Long-term follow-up of 246 hyperprolactinemic patients

Background. We wanted to evaluate the very long‐term effects of bromocriptine on prolactin (PRL) levels and pituitary tumor size in a large cohort of hyperprolactinemic patients. Methods. We conducted a retrospective cohort study in the Department of Endocrinology from Necker Hospital in Paris, France. Two hundred and forty‐six patients consulted primarily for menstrual disorders, with diagnosis of hyperprolactinemia. Patients were followed‐up for 99.9±3.6 months. One hundred and ninety‐one were treated with bromocriptine, 32 underwent surgery, and 23 received no treatment. Results. The mean initial plasma PRL level was 135.0±20.2 ng/ml. Presence of an adenoma was detected in 60% of our patients and comprised a microadenoma in 64% of cases. Compared to oligomenorrheic women, amenorrheic patients had significantly higher levels of PRL and larger pituitary tumor size. In the bromocriptine group, PRL levels decreased from 99.6±7.9 to 20.0±1.5 ng/ml (p=0.00001). The medical treatment was associated with disappearance of the adenoma in 45% of the women and with stabilization of pituitary tumor size in 40% of patients. Surgery led to disappearance of the adenoma in almost all cases, but failed to definitively cure hyperprolactinemia. Conclusion. In this large‐scale retrospective study, the medical treatment of mild hyperprolactinemia was shown to be effective and sufficient after 9 years of follow‐up.