Occasional SurveyIMPACT OF NEW DIAGNOSTIC METHODS ON THE DIFFERENTIAL DIAGNOSIS AND TREATMENT OF SECONDARY AMENORRHŒA

The development of homologous prolactin assays, multiple pituitary stimulation, tomography, and computerised axial tomography permit more detailed investigation of patients with secondary amenorrhœa than was formerly possible. 39% of 90 patients with secondary amenorrhœa had hyper-prolactinaemia. 10 patients (11% of total) had pituitary tumours. 8 of these women had galactorrhœa (27% of those with galactorrhœa). For patients with hyperprolactinaemia but no tumour, bromocriptine is the treatment of first choice rather than clomiphene or human gonadotrophins. The best treatment for patients with detectable tumour is controversial, particularly when the tumour is confined to the sella turcica. Whether or not these tumours are true neoplasms remains to be determined. Clinically, a history of secondary amenorrhœa with or without galactorrhœa following withdrawal of oral contraceptives remains the commonest presenting syndrome.