleinberg, D. L., Noel, G. L. and Frantz, A. G. (1977). Galactorrhea: 235 cases including 48 with pituitary tumors. N. Engl. J. Med., 296, 589PubMedCrossRefGoogle Scholar
  7. 7.
    Hardy, J., Beauregard, H. and Robert, F. (1978). Prolactin-secreting pituitary adenomas: Transsphenoidal microsurgical treatment. In Robyn, C. and Harter, M. (eds.). Progress in Prolactin Physiology and Pathology, pp. 261–70. (New York: Elsevier)Google Scholar
  8. 8.
    Carter, J. N., Tyson, J. E., Tolis, G., Van Vliet, S., Faiman, G. and Friesen, H. G. (1978). Prolactin-secreting tumors and hypogonadism in 22 men. N. Engl. J. Med., 299, 847PubMedCrossRefGoogle Scholar
  9. 9.
    Segal, S., Yaffee, H., Laufer, N. and Ben-David, M. (1979). Male hyperprolactinemia: effects on fertility. Fertil. Steril., 32, 556PubMedGoogle Scholar
  10. 10.
    Thorner, M. O., Edwards, C. R. W., Hanker, J. P., Abraham, G. and Besser, G. M. (1977). Prolactin and gonadotropin interaction in the male. In Troen, P. and Nankin, H. (eds.) The Testis in Normal and Infertile Men. pp. 351–66. (New York: Raven Press)Google Scholar
  11. 11.
    Molitch, M. E. and Reichlin, S. (1982). Hyperprolactinemia. In Cotsonas, N. J. (ed). Disease-A-Month, 28, 1Google Scholar
  12. 12.
    Hemminghytt, S., Kalkhoff, R. K., Daniels, D. L., Williams, A. L., Grogan, J. P. and Haughton, V. M. (1983). Computed tomographic study of hormone-secreting microadenomas. Radiology, 146, 65PubMedGoogle Scholar
  13. 13.
    Perryman, R. L., Rogol, A. D., Kaiser, D. L., MacLeod, R. M. and Thorner, M. O. (1981). Pergolide mesylate: Its effects on circulating anterior pituitary hormones in man. J. Clin. Endocrinol. Metab., 53, 772PubMedCrossRefGoogle Scholar
  14. 14.
    Thorner, M. O. and Besser, G. M. (1978). Bromocriptine treatment of hyperprolacti-nemic hypogonadism. Acta Endocrinol., 88, Suppl. 216, 131Google Scholar
  15. 15.
    Gemzell, C. and Wang, C. F. (1979). Outcome of pregnancy in women with pituitary adenoma. Fertil. Steril., 31, 363PubMedGoogle Scholar
  16. 16.
    Skrabanek, P., McDonald, D., Meagher, D. et. al. (1980). Clinical course and outcome of thirty-five pregnancies in infertile hyperprolactinemic women. Fertil. Steril., 33, 391PubMedGoogle Scholar
  17. 17.
    Turkalj, I., Braun, P. and Krupp, P. (1982). Surveillance of bromocriptine in pregnancy. J. Am. Med. Assoc, 247, 1589CrossRefGoogle Scholar
  18. 18.
    Tindall, G. T., Kovacs, K., Horvath, E. and Thorner, M. O. (1982). Human prolactin-producing adenomas and bromocriptine: A histological, immunocytochemical, ultrastructural, and morphometric study. J. Clin. Endocrinol. Metab., 55, 1178PubMedCrossRefGoogle Scholar
  19. 19.
    Chiodini, P., Luizzi, A., Cozzi, R., et al. (1981). Size reduction of macroprolactin-omas by bromocriptine or lisuride treatment. J. Clin. Endocrinol. Metab., 53, 737PubMedCrossRefGoogle Scholar
  20. 20.
    George, S. R., Burrow, G. N., Zinman, B. and Ezrin, C. (1979). Regression of pituitary tumors, a possible effect of bromergocryptine. Am. J. Med., 66, 697PubMedCrossRefGoogle Scholar
  21. 21.
    Grisoli, F., Vincentelli, F., Jaquet, P., Guilbout, M., Hassoun, J. and Farnarier, P. (1980). Prolactin secreting adenomas in 22 men. Surg. Neurol, 13, 241PubMedGoogle Scholar
  22. 22.
    Hamilton, D. J., George, B., Sommers, C., Zaniewski, M., Bryan, J. and Boyd, A. E. (1983). Comparison of pergolide and bromocriptine in prolactin disorder. Presented at the 64th Annual Meeting, The Endocrine Society, San Francisco, abstract 564Google Scholar
  23. 23.
    McGregor, A. M., Scanlon, M. F., Hall, K., Cook, D. B. and Hall, R. (1979). Reduction in size of a pituitary tumor by bromocriptine therapy. N. Engl. J. Med., 300, 291PubMedCrossRefGoogle Scholar
  24. 24.
    Thorner, M. O., Martin, W. H., Rogol, A. D. et. al. (1980). Rapid regression of pituitary prolactinomas during bromocriptine treatment. J. Clin. Endocrinol. Metab., 51, 438PubMedCrossRefGoogle Scholar
  25. 25.
    Thorner, M. O., Perryman, R. L., Rogol, A. D., et al. (1981). Rapid changes of prolactinoma volume after withdrawal and reinstitution of bromocriptine. J. Clin. Endocrinol. Metab., 53, 480PubMedCrossRefGoogle Scholar
  26. 26.
    Vaidya, R. A., Allorkar, S. D. and Rege, N. R. (1978). Normalization of visual fields following bromocriptine treatment in hyperprolactinemic patients with visual field constriction. Fertil. Steril., 29, 632PubMedGoogle Scholar
  27. 27.
    Wollesen, F., Andersen, T. and Karle, A. (1982). Size reduction of extrasellar pituitary tumors during bromocriptine treatment: Quantitation of effect on different types of tumors. Ann. Intern. Med., 96, 281PubMedGoogle Scholar
  28. 28.
    Vance, M. L., Evans, W. S. and Thorner, M. O. (1983). Drugs five years later: bromocriptine. Ann. Intern. Med. (In press.)Google Scholar

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© MTP Press Limited 1984

Authors and Affiliations

  • M. O. Thorner
  • M. L. Vance
  • R. M. Macleod

There are no affiliations available

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