Long-Lasting Suppression of Prolactin Secretion and Rapid Shrinkage of Prolactinomas After a Long-Acting, Injectable Form of Bromocriptine

Abstract

Since Corenblum reported in 1975 the first documented reduction of tumor size in two patients with macroprolactinoma, evidence has accumulated that bromocriptine causes shrinkage of PRL-secreting adenomas in most patients. Recently a long-acting form of bromocriptine (bromocriptine LA) was developed. A single dose of 50 mg i.m. decreases basal and sleep-related PRL secretion in normal subjects for 28 days. We treated 13 patients (8 women, 5 men) with PRL secreting tumors (5 macroadenomas and 8 microadenomas) with a single dose (50 mg) of bromocriptine LA. In the 5 patients with macroprolactinomas plasma PRL levels decreased markedly within 12 hours, reaching normal levels in only one patient. In all patients the suppression of PRL secretion lasted at least 28 days and the tumor size was reduced by 20% to 59% within 21 days after the injection. Visual fields improved in all 3 patients with abnormal vision prior to the injection. In one patient with bitemporal hemianopsia an almost normalization of the visual field was noted 24 hours after bromocriptine LA administration. In 7/8 patients with microprolactinomas plasma PRL levels decreased to within the normal range within 12 hours after the administration of bromocriptine LA. The normalization of PRL secretion lasted for at least 28 days. Menses resumed in all 6 women 7 to 41 days after the injection, galactorrhea disappeared in all 4 patients, and libido and potency become normal in both men with microprolactinomas. Patients treated with bromocriptine LA reported only short-lasting (1 hour - 2 days) mild or moderate adverse effects, consisting of dizziness (4 patients) and nausea (4 patients). Long-acting bromocriptine should be considered as the initial management for patients with PRL-secreting tumors. The use of bromocriptine LA could also overcome the compliance problems that occur in many patients soon after the initiation of oral bromocriptine therapy.

Cabergoline: Long-Acting Oral Treatment of Hyperprolactinemic Disorders

“…Furthermore, due to their relatively short duration of action all of these drugs must be administered two or three times daily, like bromocriptine, except for pergolide, which is given once daily. A depot preparation of bromocriptine acting for about 1 month has recently become available (19,20), but it has to be injected im.…”

Rapid Improvement of Visual Defects with Parenteral Depot-Bromocriptine in a Patient with a Non-Functioning Pituitary Adenoma

“…2). The tolerance to the parenteral form of the drug is generally good and, during the first 24 h after administration, the only side effects reported are dizziness and transitory hypotension [6,22,23], Some patients with oral bromo criptine intolerance or resistance have been sensitive to treatment with depot-bromocriptine [6], In our case the drug was well tolerated, without any side effects. During treatment there were no symptoms to indicate the exis tence of tumor necrosis.…”

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

“…This response rate with regard to tumour size is in the range of previous results with oral bromocriptine in macroadenomas (63% (Wass et al, 1982)), and in macroprolactinomas (76% (Liuzzi et al, 1985), 57% (Nissim et al, 1982)), and with quinagolide (81% (Vance et al, 1990)). In some series even higher percentages of shrinking macroprolactinomas were observed: with oral bromocriptine in all of 27 patients studied by Molitch et al (1985); with oral and/or parenteral bromocriptine in 24 of 25 prolactinomas treated preoperatively (Fahlbusch et al, 1987); with parenteral bromocriptine in five of five macroprolactinomas shrinking in all of three equally sized series (with Parlodel LA (Montini et al, 1986) with Parlodel LAR ( Van't Verlaat et al, 1988;Schettini et al, 1990)); with quinagolide in 89% (eight of nine) macroprolactinomas (Khalfallah et al, 1990). Thus, it appears that the tumour shrinkage response rate may be more dependent on the particular group of patients studied than on the dopaminergic agent used.…”

“…To overcome these shortcomings, a parenteral form of bromocriptine was developed. In contrast to an earlier preparation which was shown to be efficacious (Benker et al, 1986;Montini et al, 1986), the current agent was prepared for repeated treatments with intramuscular, usually four-weekly, injections. The preparation was shown to be efficacious and safe in two series with five macroadenoma patients each ( Van't Verlaat et al, 1988;Schettini et al, 1990).…”