Redergin treatment of hypertensive menopausal women

AIM: To assess a hypotensive effect of redergin (dihydroergotoxin)--agonist of dopaminergic receptors--in monotherapy (4.5-6 mg/day) and in combination with enalapril and amlodipin (10 mg/day). MATERIAL AND METHODS: Redergin in monotherapy or combined therapy was given to 106 hypertensive women in pre- or postmenopause and 24 hypertensive women of reproductive age. Antihypertensive effect was assessed by changes in arterial pressure, frequency and severity of hypertensive crises, diuresis, clinical symptoms of menopausal syndrome. RESULTS: A significant fall in arterial pressure, intensive diuresis, less frequent or absent hypertensive crises, relief of menopausal symptoms were observed on day 10-14 of redergin monotherapy of menopausal patients with mild hypertension and in combined treatment of menopausal women with moderate and severe hypertension. CONCLUSION: Antihypertensive and diuretic effect of redergin confirm a pathogenetic role of deficient dopaminergic activity in development of menopausal hypertension.     

Effect of bromocriptine treatment on prolactin, noradrenaline and blood pressure in hypertensive haemodialysis patients

Bromocriptine (2.5 mg/day orally) produced a significant fall in supine mean arterial pressure in nine hypertensive haemodialysis patients with high serum prolactin levels, without causing significant changes in heart rate. On bromocriptine, there was a significant decrease in the mean value of both serum prolactin and plasma noradrenaline, without significant changes in the mean value of plasma renin activity. A significant relationship was found between the changes in supine plasma noradrenaline and the changes in supine mean arterial pressure induced by bromocriptine. The increase in mean arterial pressure in response to the tilt test was greater on bromocriptine than on placebo although the changes in plasma noradrenaline were reduced by bromocriptine. Similar results were observed during the cold pressor test. These findings suggest that the arterial pressure-lowering effect of bromocriptine is related to the reduction in sympathetic out-flow. The parallel decrease in serum prolactin raises the question of the possible involvement of dopaminergic mechanisms in the development of hypertension in our patients. Moreover, bromocriptine seems to enhance the vascular response to endogenous noradrenaline.     

Clinical efficacy of xefocam and its effect on arterial pressure and heart rhythm variability in patients with rheumatoid arthritis in combination with arterial hypertension

AIM: To try clinical response to xefocam, its safety, effects on arterial pressure and heart rhythm variability in rheumatoid arthritis (RA) patients with arterial hypertension (HT). MATERIAL AND METHODS: Xefocam (lornoxicam), a new non-steroid antiinflammatory drug, was given for 12 weeks in a daily dose 12 mg/day to 44 RA patients (mean age 54.5 +/- 7.3 years). 24-h arterial pressure monitoring was made with Cardiotens-01 device. RESULTS: Xefocam in a dose 12 mg/day has shown good tolerance, a high analgetic and antiinflammatory effect as indicated by a positive response of articular syndrome, a significant fall of systolic arterial pressure, decreased heart rate, better heart rhythm variability. CONCLUSION: In hypertensive RA patients xefocam in a dose 12 mg/day proved effective and safe.     

Success of a parlodel test in the differential diagnosis of syndromes of disturbed prolactin secretion

Altogether 33 women with various forms of the syndrome of hyperprolactinemia (hypophyseal adenoma, idiopathic disorders of prolactin secretion--PL, and normoprolactinemic galactorrhea) and 6 controls were investigated. An acute parlodel test at a dose of 5 mg with subsequent determination of the blood levels of PL and TSH was performed in 2 and 4 h after drug administration. The most noticeable disorders in the dopaminergic regulation of pituitary activity were observed in pituitary adenomas which were characterized by a dramatically disturbed response of PL and TSH to parlodel. In hyperprolactinemia of nontumorous genesis PL and and TSH secretion in tests was also changed. The parlodel test seems to be a valuable method for differential diagnosis of the syndrome of disturbed PL secretion.     

The effect of external pituitary irradiation on elevated serum prolactin levels in patients with pituitary macroadenomas.

