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Pituitary

, Volume 3, Issue 3, pp 189–192 | Cite as

Rapid Re-expansion of a Macroprolactinoma After Early Discontinuation of Bromocriptine

  • John J. Orrego
  • William F. Chandler
  • Ariel L. Barkan
Article

Abstract

Prolactin (PRL)-secreting pituitary adenomas are the most common functioning pituitary tumors. Medical treatment with dopamine agonists is the therapy of choice for macroprolactinomas (≥10 mm). Withdrawal of bromocriptine after weeks or months of uninterrupted therapy has been associated with rapid tumor re-expansion as evidenced by x-ray and CT scanning of the pituitary region. We report a patient with a giant macroprolactinoma who had a dramatic response to bromocriptine (tumor volume shrinkage of 53% within a month) but rapid re-expansion to its original dimensions one week after discontinuation of bromocriptine. To our knowledge, this is the first time that the rapid shrinkage/re-expansion of a macroprolactinoma has been documented with serial MRI scans.

hyperprolactinemia prolactinoma bromocriptine pituitary tumors dopamine agonists 

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References

  1. 1.
    Molitch ME, Thorner MO, Wilson C. Management of prolactinomas. J Clin Endocrinol Metab 1997;82:996–1000.Google Scholar
  2. 2.
    Soule SG, Farhi J, Conway GS, Jacobs HS, Powell M. The outcome of hypophysectomy for prolactinomas in the era of dopamine agonist therapy [see comments]. Clin Endocrinol (Oxf) 1996;44:711–716.Google Scholar
  3. 3.
    Tsang RW, Brierley JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ. Role of radiation therapy in clinical hormonally-active pituitary adenomas. Radiother Oncol1996;41:45–53.Google Scholar
  4. 4.
    Orrego JJ, Barkan AL. Pituitary disorders. Drug treatment options. Drugs 20009:93–106.Google Scholar
  5. 5.
    Freda PU, Andreadis CI, Khandji AG, Khoury M, Bruce JN, Jacobs TP, Wardlaw SL. Long-term treatment of prolactinsecreting macroadenomas with pergolide. J Clin Endocrinol Metab 2000;85:8–13.Google Scholar
  6. 6.
    Molitch ME. Medical treatment of prolactinomas. Endocrinol Metab Clin North Am 1999;28:143–169.Google Scholar
  7. 7.
    Thorner MO, Perryman RL, Rogol AD, Conway BP, Macleod RM, Login IS, Morris JL. Rapid changes of prolactinoma volume after withdrawal and reinstitution of bromocriptine. J Clin Endocrinol Metab 1981;53:480–483.Google Scholar
  8. 8.
    Molitch ME. Pathologic hyperprolactinemia. Endocrinol Metab Clin North Am 1992;21:877–901.Google Scholar
  9. 9.
    Bevan JS, Webster J, Burke CW, Scanlon MF. Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 1992;13:220–240.Google Scholar
  10. 10.
    MacLeod RM, Lehmeyer JE. Suppression of pituitary tumor growth and function by ergot alkaloids. Cancer Res 1973;33:849–855.Google Scholar
  11. 11.
    Maurer RA. Dopaminergic inhibition of prolactin synthesis and prolactin messenger RNA accumulation in cultured pituitary cells. J Biol Chem 1980;255:8092–8097.Google Scholar
  12. 12.
    Johansen PW, Clausen OP, Haug E, Fossum S, Gautvik KM. Effects of bromocriptine on cell cycle distribution and cell morphology in cultured rat pituitary adenoma cells. Acta Endocrinol (Copenh) 1985;110:319–328.Google Scholar
  13. 13.
    Niwa J, Minase T, Mori M, Hashi K. Immunohistochemical, electron microscopic, and morphometric studies of human prolactinomas after short-term bromocriptine treatment. Surg Neurol 1987;28:339–344.Google Scholar
