DISCORDANT PATTERNS OF HYPERPROLACTINAEMIA AND GALACTORRHOEA IN SECONDARY AMENORRHOEA

ABSTRACT Hyperprolactinaemia occurred in 40 of 123 unselected patients (33%) with functional secondary amenorrhoea. Galactorrhoea was present only in 15 of these patients (38 %). On the other hand, galactorrhoea was found in 10 of 83 euprolactinaemic patients (12%). The frequency and severity of hyperprolactinaemia and galactorrhoea dissociated in various forms of amenorrhoea. Anorexia nervosa was characterized by euprolactinaemia and the absence of galactorrhoea. Self-induced weight loss resulted in amenorrhoea with a moderate degree of hyperprolactinaemia in 23 % of the cases. Yet, galactorrhoea was uncommon (1.6 %). Amenorrhoea following stress was also associated with moderate hyperprolactinaemia in 31 % of patients and a low frequency of galactorrhoea. By contrast, both hyperprolactinaemia and galactorrhoea occurred more frequently (36 %) and were more severe in patients who had post-pill amenorrhoea, but still 50 % of hyperprolactinaemic patients had no galactorrhoea and 28 % of euprolactinaemic patients had galactorrhoea. This discordance was accentuated in those patients who had been pregnant even if pregnancy did not immediately precede amenorrhoea. Galactorrhoea (63 %) and hyperprolactinaemia (36 %) were common in these patients and very high serum prolactin values were sometimes seen. Our results point to different mechanisms involved in the regulation of hypothalamic pituitary function and breast secretion in various forms of secondary amenorrhoea, and they may help select patients in whom the prolactin assay is likely to identify indication for specific treatment.

Brom-ergocryptine in the Treatment of Phenothiazine-Induced Galactorrhoea

An ergot alkaloid, 2-br-alpha-ergocryptine (CB 154), referred to hereafter as brom-ergocryptine, has been reported to inhibit puerperal lactation (Varga, Lutterbeck et al., 1972), and to terminate breast secretion in patients with inappropriate lactation (Lutterbeck, Pryor et al., 1971). Besser, Park et al. (1972) found that the drug suppressed elevated levels of plasma prolactin in five patients whose inappropriate lactation was due to a variety of causes. This hormonal effect was accompanied by clinical changes such as the disappearance of galactorrhoea, return of menstruation, and an increase in sexual potency.