Androgen suppression and clinical improvement with dopamine agonists in hyperandrogenic-hyperprolactinemic women

OBJECTIVE: To examine the effect of dopamine agonist (DA) treatment on clin ical and biochemical features in hirsute, hyperprolactinemic (HPRL) women a nd the relationship between prolactin (PRL) and androgens. STUDY DESIGN: We evaluated 80 hirsute HPRL women (age, 27+/-1 years [mean /- SE]) with neuroleptic treatment, prolactinoma and idiopathic HPRL (12, 1 3 and 55, respectively). DA, mainly bromocriptine, was administered for 11 +/- 1 months. Response indicators were Ferriman-Gallwey hirsutism (FGS) and Leeds acne (LAS) scores, circulating PRL, dehydroepiandrosterone sulfate ( DHEAS),free and total testosterone, and androstenedione. RESULTS: Baseline PRL correlated positively with DHEAS (r =.23, P =.03) and free testosterone (r =36, P <.001). In all women, FGS, LAS, PRL, free test osterone, DHEAS and androstenedione decreased by 40-85% during, DA treatmen t (P <.001). The decline in free testosterone was higher when PRL was great er than or equal to 65 ng/mL than when PRL was < 65 (P =.03) and correlated positively with basal DHEAS (r =.40, P <.001). CONCLUSION: Our data suggest a modulation by PRL of adrenal androgen produc tion. DA treatment reduces PRL and serum androgens. It results in a signifi cant clinical improvement in acne and hirsutism. Therefore, DA is recommend ed as monotherapy for hyperandrogenic, HPRL women.