Serum adrenal androgens in hyperprolactinaemic women prior to, during, and after chronic treatment with bromocriptine

Conflicting data exist in the literature regarding serum adrenal androgen concentrations in hyperprolactinaemic states and the influence or lack thereof of dopaminergic drugs on the androgens. We carried out a prospective study on 7 hyperoprolactinaemic women, none of whom had clinical features commonly associated with elevated androgens. Serum levels of prolactin (Prl), cortisol, androstenedione, dehydroepiandrosterone (DHA) and dehydroepiandrosterone sulphate (DHAS) were measured basally, at 3, 6, and 12 months during chronic bromocriptine therapy, and 2 months following withdrawal of the drug. Prior to bromocriptine therapy, and despite a mean serum Prl of 178 ng/ml, all values of cortisol, androstenedione and DHA were normal as were 6 of 7 DHAS values. During treatment with bromocriptine for 12 months, the mean Prl level dropped into the normal range, but levels of cortisol, androstenedione and DHA remained unchanged. DHAS was significantly lower at 12 months when compared to initial levels but was not significantly different at 3 and 6 months. No significant differences were observed in cortisol or androgens 2 months after termination of the bromocriptine compared to basal levels. A significant correlation was observed between cortisol and both androstenedione (P = 0.0042) and DHA (P = 0.0002) but not with DHAS. A significant correlation was found to exist between Prl and DHAS (P < 0.0001) but not with androstenedione or DHA. Thus, we found normal levels of serum adrenal androgens in 6 of 7 hyperprolactinaemic women, none of whom demonstrated clinical features of the polycystic ovary syndrome. These data suggest: 1) increased basal adrenal androgens in hyperprolactinaemia may not be as common as previously reported; 2) androstenedione and DHA do not correlate with Prl; 3) DHAS is correlated with Prl. Although it appears that DHAS and prolactin concentrations are related, the mechanism underlying this relationship remains uncertain.