Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist.
Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome. Herein, we document the results of bromocriptine administration as initial treatment during average 44 months follow-up (up to 12 years) period. We retrospectively categorized 36 patients into four groups according to the results of 3 months of bromocriptine treatment: group 1, tumor volume reduction (TVR) >25% with normalized serum prolactin (NP) (n = 24); group 2, TVR >25% without NP (n = 4); group 3, TVR <25% with NP (n = 5); and group 4, TVR <25% without NP (n = 3). During follow-up, 22 patients (91.7%) in group 1 achieved TVR >50% with NP. Three patients (75%) in group 2 achieved TVR >50% with NP after treatment for 8 months. In group 3, four patients (80.0%) continued medication because of improvement of symptoms and achieved additional TVR (18.8-46.4%). Surgery was performed on five patients (one in group 2, one in group 3, and all three in group 4), and complete resection was achieved in four (80.0%). Overall, 25 (69.4%) of the 36 patients treated with bromocriptine had complete response and 6 (16.7%) had partial response but did not require surgery. Thus, the overall response rate was 86%, with only five patients (14%) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor. Patients who achieve TVR >25% with NP with 3 months of bromocriptine administration had a high possibility of showing good long-term response (TVR >50% with NP) to bromocriptine. A higher dose of dopamine agonist (DA) or other DA should be considered for patients who achieve TVR >25% without NP.
Department of Neurosurgery, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemun-gu, Seoul 120-752, South Korea.
Moon Sool
MS
Yang
Jae Won
JW
Hong
Seung Koo
SK
Lee
Eun Jig
EJ
Lee
Sun Ho
SH
Kim
D000328:Adult; D001971:Bromocriptine / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000188:drug therapy; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000188:drug therapy / Q000209:etiology; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D011388:Prolactin / Q000378:metabolism; D015175:Prolactinoma / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy / Q000209:etiology; D014794:Visual Fields / Q000187:drug effects; D055815:Young Adult
D018491:Dopamine Agonists; D001971:Bromocriptine; D011388:Prolactin