  14. 14.
    Hassoun J, Jaquet P, Devictor B, Andonian C, Grisoli F, Gunz G, Toga M. Bromocriptine effects on cultured human prolactin-producing pituitary adenomas: in vitro ultrastructural, morphometric, and immunoelectron microscopic studies. J Clin Endocrinol Metab 1985;61:686–692.Google Scholar
  15. 15.
    Mori H, Mori S, Saitoh Y, Arita N, Aono T, Uozumi T, Mogami H, Matsumoto K. Effects of bromocriptine on prolactin-secreting pituitary adenomas. Mechanism of reduction in tumor size evaluated by light and electron microscopic, immunohistochemical, and morphometric analysis. Cancer 1985;56:230–238.Google Scholar
  16. 16.
    Nissim M, Ambrosi B, Bernasconi V, Giannattasio G, Giovanelli MA, Bassetti M, Vaccari U, Moriondo P, Spada A, Travaglini P, Faglia G. Bromocriptine treatment of macroprolactinomas: studies on the time course of tumor shrinkage and morphology. J Endocrinol Invest 1982;5:409–415.Google Scholar
  17. 17.
    Barrow DL, Tindall GT, Kovacs K, Thorner MO, Horvath E, Hoffman JC Jr. Clinical and pathological effects of bro-mocriptine on prolactin-secreting and other pituitary tumors. J Neurosurg 1984;60:1–7.Google Scholar
  18. 18.
    Kovacs K, Stefaneanu L, Horvath E, Lloyd RV, Lancranjan I, Buchfelder M, Fahlbusch R. Effect of dopamine agonist medication on prolactin producing pituitary adenomas. A morphological study including immunocytochemistry, electron microscopy and in situ hybridization. Virchows Archiv A Pathol Anat Histopathol 1991;418:439–446.Google Scholar
  19. 19.
    Anniko M, Wersall J. Clinical and morphological findings in two cases of bromocriptine-treated prolactinomas. Acta Pathol Microbiol Scand [A] 1981;89:41–47.Google Scholar
  20. 20.
    Gen M, Uozumi T, Ohta M, Ito A, Kajiwara H, Mori S. Necrotic changes in prolactinomas after long term administration of bromocriptine. J Clin Endocrinol Metab 1984;59:463–470.Google Scholar
  21. 21.
    Vance ML, Evans WS, Thorner MO. Drugs five years later. Bromocriptine. Ann Intern Med 1984;100:78–91.Google Scholar
  22. 22.
    Johnston DG, Hall K, Kendall-Taylor P, Patrick D, Watson M, Cook DB. Effect of dopamine agonist withdrawal after long-term therapy in prolactinomas. Studies with high-definition computerised tomography. Lancet 1984;2:187–192.Google Scholar
  23. 23.
    van 't Verlaat JW, Croughs RJ.Withdrawal of bromocriptine after long-term therapy for macroprolactinomas; effect on plasma prolactin and tumour size [see comments]. Clin Endocrinol (Oxf) 1991;34:175–178.Google Scholar
  24. 24.
    Wang C, Lam KS, Ma JT, Chan T, Liu MY, Yeung RT. Long-term treatment of hyperprolactinaemia with bromocriptine: effect of drug withdrawal. Clin Endocrinol (Oxf) 1987;27:363–371.Google Scholar
  25. 25.
    Liuzzi A, Dallabonzana D, Oppizzi G, Verde GG, Cozzi R, Chiodini P, Luccarelli G. Low doses of dopamine agonists in the long-term treatment of macroprolactinomas. N Engl J Med 1985;313:656–659.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • John J. Orrego
    • 1
    • 2
  • William F. Chandler
    • 1
    • 2
  • Ariel L. Barkan
    • 1
    • 3
  1. 1.Section of Neurosurgery, Department of SurgeryPituitary and Neuroendocrine CenterUSA
  2. 2.Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Michigan Medical CenterAnn Arbor
  3. 3.Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Michigan Medical CenterAnn Arbor

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