The response of serum prolactin to external radiotherapy was studied in 58 patients (32 women) with pituitary tumours, aged between 16 and 75 years. Forty-four patients underwent pituitary surgery before radiotherapy. Six patients were irradiated with a regimen of 20 Gy in eight fractions over 10-11 days and the remainder received 35-42.5 Gy in 15 fractions over 20-22 days. Following radiotherapy, 44 patients received additional treatment with dopaminergic agonists. Prolactin levels ranged from 1078 to 491,000 mU/l (median 11,750 mU/l) before radiotherapy and all but three patients showed a fall in serum prolactin (measured 4 weeks after stopping bromocriptine in those on dopamine agonist therapy) during observation over periods of up to 154 months. All patients had evidence of pituitary fossa erosion or expansion at presentation and large tumours (Hardy-Vezina Grade 3-4) were more common in male patients (chi 2 = 10.08, p less than 0.01). The rate of fall of serum prolactin levels was greater in patients with true prolactin-secreting tumours when compared with those who had stalk or hypothalamic damage (p less than 0.005). The rate of decline of serum prolactin was also significantly related to the pre-radiotherapy value (rho = 0.519, p less than 0.01). A serum prolactin level less than 500 mU/l was achieved in 31 out of 44 patients treated with radiotherapy and dopaminergic agonist but only nine remained normoprolactinaemic when medication was discontinued for 4 weeks or more. The serum prolactin level fell permanently to less than 500 mU/l in two of 14 patients treated with radiotherapy only. Actuarial analysis of data from all patients indicated a 50 per cent probability that prolactin would be reduced to less than 500 mU/l by 10 years; this increased to 58 per cent for patients with smaller tumours (Hardy-Vezina grade 2).(ABSTRACT TRUNCATED AT 250 WORDS)     

Renal dopamine excretion in healthy volunteers after oral ingestion of l-Dopa

Summary— l -Dopa is converted to dopamine by aromatic- l -amino acid decarboxylase (AADC). In the kidney, proximal tubular epithelial cells are rich in AADC and urinary free dopamine excretion is a marker for endorenal extraneuronal dopamine synthesis. The urinary free dopamine excretion was analysed in a double-blind cross-over study after oral ingestion of l -Dopa or a placebo in five healthy volunteers. The drug ingestions were separated by one week's wash-out. Since in a preliminary study, two volunteers ingesting a single l -Dopa dose of 500 mg with breakfast experienced nausea, the five volunteers of the present study were given 300 mg l -Dopa (50 mg at 9 am with breakfast, 100 mg before lunch and 150 mg before dinner) without any adverse effects. l -Dopa induced an increase in 24-h urinary dopamine excretion (HPLC with electrochemical detection). Free urinary dopamine (1900 μg/24 h) accounted for 0.8% of the daily oral l -Dopa dose and represented 10% of total urinary dopamine excretion. l -Dopa treatment had no significant effect on mean ambulatory arterial blood pressure and heart rate measured from 9 am to 6 pm (Spacelabs) or on 24 h urinary water and sodium excretion.     

Altered behavioral response to a D2 agonist, LY141865, in spontaneously hypertensive rats exhibiting biochemical and endocrine responses similar to those in normotensive rats

LY141865, a dopamine agonist selective for D2 dopamine receptors, caused hypomotility at low doses (0.01 and 0.1 mg/kg) and hypermotility at high doses (1 and 10 mg/kg) after i.p. injection into normotensive rats (WKY). In age-matched hypertensive rats (SHR), LY141865 caused hypomotility (not hypermotility) at all of these doses. The basal locomotor activity was higher in SHR than in WKY, but striatal concentrations of dopamine and its metabolites, 3,4-dihydroxyphenylacetic acid and homovanillic acid, and of serotonin and its metabolite, 5-hydroxyindoleacetic acid, were not different between the two groups of rats. The specific binding of a dopamine receptor radioligand, tritiated pergolide, in striatum and mesolimbic regions, did not differ in SHR compared with WKY. In contrast to the lack of locomotor stimulation in SHR, other dopaminergic responses to LY141865 occurred in SHR as well as WKY. For instance, LY141865 decreased striatal and mesolimbic concentrations of 3,4-dihydroxyphenylacetic acid and homovanillic acid, increased striatal and mesolimbic concentrations of acetylcholine, decreased hypothalamic concentrations of epinephrine, increased serum corticosterone concentration and decreased serum prolactin concentration in SHR as in WKY. Because radioligand-labeled dopamine receptors and several LY141865 responses mediated by dopamine receptors did not differ appreciably in SHR compared with WKY, the lack of behavioral hypermotility in response to LY141865 in SHR may be due to abnormalities in some synaptic mechanisms beyond dopamine receptor activation that are involved in the expression of increased locomotion in response to the dopamine agonist.     

