Department

of

Departments I and II of Obstetrics and Gynaecology1), University Central Hospital, 00290 Helsinki 29, Serology and Bacteriology2), University of Helsinki, 00290

Helsinki 29

PYRIDOXINE TREATMENT OF GALACTORRHOEA-AMENORRHOEA SYNDROMES

By P. Lehtovirta, T. Ranta

and M.

Sepp\l=a"\l\l=a"\

ABSTRACT

pyridoxine (B6) on galactorrhoea, amenorrhoea, and the galactorrhoea-amenorrhoea syndrome was studied in 22 patients. No consistent change in serum prolactin concentration and no resumption of ovulation were seen during 3 months B6 therapy. Inappropriate lactation ceased in 3 of 10 patients with galactorrhoea alone, and menses were restored in 2 of 9 patients with the galactorrhoea-amenorrhoea syndrome while on B6 therapy. Our results suggest that B6 is not generally effective in the treatment of galactorrhoea-amenorrhoea syndromes. The effect of

The effect of pyridoxine (B(¡) in suppressing puerperal lactation and in the treatment of galactorrhoea-amenorrhoea syndrome has been a subject of both interest and confusion. The original finding (Foukas 1973) that Bq administra¬ tion suppresses puerperal lactation was not confirmed in later studies (MacDonald et al. 1976; Del Pozo et al. 1975). Pyridoxine was subsequently claimed to lower serum prolactin concentration in normal volunteers (Delitala et al. 1976) and to restore gonadal function in patients with galactorrhoea-amenor¬ rhoea syndromes (Mclntosh 1976). In these studies a decrease of serum pro¬ lactin was assumed to be due to dopaminergic action of pyridoxine. Again, Tolis et al. (1977) were unable to find any therapeutic effect by pyridoxine on 9 patients with galactorrhoea-amenorrhoea syndromes. These controversial reports led us to investigate the significance of a long-term treatment by B(¡ of galactorrhoea-amenorrhoea syndromes. 682

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0.05) was seen in serum prolactin concentrations (Table 1). The level decreased by 50% or more in 6 pa¬ tients and increased in 6 other patients. The overall results on clinical symp¬ toms are summarized in Tables 2 and 3. None of the 3 patients with amenorNo consistent

during B(i

treatment

Table 3. The effect of Bn treatment Weeks of

Ovulated

treatment

3- 8 9-12

on

amenorrhoea. Menses recovered

No effect

12 7

12 9

684

rhoea alone responded favourably to BR treatment. After 9-12 weeks treatment menstruation but not ovulation was restored in 2 of 9 patients with galactor¬ rhoea-amenorrhoea syndrome, but inappropriate lactation was unaffected when associated with amenorrhoea. However, among 10 patients with galactorrhoea alone there were three whose galactorrhoea ceased during B(i treatment, but the prolactin levels were usually elevated.

DISCUSSION

The

physiologic control of prolactin secretion involves the interaction of two opposing neuronal systems, serotonergic and dopaminergic (Voogt 8c Carr 1975). The former is stimulatory and the latter inhibitory. Pyridoxine is a precursor of pyridoxal-5'-phosphate, a co-factor required for decarboxylation of both DOPA to dopamine and 5-hydroxytryptophan to serotonin. Thus, B(¡ admini¬ stration can increase both dopaminergic and serotoninergic activities in the brain, and the net effect on prolactin release cannot be predicted. Our results show a wide variation of prolactin concentrations during B(; treat¬ ment. Elevated prolactin levels decreased to normal in 4 of 10 hyperprolactinaemic patients, but menses were not recovered in any of them. In 4 other pa¬ tients the levels somewhat decreased, but remained well above normal, and in two cases they actually increased. The lack of ovulation in these patients is likely to result from sustained hyperprolactinaemia. In contrast to the results by Mclntosh (1976), and in keeping with those of Tolis et al. (1977) our clinical findings show that Be is ineffective in the treatment of galactorrhoea-amenor¬ rhoea syndromes. Our conclusion is that Bß hardly offers any substitute to bromocriptine treatment (Del Pozo et al. 1974; Seppälä et al. 1976; Thorner et al. 1974) of these patients.

ACKNOWLEDGMENTS We thank the National Pituitary Agency, NIAMDD, Bethesda, Md., for human pro¬ lactin and the antiserum, and Mrs. Anne Mäkelä and Mrs. Seija Hämäläinen for tech¬ nical assistance. This study was made under contract with the Association of the Finnish Life Insurance Companies.

REFERENCES Delitala G., Másala A., Alagna S. Se Devilla L.: J. clin. Endocr. 42 (1976) 603. Del Pozo E., Brun del Re M., Hinselmann M. Se Wyss H.: Arch. Gynäk. 219 (1975) 469 Del Pozo E., Varga L., Wyss H., Tolis G., Friesen H., Werner R., Vetter L. Se Uettviler A.: J. clin. Endocr. 39 (1974) 18.

685

Foukas M. D.: J. Obstet. Gynaec. Brit. Cwlth 80 (1973) 718. MacDonald H. N., Collins Y. D., Tobin M. J. W. 8c Wijayaratne D. N.: Brit. J. Obstet. Gynaec. 83 (1976) 54. Mclntosh E. N.: J. clin. Endocr. 42 (1976) 1192. Seppälä M., Hirvonen E. Se Ranta T.: Lancet 1 (1976) 1154. Seppälä M., Hirvonen E., Ranta T., Virkkunen P. Se Leppïduolo J,: Brit. med. J. 2

(1975)

305.

Thorner M. O., McNeilly A. S., Hagen C. Se Besser G. M.: Brit. med. J. 2 (1974) 419. Tous G., Laliberte R., Guyda H. 8c Naftolin F.: J. clin. Endocr. 44 (1977) 1197. Voogt L. J. 8c Carr L. A.: Endocrinology 97 (1975) 891. Received

on

September 8th,

1977.

686

Pyridoxine treatment of galactorrhoea-amenorrhoea syndromes.

Department of Departments I and II of Obstetrics and Gynaecology1), University Central Hospital, 00290 Helsinki 29, Serology and Bacteriology2), Uni...
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