Bromocriptine as Primary Therapy for Prolactin-Secreting Macroadenomas

Molitch, Mark E.; Elton, Richard L.; Blackwell, Richard E.; Caldwell, Burton V.; CHANG, R. JEFFREY; Jaffe, Robert B.; Joplin, G. F.; Robbins, Richard J.; Tyson, John E.; Thorner, Michael O.

doi:10.1097/00006254-198601000-00016

Cited by 3 publications

(5 citation statements)

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“…Sensitivity analysis indicated three studies, Molitch’s study published in 1985, Sobrinho’s study published in 1981 and VanT Verlaat’s study published in 1991, were the source the heterogeneity. The recurrence proportions of prolactinoma after withdrawal of DAs in these three studies were 75% (3/4), 33.3% (3/9) and 25% (3/12), respectively [ 25 – 27 ]. These three studies were published before 2000 [ 25 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…The recurrence proportions of prolactinoma after withdrawal of DAs in these three studies were 75% (3/4), 33.3% (3/9) and 25% (3/12), respectively [ 25 – 27 ]. These three studies were published before 2000 [ 25 – 27 ]. Long time gap may lead to changes in many aspects, such as the way the DAs was used, the purity of DAs, the manufacturer of DAs, the detect accuracy of prolactinoma and the guideline of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Long time gap may lead to changes in many aspects, such as the way the DAs was used, the purity of DAs, the manufacturer of DAs, the detect accuracy of prolactinoma and the guideline of treatment. Besides, the DAs used in these three studies were all BRC [ 25 – 27 ]. Compared with CAB, the way the BRC is used is more complicated due to shorter duration of action, which indicates the poorer compliance of BRC.…”

Section: Discussionmentioning

confidence: 99%

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The recurrence of prolactinoma after withdrawal of dopamine agonist: a systematic review and meta-analysis

Zou

et al. 2021

BMC Endocr Disord

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Background Prolactinoma is the major cause of hyperprolactinemia, and dopamine agonists (DAs) are generally the first-line treatment for them. Several studies have reviewed the recurrent rate of hyperprolactinemia after DAs withdrawal. However, few of them have concerned the recurrence risk of prolactinoma following the withdrawal of DAs. Methods Three medical databases, PubMed, EMBASE and Cochrane library, were retrieved up to February, 14, 2021 to identify studies related to recurrence of prolactinoma and withdrawal of DAs. Statistical analyses including meta-analysis, sensitivity analysis, meta-regression, funnel plot and Egger test were performed through software R. Results A total of 3225 studies were retrieved from the three data bases, and 13 studies consisted of 616 patients and 19 arms were finally included in this systematic analysis. There was no significant heterogeneity among the included studies, and fixed effect model was thus used. The pooled recurrence proportion of prolactinoma after withdrawal of DA was 2% with a 95% confidence interval (CI) of 1–3%. Conclusion Our study showed a very low recurrent rate of prolactinomas after DAs withdrawal. Much more prospective studies with larger cases and longer follow-up period are encouraged to confirm our finding. Trial registration Registration numberCRD42021245888 (PROSPERO).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The recurrence of prolactinoma after withdrawal of dopamine agonist: a systematic review and meta-analysis

Zou

et al. 2021

BMC Endocr Disord

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“…Three DA, namely Bromocriptine, Cabergoline, and Quinagolide, are currently commercialized. Bromocriptine (BRC) represents the historical compound which is, currently, almost exclusively used in cases of intolerance to other DA [13,14]. BRC efficacy, defined on the basis of normalization of PRL and significant tumor shrinkage (≥50% from initial tumor volume), is close to 90% in patients with microPRLomas, and 70% in patients with macroPRLomas [7].…”

Section: Current Medical Therapies Approved In the Treatment Of Ptmentioning

confidence: 99%

Current and Emerging Medical Therapies in Pituitary Tumors

Sahakian

Castinetti

Brue

et al. 2022

JCM

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Pituitary tumors (PT) represent in, the majority of cases, benign tumors for which surgical treatment still remains, except for prolactin-secreting PT, the first-line therapeutic option. Nonetheless, the role played by medical therapies for the management of such tumors, before or after surgery, has evolved considerably, due in part to the recent development of well-tolerated and highly efficient molecules. In this review, our aim was to present a state-of-the-art of the current medical therapies used in the field of PT and the benefits and caveats for each of them, and further specify their positioning in the therapeutic algorithm of each phenotype. Finally, we discuss the future of PT medical therapies, based on the most recent studies published in this field.

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“…Dopamine agonists have been routinely used for the treatment of hyperprolactinaemic states since 1971. They have been shown to be successful in reducing prolactin levels as well as inducing prolactinoma shrinkage ( Vance et al ., 1984 ; Clayton et al ., 1985 ; Molitch et al ., 1985 ; Bevan et al ., 1992 ; Thorne et al ., 1992 ). These drugs are now usually used as first line treatment for both micro and macroprolactinomas ( Serri et al ., 1983 ), and are particularly useful for macroprolactinomas.…”

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confidence: 99%

CSF rhinorrhoea following treatment with dopamine agonists for massive invasive prolactinomas

Leong¹,

Foy

Swift³

et al. 2000

Clinical Endocrinology

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OBJECTIVE The management of CSF rhinorrhoea following dopamine agonist (DA) treatment for invasive prolactinomas is difficult and there is no clear consensus for its treatment. Our objective was therefore to investigate the different treatments for this condition. DESIGN AND PATIENTS We examined the case notes of five patients with invasive prolactinomas and CSF rhinorrhoea following DA treatment. The different ways in which this complication had been managed is detailed along with a review of the literature. RESULTS Five patients aged 24–67 years (3 male) with massive invasive prolactinomas (serum prolactin 95000–500000 mU/l) eroding the skull base were treated with dopamine agonists (3 bromocriptine, 1 cabergoline and 1 both). CSF rhinorrhoea developed in all patients between 1 week and 4 months after commencing dopamine agonist treatment. In two patients (cases 1 and 4), CSF rhinorrhoea ceased within a few days of stopping bromocriptine but restarted when treatment was resumed. One of these (case 4), a 67‐year‐old woman had no further treatment and CSF leakage stopped completely. She died of unrelated medical problems 3 years later. In one patient staphylococcus aureus meningitis and pneumocephalus developed as a complication of CSF rhinorrhoea. Three patients had endoscopic nasal surgery to repair the fistula using muscle grafts, and to decompress the pituitary tumour, with success in two. One patient had intracranial surgery and dural repair, which was successful in sealing the leak. CONCLUSIONS We suggest that surgery as soon as is feasible is the treatment of choice for the repair of a CSF leak following dopamine agonist treatment. An additional strategy is the withdrawal of dopamine agonist to allow tumour re‐growth to stop the leak.

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Bromocriptine as Primary Therapy for Prolactin-Secreting Macroadenomas

Cited by 3 publications

References 0 publications

The recurrence of prolactinoma after withdrawal of dopamine agonist: a systematic review and meta-analysis

The recurrence of prolactinoma after withdrawal of dopamine agonist: a systematic review and meta-analysis

Current and Emerging Medical Therapies in Pituitary Tumors

CSF rhinorrhoea following treatment with dopamine agonists for massive invasive prolactinomas

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