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Pituitary Autonomy in Hyperprolactinemic Secondary Amenorrhea: Results of Hypothalamic-Pituitary Testing

¹ Prince Henry's Hospital, Medical Research Centre and Department of Endocrinology, Royal Women's Hospital, Melbourne, Victoria, Australia
³ Melbourne University Department of Obstetrics and Gynecology, Royal Women's Hospital Melbourne, Victoria, Australia

Reprint requests: David L. Healy, Medical Research Centre, Prince Henry's Hospital, Melbourne, Victoria, Australia.

Twenty-seven women with secondary amenorrhea of greater than six months duration were subjected to multiple testing of hypothalamo-pituitary function. They were divided into normo-prolactinemic (Group 1 mean serum prolactin (PRL) 9.8 ng/ml; range 6.8 to 13.0 ng/ml; n = 9) and hyperprolactinemic (Group 2 mean 37.5 ng/ml; range 19.2 to 93.7 ng/ml; n = 18) groups on the basis of 4 weekly baseline determinations. Group 2 had significantly (P < .05) lower serum LH and urinary pregnanediol levels than did Group 1; there was no statistical difference between the groups in serum FSH, T₄ T₃ or urinary estrogen measurements. Two women in Group 2 were found to have a pituitary chromophobe adenoma.

Group 2 women showed no significant rises in serum PRL following stimulation tests with thyrotropin releasing hormone (TRH, 200µg iv) and metoclopramide (10 mg orally), which caused significant responses in Group 1. The TSH response to TRH was, however, preserved in Group 2, while it was subnormal in Group 1 subjects. Both groups showed similar FSH and LH responses to luteinizing hormone-releasing hormone (LHRH, 25 µg iv). No significant suppression of serum PRL was seen in Group 2 patients given L-Dopa (500 mg orally), which produced a significant response (P < 0.05) in Group 1 subjects, while all patients showed marked reduction in serum PRL values following 2-bromo-aergocryptine (CB-154, 2.5 mg orally). When compared with other Group 2 members, the 2 cases with proven pituitary adenomata gave similar responses to the stimulation-inhibition tests and were not clearly distinguished on this basis.

We conclude: 1. The pattern of PRL responses to dynamic tests, although of pathophysiological interest, an autonomous pituitary lesion in patients with hyperprolactinemic secondary amenorrhea. 2. Such dynamic tests, although a pathophysiological interest, provide no clinical information additional to that provided by the mean basal serum PRL value. 3. In clinical practice, such dynamic tests should be confined to patients with mean serum PRL levels at around the upper limit of the normal range.

² Postgraduate Medical Research Scholar of the National Health and Medical Research Council of Australia.

Supported by the National Health and Medical Research Council of Australia and the Anti-Cancer Council of Victoria.

Part of the data has been presented at the 19th Annual Meeting of the Endocrine Society of Australia, August, 1976.

Received October 4, 1976.

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