Age- and sex-related differences for the urinary excretion of norepinephrine, epinephrine, and dopamine in adults

Using a specific high-performance liquid-chromatographic method, we measured norepinephrine, epinephrine, and dopamine in 24-h urine collections from 459 men and 497 women, ages 17 to 88 years. We found a significant negative correlation between age and the 24-h excretion of dopamine in men and women (P less than 0.001). Epinephrine excretion decreased with age in men (P less than 0.001). No age dependence was observed for norepinephrine (P greater than 0.2). The excretion of all three catecholamines, expressed in nmol/24 h, was significantly greater in men than in women. The differences, however, were small. With data expressed in nmol/g of creatinine, only epinephrine excretion was greater in men; norepinephrine and dopamine excretions were slightly greater in women. Also, expressed in these units, urinary excretion of norepinephrine in both sexes and of epinephrine in women was significantly positively related with age; urinary excretion of dopamine was significantly inversely related to age in women, but not in men. Reference values are provided for age-independent variables in both sexes.     

Clinical, vegetative and cognitive disorders in hypertensive postmenopausal women in relation to menopause causes

AIM: To specify clinical, vegetative and cognitive disorders in hypertensive women depending on the type of menopause. MATERIAL AND METHODS: A total of 195 hypertensive women were divided into three groups: group 1 (n = 50, age 45.6 +/- 4.5 years) consisted of premenopausal women, group 2 (n = 100, age 57.4 +/- 4.7 years) - of women with natural menopause, group 3 (n = 45, age 55.1 +/- 5.9 years)--with early and/or surgical menopause. Severity of the menopausal syndrome, anxiety, depression, alexitimia, mental performance, vegetative regulation of heart rhythm were examined. RESULTS: The premenopausal women were characterized by cardial and cerebral disorders, unaffected psychovegetative function and initial symptoms of lowering mental performance. Hypertensive women with natural menopause showed combination of cardial and cerebral symptoms with moderate anxio-depressive disorders, alexitimia, subnormal parasympathetic activity of the autonomic nervous system in high centralization of heart rhythm regulation and attention disturbances. Patients with surgical and/or early menopause had marked cardial and cerebral symptoms, moderate anxiodepressive disorders, alexitimia, inhibition of mental performance, vegetative dysfunction, overcentralization of heart rhythm control. CONCLUSION: With development of postmenopausal metabolic symptom complex, severity of hypertension grows with emergence of anxiodepressive disorders which combine with vegetative regulation disorders and attenuation of mental performance.     

Hypothalamic-Pituitary Function in Diverse Hyperprolactinemic States

Prolactin secretion in normal adults is characterized by periods of episodic secretion which increase in magnitude during sleep. In this study, we report the 24-h mean prolactin concentrations, prolactin secretory patterns, and associated pituitary hormone function in nine patients (seven women and two men) with hyperprolactinemia of diverse etiologies. Four of the women and one of the men had clinically demonstrable pituitary tumors, one boy had a hypothalamic tumor, and the three other women had "functional" hyperprolactinemia. The 24-h mean prolactin concentrations derived from averaging the 20-min interval samples for 24 h ranged from 28.6 to 1,220 ng/ml. The plasma prolactin patterns in these patients showed persistence of episodic secretion in all and loss of the normal sleep-wake difference in plasma prolactin in seven of nine. Three of the patients with galactorrhea and comparable 24-h mean prolactin concentrations (58.3, 59.7, and 64.3 ng/ml) showed similar prolactin secretory patterns despite different etiologic mechanisms. Evaluation of the secretory patterns of luteinizing hormone (LH) in these patients showed loss of normal pulsatile LH release and a low 24-h mean LH concentration in the patient with the pituitary tumor, while the two patients without clinically demonstrable pituitary tumors ("post-pill" galactorrhea and "idiopathic" galactorrhea) showed normal LH secretory patterns and 24-h mean LH concentrations. The 24-h mean cortisol concentrations and secretory patterns were normal in five of the seven patients who had these parameters measured. The patient with the hypothalamic tumor had a low 24-h mean cortisol concentration and production rate and absent response to metyrapone. The patient with "idiopathic" galactorrhea had an elevated 24-h mean cortisol concentration but normal cortisol production rate and urinary 17-hydroxycorticoid excretion. Growth hormone secretion was abnormal in four of the patients (one with the hypothalamic tumor and three with pituitary tumors). Thyrotropin-releasing hormone (TRH) administration in four patients resulted in normal TSH release in two patients (one of whom developed galactorrhea after the test), an absent response in the patient with the hypothalamic tumor, and a blunted response in one of the women with a pituitary tumor. The two men had low 24-h mean plasma testosterone concentrations (69 and 30 ng/100 ml) and symptoms of impotence and loss of libido. Five of the women (four with pituitary tumors and one with Chiari-Frommel syndrome) had either low 24-h mean LH concentrations, abnormal LH secretory patterns, or both. These data indicate that patients with hyperprolactinemia encompassing a varied etiological range frequently show loss of the normal sleep-associated increase in prolactin secretion as well as abnormalities in the regulation of the other hypothalamic pituitary-regulated hormones. The finding that the abnormalities in LH, growth hormone, thyrotropin, and cortisol (adrenocorticotrophic) secretion were almost uniformly confined to the patients with the clinically demonstrable hypothalamic or pituitary tumors suggests that the size of the lesion is the critical factor.     

