Extrasellar Prolactinomas: Successful Management of 24 Patients Using Bromocriptine

Abstract

24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5–40 mg bromocriptine daily for 13–252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.

Combined Treatment of Invasive Giant Prolactinomas

“…Another possible reason could be associated with radiotherapy; 11 cases (85%) in Group A and 7 cases (58%) in Group B received radiotherapy. Many authors [1,2,7,[8][9][10][11][12][13][14] confirm that visual symptoms of patients with giant prolactinomas can be relieved after several days to several weeks of bromocriptine treatment.…”

“…Bromocriptine, which is the most commonly used D-2-receptor agonist in our clinic, can normalize the serum prolactin level and decrease the volume of the tumor in 75∼92% of the patients with prolactinomas [5][6][7][8][9][10][11][12][13][14]. The primary mechanism is the selective activation of the D-2-receptor on the cell membrane of prolactin cells, thus inhibiting the expression of the PRLm- (4A, B).…”

“…That is, pharmacotherapy (bromocriptine) was the only effective treatment for controlling the serum PRL level. [8][9][10][11][12][13][14]. Sieck [9] reported 24 cases of IGPs, with bromocriptine as the only treatment.…”

“…[8][9][10][11][12][13][14]. Sieck [9] reported 24 cases of IGPs, with bromocriptine as the only treatment. The mean percentage decrease in prolactin level was 89% in two days, and 95% in 6 weeks, with 16 of their cases achieving a normal level.…”

Surgical management of giant pituitary tumours ? A review of 30 cases

“…Estimation of the prolactin level can sometimes be crucially important as some of these turnouts respond dramatically to bromocriptine therapy [31]. Although there are reports showing effectiveness of radiation treatment, there is insufficient evidence of its effects on long term outcome of these patients [22,26,34].…”