Suginami H, Hamada K, Yano K, Kuroda G, Matsuura S
J Clin Endocrinol Metab. 1986 May;62(5):899-903. doi: 10.1210/jcem-62-5-899.
Afternoon-evening and nocturnal serum PRL levels and PRL responsiveness to metoclopramide (MCP) were determined in 34 women with normoprolactinemic anovulation (nPRL-Anov) and in the early follicular phase (EFP) in 6 normal women. Subsequently, the nPRL-Anov women were treated with 5 mg bromocriptine (Br) twice daily for 2 months, and its action on ovulation was determined. Those women who did not respond to Br received 50-150 mg clomiphene for 5 days. The nPRL-Anov patients were classified into 3 groups in terms of the efficacy of Br treatment: group I, those who ovulated with Br (n = 13); group II, those who ovulated after receiving Br and clomiphene (n = 7); and group III, those who failed to ovulate after the above treatments (n = 10). Four patients dropped out of the study. Diurnal serum PRL levels were approximately 10 ng/ml in all patients, and no statistical difference was found among the groups. Peak nocturnal serum PRL levels (the highest PRL value during the 0000-0400 h period) were 38.0 +/- 23.9 (+/- SD) ng/ml in group I patients, higher (P less than 0.05) than in groups II and III and normal (EFP) women (20.1 +/- 9.1, 20.7 +/- 7.7, and 16.3 +/- 2.7 ng/ml for the group II and III patients and the EFP women, respectively). MCP induced rapid and marked elevation in serum PRL levels in all subjects. The maximum post-MCP PRL value in the group I patients was 224.2 +/- 89.7 ng/ml, which was significantly higher (P less than 0.002) than the maximum value in the remaining groups (120.5 +/- 25.8, 121.3 +/- 54.2, and 101.9 +/- 28.1 ng/ml, respectively). Ten (76.9%) and 12 (92.3%) group I patients had nocturnal PRL levels above 25 ng/ml and maximum PRL values after MCP above 150 ng/ml, respectively. We conclude that some nPRL-Anov patients have elevated nocturnal serum PRL levels or enhanced PRL responsiveness to MCP, indicative of nocturnal or latent hyperprolactinemia. Br effectively induced ovulation in these patients. A MCP provocation test can predict the outcome of Br treatment in such nPRL-Anov patients.
对34名催乳素水平正常的无排卵女性（nPRL - Anov）以及6名正常女性卵泡早期（EFP）的下午 - 傍晚及夜间血清催乳素（PRL）水平和PRL对甲氧氯普胺（MCP）的反应性进行了测定。随后，nPRL - Anov组女性每天两次服用5mg溴隐亭（Br），持续2个月，并确定其对排卵的作用。对溴隐亭无反应的女性接受50 - 150mg克罗米芬治疗5天。根据溴隐亭治疗效果，将nPRL - Anov患者分为3组：第一组，服用溴隐亭后排卵的患者（n = 13）；第二组，服用溴隐亭和克罗米芬后排卵的患者（n = 7）；第三组，经过上述治疗仍未排卵的患者（n = 10）。4名患者退出研究。所有患者日间血清PRL水平约为10ng/ml，各组间无统计学差异。第一组患者夜间血清PRL峰值水平（00:00 - 04:00时段最高PRL值）为38.0±23.9（±SD）ng/ml，高于第二组、第三组及正常（EFP）女性（第二组、第三组患者及EFP女性分别为20.1±9.1、20.7±7.7和16.3±2.7ng/ml，P＜0.05）。MCP使所有受试者血清PRL水平迅速且显著升高。第一组患者MCP后PRL最大值为224.2±89.7ng/ml，显著高于其余各组（分别为120.5±25.8、121.3±54.2和101.9±28.1ng/ml，P＜0.002）。第一组分别有10名（76.9%）和12名（92.3%）患者夜间PRL水平高于25ng/ml及MCP后PRL最大值高于150ng/ml。我们得出结论，部分nPRL - Anov患者夜间血清PRL水平升高或对MCP的PRL反应性增强，提示夜间或潜在高催乳素血症。溴隐亭可有效诱导这些患者排卵。MCP激发试验可预测此类nPRL - Anov患者溴隐亭治疗的结果。