Effect of diroton on characteristics of 24-hours arterial pressure monitoring in hypertensive patients with polycythemia vera

AIM: To study the data of 24-h monitoring of blood pressure (MBP) and effects of an ACE inhibitor lisinopril (diroton) in hypertensive patients with polycythemia vera (PV). MATERIAL AND METHODS: 20 patients with arterial hypertension of degree II and III with PV aged 41 to 77 years. Mean duration of AH and PV was 11.8 +/- 2.2 and 2.0 +/- 0.2 years, respectively. Diroton was given as monotherapy in a single morning dose 10-40 mg for 4 weeks. 24-h MBP was made before the treatment and on the 4th week of the treatment. In addition to standard estimations, hour-to-hour double product (DP) was estimated. RESULTS: After 4 weeks of diroton therapy there was a 12.2%, 9.5%, 25% and 15.4% fall in mean 24-h systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), DP, respectively. A positive effect was registered on variability and 24-h profile of BP. A response was achieved in 85% patients. The target level of mean 24-h blood pressure < 135/85 mm Hg was achieved in 65%, and 10% fall in SBD and/or DBP in 20% patients. ACE inhibitors' side effect--severe dry cough--was not encountered. CONCLUSION: PV aggravates arterial hypertension. Monotherapy with diroton effectively controls BP in hypertensive patients with PV in a 4-week course intake in a single morning dose and is well tolerated.     

Role of hypothalamo-hypophyseal-adrenal axis in the pathogenesis of arterial hypertension in patients with prolactinoma of the anterior lobe of the hypophysis

AIM: To elucidate mechanisms underlying arterial hypertension (AH) in patients with hyperprolactinemia, prolactin-secreting adenoma of the anterior lobe of the hypothesis, in particular. MATERIAL AND METHODS: 9 females with microprolactin-secreting and 4 females with macroprolactin-secreting adenoma of the anterior lobe of the hypophysis (mean age 33.8 +/- 3.7 years) were examined using radioimmunoassay of the hormones, computed tomography, MR-tomography of the adrenals and brain. RESULTS: Humoral regulation of the hypothalamic-hypophyseal-adrenal axis was found different in patients with microadenoma due to dopaminergic insufficiency of the hypothalamus and in patients with macroadenoma--tumor of the hypophyseal genesis. Patients with microadenoma were diagnosed to have low-renin diastolic arterial hypertension with clinical symptoms of hyperaldosteronism and high levels of plasma aldosterone. Patients with macroadenoma had normal arterial pressure, aldosterone levels and plasma renin activity. Treatment with parlodel, agonist of dopaminergic receptors, reduced arterial pressure, prolactin level, plasma aldosterone and raised plasma renin activity in patients with microadenoma. Such changes were not observed in patients with macroadenoma. CONCLUSION: It is suggested that one of the causes of AH in patients with microprolactin-secreting hypophyseal adenoma lies in hyperaldosteronemia which develops as a result of dopaminergic insufficiency of the hypothalamus and hyperprolactinemia.     

Treatment of uremic hypogonadism with parlodel

Signs of hypogonadism and an elevated prolactin level (EPL) were found in the blood serum of 12 men and 9 women with different stages of chronic renal insufficiency (CRI) as compared to 20 healthy persons. The treatment with parlodel, a EPL secretion inhibitor, at a dose of 2.5-7.5 mg a day for 1-6.5 mos raised potency in 10 men, brought the sperm composition to normal in 5. Dysfunctional uterine bleeding was cut short in 4 women, the menstrual cycle was resumed in 3, the absence of any effect was noted in 2. The EPL level decreased significantly in all the patients. The results of the parlodel therapy of uremic hypogonadism were discussed with respect to CRI gravity and duration and the time period of a therapeutic course. Problems concerning the pathogenesis of uremic hypogonadism were considered.     

