Results of Primary Treatment with Bromocriptine of Prolactinomas with Extrasellar Extension

Abstract

Nineteen patients, seven women and twelve men, with macroprolactinomas characterized by extrasellar extension and basal prolactin levels above 6 U/l were treated with 10-20 mg bromocriptine daily in four divided doses for a mean period of 3.4 years (range 1.5-5.5 years). Plasma prolactin levels fell dramatically in all patients and values in the low normal range were obtained in sixteen patients. Tumor size was reduced by more than 75% in seventeen patients and by 50-75% in two patients. Tumor reduction was associated with the development of a partial empty sella in fourteen cases. In seventeen cases the pituitary became visible. Diminished visual acuity (six patients), bitemporal hemianopia (nine patients), unilateral and bilateral central scotomas (three patients) and oculomotor palsy (two patients) improved or normalized in all cases. Hypogonadism (all patients), hypothyroidism (nine patients) and hypocorticism (four patients) improved or normalized in most cases. It is concluded that in the medical treatment of macroprolactinomas 10-20 mg bromocriptine in four divided doses effectively reduces both plasma prolactin level and tumor size. The good results in this study may be related to the continued use of a fixed dose regimen of bromocriptine regardless of the plasma prolactin lowering effect. RESUME: Resultats du traitement primaire par la bromocriptine des prolactinomes avec extension extrasellaire Dix-neuf patients, septs et douze hommes, porteurs de macroprolactinomes caracteris£s par une extension extrasellaire et des taux de prolactine plasmatique de base superieurs a 6 U/L ont ete traites avec 10-20 mg de Bromocriptine par jour en quatre doses separees pendant une duree moyenne de 3.4 ann£es (ecart de 1.5 a 5.5 annees). Les taux de prolactine plasmatique ont baisse de facon marquee chez tous les patients et des valeurs proches de la normale basse ont 6te" obtenues chez 16 patients. La taille de la tumeur etait reduite de plus de 75% chez dix-sept patients et de 50-75% chez deux patients. La reduction du volume tumoral etait associee avec I'apparition d'une selle partiellement vide dans quatorze cas. Dans dix-sept cas, l'hypophyse normale devenait visible. L'acuite visuelle abaissee (6 patients), PheVnianopsie bitemporale (9 patients), des scotomes centraux uni ou bilateraux (3 patients) et les paralysies oculo-motrices (2 patients) furent ameliores ou se normaliseront dans tous les cas. L'hypogonadisme (tous les patients), l'hypothyroi'die (9 patients) et l'hypocorticisme (4 patients) se sont ameliores ou normalises dans la plupart des cas. Les auteurs concluent que dans le traitement medical des macroprolactinomes, 10-20 mg de de bromocriptine en quatre doses s6parees reduit efficacement et la taille tumorale et le taux plasmatique de prolactine. Les bons rdsultats observes dans cette etude pourraient etre relies a l'utilisation continue d'une zone predeterminee de bromocriptine, quel que soit son effet r6ducteur du taux de prolactine serique.

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.…”

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

“…[3,[7][8][9][10]. However, besides our previous report [3], there are few detailed reports on the curative effects of drugs on macroprolactinomas with cavernous sinus invasion, particularly on the control of the prolactinomas within the cavernous sinus areas, whose results are rather unsatisfactory [5,9,[11][12][13][14]. In our previous report on the treatment of the invasive giant prolactinomas with bromocriptine, it was thought that in the course of tumor reduction, the part in the cavernous sinus area was always the last to shrink [3].…”

Prolactinomas: Aspectos neurocirúrgicos

“…Verlaat et al 20 trataram 19 pacientes com dose de 10 a 20 mg de bromoergocriptina em pacientes com adenomas acima de 2 cm e conseguiram resultado satisfatório com redução significativa da prolactina plasmática e redução expressiva do tamanho do tumor em mais de 75% dos casos, salientando melhora espontânea do hipogonadismo, hipotireoidismo e hipocortisolismo em alguns dos pacientes. Wilson recomenda para os macroprolactinomas não invasivos tratamento inicial com bromoergocriptina, para redução da massa tumoral e a seguir cirurgia 17 .…”