Why is bromocriptine preferred for the treatment of hyperprolactinemia? Precautions during administration] Bromocriptine, a dopamine agonist, is clinically preferred for the pharmacological treatment of HPRL. This is because bromocriptine is the first clinically used and very effective drug. Its advantage over the other two drugs – cabergoline and quinagolide – is that it is easily available (generally available in hospital pharmacies). But at the same time it is also a drug with very pronounced side effects. The side effects of bromocriptine include headache, dizziness, nausea, vomiting, abdominal pain, postural hypotension, and psychiatric disorders, which often appear at the beginning of the dose and may resolve on their own in some patients. Therefore, do not engage in activities that may lower blood pressure, avoid sudden standing up, hot showers or tub baths, and do not use drugs that cause an increase in serum prolactin levels at the same time. The general principle of taking bromocriptine is to start with small doses, starting with 1/2 tablet orally and gradually increasing the dose, and taking it at bedtime can reduce side effects. Some doctors recommend vaginal or rectal administration for those who cannot tolerate oral administration. The dose can be adjusted according to the patient’s response during the dosing period until the clinical symptoms disappear and the lactogen drops to a normal level and stabilizes, and the lactogen is reviewed regularly. Ultimately, a normal serum lactate level is maintained at the lowest dose. Bromocriptine treatment can achieve good results in 70% to 90% of patients. About 10% of patients who are not sensitive to bromocriptine, have unsatisfactory results, or cannot tolerate it, can be replaced by other drugs or surgical treatment. Cartegolide and quinagolide are highly selective dopamine D2 receptor agonists, which are substitutes for bromocriptine and are characterized by more powerful lactogen suppression with relatively fewer adverse effects and longer duration of action. Can bromocriptine cure hyperprolactinemia? The treatment of HPRL and pituitary prolactin adenoma with bromocriptine (including cartegolide and quinagolide) is reversible in terms of either lowering serum prolactin levels or reducing tumor size, and long-term use is required to maintain the efficacy. Only a few cases achieve clinical cure after long-term treatment. During maintenance treatment, if menstrual disorders or serum prolactin levels cannot be controlled again, the cause should be investigated, such as drug effects, pregnancy, etc. If necessary, MRI should be reviewed to decide whether to adjust the dose of medication. Follow up at least twice a year to confirm normal serum prolactin levels. For patients whose serum prolactin level remains normal and adenoma basically disappears during the maintenance treatment of low-dose bromocriptine, the drug can be discontinued after 5 years on a trial basis, and if the serum prolactin level increases again after discontinuation, the drug is still needed for a long time. In patients with prolactin macroadenoma, if serum prolactin levels are normal after dopamine agonist treatment and the pituitary macroadenoma does not shrink, the diagnosis of nonprolactin adenoma or mixed pituitary adenoma should be reconsidered and whether other treatment (e.g., surgery) is needed instead. Patients with visual field defects prior to treatment should have their visual fields reviewed at the beginning of treatment. If there is no improvement or only partial improvement, MRI should be reviewed within 1 to 3 weeks after bromocriptine treatment to determine if surgical treatment is needed to relieve visual cross-compression. Microadenoma of menopausal age without associated symptoms can be left untreated because it does not cause any effect on the patient’s reproductive function. Although bromocriptine is effective in reducing the level of lactogen and shrinking the tumor, long-term administration of the drug may cause the tumor to proliferate in fibrous tissues, affecting the total resection of the tumor and reducing the surgical cure rate. The duration of observation of drug therapy is usually limited to 3 months. If the long-term dose is higher than 30mg/d, retroperitoneal fibrosis may occur in individual patients. Do all HPRL patients who want to get pregnant need to be treated with bromocriptine? What are the criteria for stopping the drug? As already mentioned, not all HPRL needs to be treated. For simple hyperprolactinemia without any etiology (e.g., no pituitary adenoma), treatment is only necessary if it affects the reproductive endocrine axis, affects ovarian function, causes menstrual disorders, or causes infertility such as ovulation or miscarriage. The incidence of spontaneous abortion, intrauterine death, fetal malformation, ectopic pregnancy, etc. does not increase in women with HPRL and pituitary prolactin microadenoma who require treatment and who become pregnant during bromocriptine treatment. The principle of management is to limit fetal exposure to the drug to as little time as possible. Unless continued treatment is necessary, the drug should generally be discontinued after definitive pregnancy. Serum prolactin levels and examination of the visual field should be measured periodically after discontinuation of the drug. In women with large adenomas with childbearing potential, pregnancy should be treated with bromocriptine only after the adenoma has shrunk. If the adenoma re-grows during pregnancy, administration of bromocriptine can still inhibit its growth, and given that the drug may have less effect on the mother and fetus than surgery, the drug must be continued throughout pregnancy until delivery. However, drug therapy requires close monitoring. How can I test my prolactin level during pregnancy? After pregnancy in normal women, serum prolactin levels can increase to about 10 times the level during non-pregnancy. If a patient’s blood prolactin level significantly exceeds that before treatment, increase the frequency of serum prolactin level monitoring and visual field examination. Once visual field defects or cavernous sinus syndrome are detected, bromocriptine needs to be added immediately, which can be expected to improve symptoms within 1 week; if no improvement is seen, surgical treatment should be considered. All pituitary adenomas combined with pregnancy need to be evaluated every 2 months during the gestation period. It is important to note that there is only a trend towards elevated levels of prolactin in the body during pregnancy, with an approximate range, and there is no absolute normal value against which to compare at each node of the gestational week. There is no point in repeatedly checking prolactin for fear that HPRL will have an effect on the fetus. Can HPRL patients breastfeed? There is insufficient evidence to believe that breastfeeding stimulates tumor growth. For women who wish to breastfeed, bromocriptine should generally be used until the patient wishes to end breastfeeding, unless pregnancy-induced tumor growth requires treatment. Treatment of infertility and infertility in HPRL patients] More than 90% of women with HPRL treated with bromocriptine and dopamine agonists have normalized serum prolactin levels and resumed ovulation. About 80% of patients resume normal menstruation, 80%-90% resume ovulation, and often patients become pregnant during treatment. If the serum prolactin level decreases but ovulation does not resume, ovulation treatment should be given after excluding other factors causing infertility. 1.Clomiphene citrate ovulation promotion: CC is used for ovulation promotion only for patients with certain functions of hypothalamus and pituitary gland, but it is not effective for patients with pituitary macroadenoma or when the pituitary tissue is severely damaged by surgery and pituitary function is impaired. 2. Gn ovulation promotion: For patients with low Gn amenorrhea caused by the destruction of pituitary tissues and impaired function after pituitary tumor surgery, exogenous Gn ovulation promotion can be used if CC ovulation promotion is ineffective. 3. If the patient has other factors leading to infertility, the pregnancy promotion measures are no different from those for other infertility patients.