Control of Prolactin-Secreting Macroadenomas With Parenteral, Long-Acting Bromocriptine in 30 Patients Treated for up to 3 Years

Abstract

OBJECTIVE We investigated the effect of intramuscular injections of long-acting bromocriptine in patients with macroadenomas.STUDY DESIGN AND PATIENTS Thirty patients with PRLsecreting pituitary macroadenomas were treated with repeated 4-weekly intramuscular injectlons of 50 or 100 mg of a long-acting, repeatable bromocriptine formulation for six to 37 injections, amounting to a total of 473 injectlons. Twenty patients received parenteral bromocrlptlne as primary therapy, ten had persisting hyperprolactinemia after previous therapies including pituitary surgery (n = 7), oral bromocriptlne (7), and pltultary Irradiation (2). MEASUREMENTS A PRL day profile was obtained and the patients' clinlcal status and history were documented, at intervals. Detailed clinical, laboratory, and radiological (pituitary nuclear magnetic resonance or computed tomography scan) evaluations were performed at baseline, after 1 injection and every 6th injection therafter. RESULTS In all patients PRL was suppressed from a mean f SEM pretreatment level of 32 620 f 8680 to 4480 f 1140 mull on the third day after the flrst injectlon. In 12 patients PRL levels normalized (<400 mUlI) with the first to fourth injection, in three additional patients PRL levels normalized after 8-15 months. in 19 patlents PRL was suppressed to less than 1000 mU/I. In three patients PRL did not decrease to less than 50% of pretreatment; in two of them on oral bromocriptine prior to this study there had been a comparable low efficacy. Of 28 patients with macroadenomas (median helght 22 mm) tumour shrinkage was evident In 15 by nuclear magnetic resonance or computed tomography scan 28 days after the first injection, and In three additional patients afler 6 months. There was further regression in seven cases after 12,18 or 24 injections. Adenoma size (mean f SEM) decreased to 66 f 7% of the pretreatment value. The 40 adverse events noted in 20 of 30 patients during 24 hours after the first injection were similar to known side-effects of oral bromocriptine, nausea and postural hypotension being the most frequent. With repeated injections, on average 0.6 adverse events were noted per injection (mostly mild asthenia).There were no local adverse reactions at the injection slte.CONCLUSION We conclude that long-acting repeatable bromocriptine in patients with macroprolactinomas offers a safe and efficacious prlmary treatment that ensures compliance and gives long-term control. Adverse reactions are comparable to oral bromocriptine but subside with repeated injections.

Prolactinomas: present day management

“…Bromocriptine has also been incorporated into glycolipid microspheres and administered intramuscularly every 28 days as Parlodel‐LAR (Haase et al 1993). There are three major advantages of this formulation which, however, has not yet been licensed in the UK.…”

Effectiveness of a long‐acting injectable form of bromocriptine in patients with prolactin and growth hormone secreting macroadenomas

“…Recently, a new longacting injectable form of BC has been developed which allows repeated administration of this depot preparation (Lancranjan et al, 1987). High levels of circulating BC may be rapidly achieved (Grossman er al., 1987;Ciccarelli et al, 1994), and in several series monthly injections of this compound effectively and rapidly lower elevated serum PRL Ciccarelli et al, 1989Ciccarelli et al, , 1993Schettini et al, 1990;Maraschini et al, 1991;Beckers et al, 1992;Haase et al, 1993). Similarly, administration of this compound in patients with GH secreting macroadenomas has been investigated in few patients (Plockinger & Quabbe, 1991).…”