Tuberoinfundibular Dopaminergic Tonus in Common Migraine

Changes in dopaminergic tonus have been hypothesized in patients with common migraine, suggesting that prolactin may play a role in the pathogenesis of the migraine. We investigated the prolactin response to domperidone, a dopamine receptor blocker. We tested 22 patients with common migraine (8 men, 7 women in the follicular phase of the menstrual cycle, and 7 women in the luteal phase), and 22 normal subjects adjusted for age, sex and phase of the menstrual cycle. Domperidone produced a significant rise of serum prolactin (p less than 0.01) in migrainous patients (7.77 +/- 3.09 vs 71.06 +/- 9.97 in men, 7.05 +/- 2.3 vs 129.58 +/- 14.15 in women in the follicular phase of the menstrual cycle, and 14.28 +/- 3.51 vs 169.71 +/- 16.63 in women in the luteal phase) and control subjects. The response did not show significant differences between migrainous patients and normal subjects. These data do not suggest changes in the tuberoinfundibular dopaminergic tonus in migrainous patients, in contrast to reports of other authors.     

Moexipril influence on quality of life in postmenopausal women with arterial hypertension

AIM: To evaluate a hypotensive effect and metabolic neutrality and safety of ACE inhibitor moexipril in postmenopausal women with arterial hypertension (AH), influence on quality of life. MATERIAL AND METHODS: Thirty two hypertensive postmenopausal women (age 63.1 +/- 0.8 years) received moexipril for 4 months. The history of AH was 10.4 +/- 2.3 years, on the average. After a free of drugs week moexipril was given in a dose 7.5 mg/day with titration to 15 mg in 2 weeks and addition (if the target pressure was not achieved) of hydrochlorothiaside in a dose 12.5 mg. The examination included 24-h monitoring of blood pressure, estimation of microalbuminuria (MAU), endothelial function and blood biochemistry. Initially and after 4 weeks of the treatment quality of life was assessed (scales SF-36 and EuroQol). RESULTS: The initial level of office BP was 164.33/94.50 mm Hg, in 3 months a target level was achieved (136/84 mm Hg). It persisted for the next month. Moexipril corrected endothelial function and vascular elasticity in all the patients. MAU fell from 28.28 to 8.10 mg/l. Quality of life improved. Lipid and carbohydrate changes were not registered. CONCLUSION: Moexipril has a hypotensive and nephroprotective effects, improves endothelial function and quality of life in hypertensive postmenopausal women.     

Defective dopaminergic regulation of prolactin secretion in patients with hyperprolactinemia

In order to evaluate the dopaminergic control of the lactotroph, we examined the plasma prolactin response to metoclopramide (a dopamine receptor blocker, 10 mg iv bolus) and to dopamine (1 microgram/Kg/min iv infusion for 120 min) in 52 hyperprolactinemic female patients and 19 healthy volunteer women. Three diagnostic categories were included: "idiopathic" hyperprolactinemia (21), microadenoma (24), and macroadenoma (7). Patients from all groups showed a marked blunting of the prolactin response to metoclopramide as compared to the prolactin rise in normal women (p less than 0.001). However, normal responses were observed in 8 patients with idiopathic hyperprolactinemia and in one patient with adenoma. The magnitude of the prolactin response to metoclopramide (percent of baseline level) correlated negatively with the level of basal prolactin in each group except for macroadenoma patients. Dopamine infusion significantly (p = 0.015) reduced the mean plasma prolactin levels in hyperprolactinemic patients and normal women. However, patients with idiopathic hyperprolactinemia were hyposensitive to dopamine (p less than 0.05). Furthermore, microadenoma patients were less responsive to dopamine suppression than were the patients with macroadenoma (p less than 0.05). The results indicate the presence of a relative resistance to dopamine in patients with idiopathic hyperprolactinemia and in patients with microadenoma. They also suggest that in these patients, the decrease in prolactin response to metoclopramide may be explained by the relative refractoriness to endogenous dopamine.     

