[Prolactin-producing pituitary adenomas as a cause of primary amenorrhea and their neurosurgical treatment].

Among 86 female patients with prolactin producing pituitary adenomas (prolactinomas) 5 were observed with primary amenorrhoea. These 5 females were aged between 30 and 33 years. Diagnosis leading to specific treatment was thus established only 16 to 19 years after failure of the expected menarche. Surgery revealed three microadenomas (diameter 6-10 mm) and two invasive macroadenomas (diameter 20 and 21 mm). After selective microsurgical removal of the adenomas spontaneous ovulation and menstruation occurred in two patients with microadenomas, in the third female it could be induced by bromocriptine treatment of the residual hyperprolactinaemia. Overall there were four successful pregnancies. In contrast, spontaneous menstruation did not occur in two females with macroadenomas due to persistent residual hyperprolactinaemia postoperatively. This remained true even after additional bromocriptine treatment which normalised the level of prolactin. These observations demonstrate the importance of early diagnosis of primary amenorrhoea caused by prolactinoma as in small adenomas selective surgical removal may result in fertility.