Convulsions, Hypertension Crisis and Acute Renal Failure in Postpartum: Role of Bromocriptine?

Prof. A. Fournier, Service de Néphrologie, Hôpital Sud, F-80054 Amiens Cedex 1 (France) Dear Sir, Bromocriptine mesylate (Parlodel®, San-doz) is a prolactin secretion inhibitor commonly used for suppression of puerperal lactation [1]. It is an ergoalkaloid derivate in which hydrogenation suppresses the usual α-adrenergic vasoconstrictive effect of these derivates. Furthermore, it is a vasodilating drug by activation of the D2 dopamine receptors [2] which has been even proposed in treatment of hypertension [3]. However, in certain conditions like acromegalia without hypopituitarism, Raynaud syndrome may occur in 36% of the patients taking bromocriptine [4] and numerous cases have been reported of ischemic neurological and cardiac complications linked to bromocriptine-favored vasospasm in predisposed patients [4-13]. The review of 1,813 women taking bromocriptine for lactation suppression by Watson et al. [14] has suggested that patients with previous pregnancy-induced hypertension were particularly at risk for bromocriptine-associated postpartum hypertension. We report here a case where a hypertensive crisis complicated with seizures and acute renal failure but without hyperuricemia, he-mostasis and liver disturbances, without brain CAT and RMI abnormality or renal histological changes, occurred 11 days after delivery of an uneventful pregnancy in a young primipara with only a sister history of preeclampsia as predisposing factor. Valerie C. is a 31-year-old white woman, 1 gravida, 1 para, with familial preeclampsia history. She had an uneventful pregnancy and an uncomplicated full-term spontaneous Fig. 1. This CAT of the kidney shows no kidney enlargement but in the right kidney two cortical triangular images taking up the contrast media. prescribed pipemidic acid (Pipram®) for 3 days at 400 mg twice a day. The urine culture revealed the presence of Proteus mira-bilís. The patient was discharged on postpartum day 8 and pipemidic acid was discontinued. Three days later, she had severe headaches followed by seizures which motivated admission at the emergency unit. Blood pressure (BP) was 190/100 mm Hg. After consciousness recovery, clinical examinavaginal delivery on December 7, 1992. Labor, delivery and immediate postpartum were normal. From day 1, she received 2.5 mg of bromocriptine twice a day for suppression of lactation. On day 5 of postpartum, she had a headache and a change in behavior but her blood pressure was