Jacques Van Campenhout

Prolactin secretion in sixty-five patients with galactorrhea

Pituitary prolactin (PRL) secretion was evaluated in 65 galactorrheic individuals with nonfunctioning hypothalamic-pituitary tumors, acromegaly, prolactin-secreting tumors, Chiari-Frommel syndrome, Argonz-del Castillo syndrome, history of phenothiazine or α-methyldopa intake, primary hypothyroidism, use of contraceptive medications, and in patients with idiopathic galactorrhea. Mean serum prolactin concentrations in patients with prolactin-secreting pituitary tumors were significantly higher than those in other groups but over all there was no correlation between the serum prolactin levels and the grade of galactorrhea. Neither a single elevated serum prolactin level nor the degree of suppressibility after L-dopa administration was diagnostic of a pituitary tumor. However, a history of consistently high serum prolactin concentrations was highly indicative of a prolactin-secreting tumor.

Oral contraceptives and prolactinomas: A case-control study

The increase in the number of newly diagnosed cases of prolactinomas seems to coincide with the use of oral contraceptives during the past two decades. The following retrospective case-control study was undertaken in an attempt to disprove a null hypothesis of relationship between oral contraceptive use and prolactinomas. Each of 70 patients operated upon for removal of a prolactinoma was closely matched for age, gravidity, and year of final diagnosis with one patient in each of three control groups. The control groups selected were constituted, respectively, of patients with secondary amenorrhea and normal prolactin levels, patients with normal ovulatory cycles consulting for infertility, and subjects without medical or gynecologic problems. No statistically significative differences were found in the exposure rates to oral contraceptives among four groups. This study thus failed to reveal a significant association between prolactinomas and oral contraceptives but, given the sample size, a relative risk lower than 3.32 cannot be demonstrated or disproved.

The expectancy of pregnancy for “normal” infertile couples

The prognosis of unexplained infertility was studied for 47 couples. The cumulative rate of pregnancy was 65%, with 81% achieving a full-term pregnancy. The type and duration of infertility, the age of the woman, and the previous use of contraceptives did not significantly modify the results. This study indicates that a complete investigative protocol should include laparoscopy. It also suggests caution in the application of untried empirical treatments to normal infertile couples.

Amenorrhea following the use of oral contraceptives.

Clinical aspects and the incidence of the various underlying etiologic factors were studied in 86 patients with post-oral contraceptive amenorrhea. Patients were divided into two groups according to the presence or absence of detectable galactorrhea. Group I was composed of 55 amenorrheic patients without detectable galactorrhea and group II included 31 patients with amenorrhea associated with galactorrhea. Both groups were comparable for age, gravidity, duration of intake of oral contraceptives, and duration of amenorrhea. The incidence of previous oligomenorrhea and late menarche was high in both groups. The most striking difference between the two groups was in the incidence of pituitary prolactin-secreting tumor--32% among patients with galactorrhea and less than 2% among patients without galactorrhea. Identification of galactorrhea and accurate diagnosis of its causes are mandatory for successful management of postpill amenorrhea.

Carbohydrate tolerance in gonadal dysgenesis

Among 42 patients with GD, one had clinical diabetes and 10 had chemical diabetes (26%) when tested by OGTT. The insulinogenic index was lower in patients with chemical diabetes than in patients with normal OGTT. Among 19 patients with isolated hypogonadotropic hypogonadism, similarly tested, three had chemical diabetes (15%). In a prospective study of 29 patients with GD tested repeatedly, the incidence of diabetic OGTT increased significantly with age. As glucose tolerance deteriorated, the plasma insulin response was delayed and the insulinogenic index decreased. The carbohydrate tolerance was unrelated to weight, estrogen replacement therapy, chromosomal pattern, and GH response. In six GD cases studied at a 6 year interval, the tolerance to oral glucose decreased with time whereas glucose utilization following its intravenous injection or tolbutamide administration was only slightly diminished; the plasma insulin was reduced by approximately 50% in response to each of these stimulations. These studies suggest that carbohydrate intolerance is frequently associated with GD and is due to a diminished beta-cell function.

The Expectancy of Pregnancy for “Normal” Infertile Couples

The prognosis of unexplained infertility was studied for 47 couples. The cumulative rate of pregnancy was 65%, with 81% achieving a full-term pregnancy. The type and duration of infertility, the age of the woman, and the previous use of contraceptives did not significantly modify the results. This study indicates that a complete investigative protocol should include laparoscopy. It also suggests caution in the application of untried empirical treatments to normal infertile couples.