Pituitary Prolactinoma and Estrogen Contraceptives

It is most unusual for advocates of surgical therapy for a disease to concede that the efficacy of their operation merely approaches that of a competing medical therapy. Generally, surgery is held out as offering a prompt, radical cure that can only be approached but rarely matched by the slow and uncertain medical management. Thus, it is with admiration for the beguiling modesty we read in the article by Post et al (p 158) that the "therapeutic success of transsphenoidal surgery in grade I adenomas approaches the efficacy of bromocryptine." Surgery is the treatment of choice because of the frequent undesirable side effects of bromocryptine and, more important, because of the danger of pituitary tumor enlargement, particularly when pregnancy ensues after restoration of normal ovulation by the drug.

Regardless of the relative merits of its surgical or medical therapy, galactorrhea and amenorrhea need no longer be a source of diagnostic