Prolactinomas and Optic Nerve Compression: Disappearance of a Suprasellar Extension and Visual Recovery after Two Weeks Bromocriptine Treatment

Abstract

4 patients with prolactinomas and visual field defects are presented. 2 were treated with bromocriptine alone; 1 patient with an 8-month history of visual disturbance had complete recovery of visual fields after 2 weeks and an acute fall in serum prolactin levels. This coincided with disappearance of the suprasellar extension on computed tomography (CT) scanning. The second patient, with a 2-year history, had no visual improvement after 1 year of treatment, although CT scanning showed absence of the suprasellar extension when repeated after 3 months. 2 other patients initially had neurosurgery; 1 with a 2-year history had complete visual recovery, the other with a 1 -year history did not recover. Both needed subsequent bromocriptine treatment. In all 4 patients this drug produced a sustained fall in serum prolactin levels. We conclude that bromocriptine therapy can rapidly reduce prolactinoma tumor size and should obviate the necessity for acute neurosurgical intervention in carefully selected patients.

Combined Treatment of Invasive Giant Prolactinomas

“…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.…”

Prolactin Levels in Pregnancy: Comparison of Normal Subjects with Patients Having Micro- or Macroadenomas after Early Bromocriptine Withdrawal

“…Although transsphenoidal surgery may be curative in a large proportion of patients with microadenomas [13], we chose bromocrip tine as the first line of treatment in patients wanting children, irrespective of tumor size, to minimize the potential risk of damage to the reproductive apparatus. This drug can in many instances reduce tumor size [14][15][16] and reverse neurological abnormalities [10][11][12][13][14][15][16][17] as well as lower the prolactin level to nor mal [9,13,18], These effects can occur rap idly [10,19], as was apparent in the patients with an extrasellar extension that disap peared or significantly decreased in size within 2 weeks of starting treatment. In 1 of them, return of normal vision coincided with the reduction in size of tumor and a CT scan after prolonged treatment revealed a partially empty sella.…”

“…Patient 7 had a bitemporal hemianopia that was confirmed by formal visual field testing. Preliminary details of this case have been published (10).…”

Extrasellar Prolactinomas: Successful Management of 24 Patients Using Bromocriptine

“…13,19,21) and improved in the other 2 patients (No. 10,20) who presented with optic pallor, absent light reflexes, and total blindness for 25 and 21 weeks, respectively. Patient No.…”