Effect of pathogenetic treatment on vasopressin secretion in patients with hypothalamic syndrome

Blood vasopressin concentration, hypothalamic response to stress resultant from insulin hypoglycemia and to acute furosemide load were measured in 72 patients with neuro-endocrine-metabolic form of hypothalamic syndrome. Pathogenetic treatment was decided upon by sensitivity to dopaminergic drug parlodel and antiserotonin drug peritol. According to the sensitivity tests the patients received either parlodel (5 mg/day) or peritol (12 mg/day) for 3-6 months. There were also patients on symptomatic treatment aimed at reduction of body weight. Peritol treatment promoted a decline in basal blood level of vasopressin and better response to insulin hypoglycemia and furosemide test. Parlodel treatment normalized vasopressin blood concentration and hypothalamic response to stimulators. Routine symptomatic therapy did not induce differences in vasopressin level compared to active stage of the disease.     

Menopausal Experiences of Women with Intellectual Disabilities

Background Little is known about the menopause in women with intellectual disabilities (ID) save that its onset is earlier than in the general population, and earlier still in women with Down’s syndrome (DS). This study directly explored menopausal experiences in women with ID, both with and without DS, with the aim of identifying levels of knowledge of the menopause and of its health and reproductive implications. Methods Information was collected from 45 women with ID (17 DS, 28 non‐DS; age 35–65 years) using a semi‐structured interview. Results Menopausal experiences of the women with and without DS were very similar. Most of the women were unaware of menopause‐associated changes in their body and few understood why they menstruated. Difficulties in disentangling behavioural consequences of menopausal symptoms from behaviours arising from other causes were evident. A need for better health education training and more accessible health resources was identified. Conclusions Promoting better awareness of menopause‐related health issues in women with ID seems warranted. Appropriately‐tailored health education materials need to be made more readily available.     

The Effect of External Pituitary Irradiation on Elevated Serum Prolactin Levels in Patients with Pituitary Macroadenomas

The response of serum prolactin to external radiotherapy wasstudied in 58 patients (32 women) with pituitary tumours, agedbetween 16 and 75 years. Forty-four patients underwent pituitarysurgery before radiotherapy. Six Patients were irradiated witha regimen of 20 Gy in eight fractions over 10–11 daysand the remainder received 35–42.5 Gy in 15 fractionsover 20–22 days. Following radiotherapy, 44 patients receivedadditional treatment with dopaminergic agonists. Prolactin levelsranged from 1078 to 491000 mU/I (median 11750 mU/I) before radiotherapyand all but three patients showed a fall in serum prolactin(measured 4 weeks after stopping bromocriptine in those on dopamineagonist therapy) during observation over periods of up to 154months. All patients had evidence of pituitary fossa erosionor expansion at presentation and large tumours (Hardy-VezinaGrade 3–4) were more common in male patients (²=10.08,p<0.01). The rate of fall of serum prolaetin levels was greaterin patients with true prolactin-secreting tumours when comparedwith those who had stalk or hypothalamic damage (p< 0.005).The rate of decline of serum prolactin was also significantlyrelated to the pre-radiotherapy value (p=0.519, p<0.01).A serum prolactin level. <500 mU/I was achieved in 31 outof 44 patients treated with radiotherapy and dopaminergic agonistbut only nine remained normoprolactinaemic when medication wasdiscontinued for 4 weeks or more. The serum prolactin levelfell permanently to <500 mU/I in two of 14 patients treatedwith radiotherapy only. Actuarial analysis of data from allpatients indicated a 50 per cent probability that prolactinwould be reduced to <500 mU/I by 10 years; this increasedto 58 per cent for patients with smaller tumours (Hardy-Vezinagrade 2). Fourteen of 19 women of premenopausal age were amenorrhoeicbefore radiotherapy, but despite bromocriptine, menstruationwas restored in only five. A separate group of nine patientswith primary suprasellar, non-prolactin-secreting tumours andelevated prolactin levels was also studied. Prolactin concentrationsranged between 1016 and >4600 mU/I intially and were reducedby radiotherapy at a rate indistinguishable from that of patientswith pituitary adenomas associated with disconnection hyperprolactinaemia.None achieved permanent reduction of serum prolactin to <500mU/I. External radiotherapy is effective in reducing serum prolactinlevels in patients with pituitary macroadenomas, particularlywhere the hyperprolactinaemia is due to true tumour hypersecretion,but normal levels may take over 10 years to achieve. Radiation-inducedhypothalamic damage probably contributes to the hyperprolactinaemiapersisting after therapy and together with tumour-associatedor radiation-induced hypopituitarism accounts for the poor prospectsfor fertility in female patients.