[Prolactin, bromocriptine and gonadal function in women: recent advances. II. Treatment of female hyperprolactinemia and other indications for the use of bromocriptine].

The surgical treatment of prolactinomas protects against the complications that these tumours have, but by itself does not cure the infertility which is found in at most 50% of all cases. The value of radiotherapy is limited to those cases where there is a contra-indication for carrying out surgery and in the tumours that have been incompletely removed and when pregnancy is not desired. The principal drugs used to lower prolactin are the dopamine agonist, which is bromocriptine and the serotonin antagonist which is methergoline which is less powerful than bromocriptine. Bromocriptine brings about normal prolactinaemia and ovulation is re-established and menstruation returns in most cases of idiopathic hyperprolactinaemia and in many cases where hyperprolactinaemia is due to a tumour. It, in certain cases, has an antitumoral effect and can definitely cure some hyperprolactinaemias whether they are tumoral or not. So bromocriptine is the specific treatment of women whose sterility is due to hyperprolactinaemia and no teratogenic effect has been reported. The only complications that have occurred in pregnancies that have been induced by this drug have been growths in the tumours in women who have pituitary adenomata, but these complications are far less frequent and serious in cases of micro-adenomata. Since the antitumoral effect of bromocriptine has been discovered the indications for surgery have lessened but it is often all the same necessary. The medical treatment of adenomata can only be considered when strict supervision is going to be undertaken. Bromocriptine can also establish ovulation in a few categories where ovulation occurs in normoprolactinaemic women and it can also be used as a treatment for the premenstrual syndrome.