Pharmacodynamic metoclopramide (cerucal) test in differential diagnosis of hypoprolactinemic hypogonadism syndrome in women

: Roentgenology revealed pituitary macroadenoma in 13 of 67 women with hyperprolactinemia. Craniographic structural abnormalities of the sella turcica suggested pituitary microadenoma in 20 women. Metoclopramide (cerucal) test was performed in the patients and a control group of 9 healthy women. Blood concentrations of prolactin (prolactin, somatotropic thyroid-stimulating hormone) were determined with a radioimmune assay. Significant disorders of the hypothalamo-pituitary control were detected, presenting as depressed and delayed prolactin and TSH response in this assay. The neuroendocrine disorders were most severe in patients with macroprolactinoma who showed a refractory prolactin secretory response to dopaminergic metoclopramide inhibition. The patients with microprolactinomas had a low prolactin response (increments less than 300-400%) and delayed TSH response. The metoclopramide test is recommended for differential diagnosis of hyperprolactinemic syndrome.