プロラクチン産生下垂体腺腫にみられる乳汁漏出,不妊症に及ぼす治療効果

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The authors investigated factors responsible for cessation of galactorrhea or restoration of ovulation in 30 women with PRL-secreting pituitary adenomas after surgery with or without bromocriptine. All the patients complained of sterility and 25 patients had galactorrhea. Microsurgical removal of adenomas was performed in all the patients and 15 patients received oral bromocriptine after surgery on account of sustained elevated serum PRL levels. Galactorrhea ceased in 19 out of 25 patients (76.0%) after the treatment. The PRL levels where galactorrhea ceased ranged from three to 1,177 ng / ml. Galactorrhea ceased even at the elevated PRL levels in nine patients and four patients sustained galactorrhea at the normal PRL levels. Therefore, the normal PRL levels per se did not inevitably ensure cessation of galactorrhea after the treatment. However, the PRL level below 140 ng/ml was considered to ensure cessation of galactorrhea. There was no difference in the frequency of cessation of galactorrhea after the treatment between microadenomas and macroadenomas although there was a prevalence of microadenomas after surgery. Another favorable factor for cessation of galactorrhea was a longer postoperative interval of more than three months after surgery. Preoperative serum PRL levels, age of the patients at surgery, duration of galactorrhea, history of nursing, severity of galactorrhea and serum estradiol or progesterone levels had no correlation with cessation of galactorrhea. Ovulation was restored in 18 out of 30 patients (60.0%) after the treatment and pregnancy was established in 12 patients. The PRL levels where ovulation was restored ranged from three to 57 ng/m/l. Ovulation was restored even at elevated PRL levels in seven patients and nine patients sustained anovulation at the normal PRL levels. Therefore, the normal PRL levels per se did not inevitably ensure restoration of ovulation. There was no difference in the frequency of restoration of ovulation after the treatment between patients with preoperative PRL levels below 200 ng/ml and those with the levels over 200 ng/ml, although there was a prevalence of patients with levels below 200 ng/ml after surgery. There was a prevalence in the frequency of restoration in amenorrhea Grade I, preoperative duration of sterility of less than five years, microadenomas, a longer postoperative interval normal serum basal LH levels and peak LH levels in response to LH -RH and the presence of positive feedback control to surge LH in response to estrogen. Age of the patients at surgery, elevated dopamine activity in the hypothalamus and serum estradiol or progesterone levels were not correlated with restoration of ovulation.
日本脳神経外科学会の論文
1981-11-15

プロラクチン産生下垂体腺腫にみられる乳汁漏出,不妊症に及ぼす治療効果

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