Long‐term Treatment of Hyperprolactinaemia With Bromocriptine: Effect of Drug Withdrawal

Abstract

Fifty-one patients with hyperprolactinaemia (23 with macroadenoma, 23 with microadenoma, and five with idiopathic hyperprolactinaemia) were treated with bromocriptine for 2-12 years (4.9 +/- 2.9 years, mean +/- SD). During therapy, the serum PRL levels were suppressed into the normal range in all but five patients. In these five patients, despite the high circulating PRL, gonadal function returned to normal in three, while in the other two gonadotrophin reserve was impaired even before therapy. Gel chromatography showed that one of these patients had a high proportion of a large molecular weight form of PRL. Twenty-four patients received bromocriptine as the sole method of treatment for over 2 years (3.4 +/- 2.3 years). In five out of the 24 subjects (21%), serum PRL remained normal with no clinical symptoms after prolonged drug withdrawal (1-4 years). Twenty-one patients received radiotherapy in conjunction with bromocriptine therapy. Of these 11 had prior surgery. After a follow-up of 6.0 +/- 3.0 years after radiotherapy, serum PRL remained within the normal range in 6 out of 21 subjects (29%), 1-4 years after bromocriptine withdrawal. One of the patients had impaired GH response to insulin hypoglycaemia developing after radiotherapy. We conclude that prolonged bromocriptine treatment is an effective treatment for prolactinomas.

Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion

“…Of the 30 patients whose PRL levels fell to normal levels, 21 maintained the condition with low-dose bromocriptine (0.625-10 mg/d), and their PRL levels and tumor volumes were well controlled. According to the reports of bromocriptine withdrawal [32][33][34][37][38], 14 patients with normal PRL level and absent tumor on MR images withdrew from bromocriptine treatment in our group, and renewed tumor growth and recurrent hyperprolactinemia were not found during an average period of 1.5-year follow-up. About 18 patients with residual tumor invading the cavernous sinus had no related compromising symptoms, of which seven patients maintained normal PRL levels with low-dose bromocriptine treatment.…”

“…Some studies showed maintenance of normoprolactinemia and absence of adenoma reexpansion after BRC withdrawal in patients on long-term treatment for prolactinomas [13,16,[31][32][33]. Passos [34] reported that 131 cases of prolactinomas withdrew from drug treatment after an average period of 44 months of bromocriptine treatment, and 15.9% of macroprolactinomas had normal PRL level with no renewed tumor growth during the 44-month period of follow-up after their drug withdrawal.…”

Advances in the Treatment of Prolactinomas

“…After withdrawal of bromocriptine (Table 8), remission rates have been reported from as low as 0 to 9% (337)(338)(339)(340) to as high as 20 to 44% (97,125,(341)(342)(343)(344). In the only study restricted to patients with macroprolactinomas, van't Verlaat and Croughs (345) reported a remission rate in 8% of 12 patients after 12 months.…”

Sustained Clinical Inactivity and Stabilization of GH/IGF-1 Levels in an Acromegalic Patient after Discontinuation of Somatostatin Analogue Treatment

“…On the contrary, prolonged suppression of a PRL secreting adenoma leads to permanent cure in many cases and PRL is shown to remain low after discontinuation of long-term bromocriptine administration [34,35].…”