Normalization of visual fields following bromocriptine treatment in hyperprolactinemic patients with visual field constriction.

Two patients with galactorrhea-amenorrhea and bilateral visual field defects were studied. Routine radiologic examination of each patient revealed a normal sella turcica and no demineralization of the posterior clinoid process. Serum prolactin levels were elevated (patient V. G., 80 ng/ml; patient S. R., 204 ng/ml). Within 2 months of bromocriptine therapy, the serum prolactin levels were normal (patient V. G., 12.21 ng/ml; patient S. R., 8.25 ng/ml) and the bilateral visual field defects were corrected. Bromocriptine has been shown to control prolactin secretion in patients with prolactin-secreting pituitary tumors. Normalization of restricted visual fields following bromocriptine therapy indicates the possibility of an anatomical regression of pituitary hyperplasia or an underlying prolactin-producing microadenoma. It is speculated that the modality of functional galactorrhea reflects hyperplasia of the lactotrophs preceding a nodular and ultimately an adenomatous change. The continuous and prolonged administration of bromocriptine may prevent such a progressive sequence. Further experience is required to validate this possibility.

Premature ovarian failure.

Twelve cases of premature ovarian failure (POF) are described. The clinical, hormonal, histopathologic and cytogenetic studies of each patient have been presented. The scope and the limitations of laparoscopic ovarian biopsy are discussed, as is the importance of radioimmunoassay of follicle-stimulating and luteinizing hormones (FSH/LH) in comparison to ovarian biopsy for the diagnosis of premature ovarian failure. A plea is made for the early diagnosis of POF so that these young women can be spared the expensive and time-consuming treatment for the associated problem of infertility.

PIP: The clinical, hormonal, cytogenetic, and ovarian histopathologic findings in 12 cases of premature ovarian failure are described. The scope and limitations of laparoscopic ovarian biopsy are discussed, as is the importance of radioimmunoassay of follicle stimulating and luteinizing hormones in comparison to ovarian biopsy for the diagnosis of premature ovarian failure. It is concluded that serum gonadotropin estimations and laparoscopic ovarian biopsies are complementary tools for the diagnosis of premature ovarian failure, and that 1 cannot replace the other for a final diagnosis. However, when facilities for radioimmunoassay for gonadotropins are not available, laparoscopic examination of ovaries and ovarian biopsies can alert the gynecologist to the diagnosis of premature ovarian failure. In the absence of a clinical response to clomid, the diagnosis could be confirmed. Early diagnosis can prevent the expense and time-consuming treatment for the associated problem of infertility.

The scope and limitations of laparoscopic ovarian biopsy in the diagnosis of secondary amenorrhea.

Laparoscopically directed ovarian biopsy has been evaluated in 39 cases of secondary amenorrhea. The definite diagnosis was achieved in 29 cases. In 10 cases, ovarian histopathology alone was insufficient, and the estimations of gonadotropins were essential for the final diagnosis. The scope and limitations of this procedure for the differential diagnosis of premature ovarian failure and hypothalamic-pituitary lesions are discussed.