[Bromocriptine treatment of invasive giant prolactinomas prior to comprehensive treatments: results of a long-term follow up].
OBJECTIVE
To observe long-term outcomes of patients with invasive giant prolactinomas (IGPs) treated with bromocriptine followed by comprehensive treatments.


METHODS
Thirty-four patients met the criteria of IGPs were treated with bromocriptine initially. Among of them, 11 had radiotherapy at the same time. During the treatments, transsphenoidal surgery or/and Gamma Knife were considered to apply to the patients according to the location, shrinkage of residual tumors and resistance of bromocriptine. Small dosage of bromocriptine was kept after operation.


RESULTS
The average follow-up duration is 33.6 months. Thirty-three patients obtained significant improvement, but one failed recovery of vision due to side-injury by radiotherapy. Tumor volume on magnetic resonance imaging (MRI) was decreased on average by 91.4%, PRL by 97.1%. The number of patients with low testosterone level restored from 17 to 6 and hypoadrenalism from 10 to 6 after combined treatment with priority of medical therapy. Rhinorrhea occurred in 2 cases, 1 restored in two weeks, 1 had transsphenoidal combined with transcranial surgery to remove the tumor and repair the fistula.4 had resistance to bromocriptine to some extend.


CONCLUSIONS
Dopamine agonist medications are effective as a first-line therapy for IGPs. In some patients treated by bromocriptine only, the tumor may disappear on MRI. Combined with surgery and Gamma Knife, the duration of treatment could be shortened and the dosage may be minimized, but using radiotherapy should be cautions.
Zhang
Hong-wei
HW
Department of neurosurgery, Beijing Sanbo Fuxing Brain Hospital & Fuxing Hospital, Affiliated to the Capital University of Medical Sciences, Beijing 100038, China.
Yu
Chun-jiang
CJ
Sun
Wei
W
Yang
Jun
J
Yan
Chang-xiang
CX
Cun
En-hao
EH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001971:Bromocriptine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007016:Hypophysectomy; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000601:surgery; D015175:Prolactinoma / Q000188:drug therapy* / Q000601:surgery; D016634:Radiosurgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D006727:Hormone Antagonists; D001971:Bromocriptine