Control of Prolactinhyphen;Secreting Macroadenomas With Parenteralcomma; Longhyphen;Acting Bromocriptine in 30 Patients Treated for up to 3 Years

摘要

Medical treatment with dopamine agonist drugs is the treatment of choice in many patients with macroprolactinomas. Oral dopamine agonists both normalize prolactin levels and reduce adenoma size. Oral treatment with dopamine agonist drugs is occasionally limited by side effects, such as nausea, vomiting, postural hypotension, and asthenia. These side effects result in diminished patient compliance. The most widely used dopamine agonist, bromocriptine, is usually given three times daily because of its short half-life. This also causes problems with compliance. In this study, the authors investigated the effects of intramuscular injections of long-acting bromocriptine in patients with pituitary macroadenomas.Thirty patients with prolactin-secreting pituitary macroadenomas were recruited for the study. Each was treated with repeated monthly intramuscular injections of 50 or 100 mg of a long-acting bromocriptine formulation. Patients received from 6 to 37 injections, amounting to a total of 473 injections. Twenty of the 30 patients received parenteral therapy as a primary treatment for the macroadenoma. Ten had undergone previous therapies, including pituitary surgery, oral bromocriptine, and pituitary irradiation.A prolactin daytime profile, in which prolactin was measured at 8 AM, 12 noon, 4 PM, and 8 PM, was obtained. The patients' clinical status and history were documented. Radiological evaluation, consisting of either magnetic resonance imaging or computed tomography scanning, were performed at baseline, after one injection, and every six injections thereafter.In all patients, prolactin levels were suppressed on the 3rd day after the first injection. In 12 patients, prolactin levels normalized with the first to fourth injections, and three additional patients had their prolactin levels normalize after 8 to 15 months (fig. 1). (Normalization was defined as a prolactin level less than 400 mU/liter). In three patients, prolactin was suppressed to less than 1000 mU/liter. In three patients, prolactin did not decrease to less than 50 per cent of pretreatment levels. Two of these three patients had had an inadequate response to oral bromocriptine therapy before study entry. Tumor shrinkage was evident in 15 of 28 patients by radiographic imaging at 28 days (fig. 2). Adenoma size decreased to 66 plusmn; 7 per cent of the pretreatment values. Forty adverse events were noted in 20 patients during the 24 hours after the first injection. These were similar to the known side effects of oral bromocriptine, including nausea and postural hypotension. Most patients reported adverse events in the first 24 hours of treatment with subsequent injections. There were no local adverse reactions at the injection site.