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Journal of Neuro-Oncology

, Volume 104, Issue 1, pp 195–204 | Cite as

Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist

  • Moon Sool Yang
  • Jae Won Hong
  • Seung Koo Lee
  • Eun Jig Lee
  • Sun Ho Kim
Clinical Study – Patient Study

Abstract

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.

Keywords

Bromocriptine Cabergoline Dopamine Hyperprolactinemia Invasive prolactinoma 

Abbreviations

DAs

Dopamine agonists

MRI

Magnetic resonance imaging

NP

Normalized serum prolactin

PRLs

Prolactin levels

TVR

Tumor volume reduction

Notes

Acknowledgment

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085136).

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  1. 1.Department of NeurosurgeryYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Endocrinology, Internal MedicineYonsei University College of MedicineSeoulSouth Korea
  3. 3.Department of Diagnostic RadiologyYonsei University College of MedicineSeoulSouth Korea
  4. 4.Pituitary Tumor ClinicYonsei University College of MedicineSeoulSouth Korea

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