NLM CIT. ID: 20177233
TITLE: Peripubertal prolactinomas: clinical presentation and long-term
outcome with different therapeutic approaches.
AUTHORS: Fideleff HL; Boquete HR; Sequera A; Suarez M
Sobrado P; Giaccio A
AUTHOR AFFILIATION:
Medicine Department, Hospital T. Alvarez, Buenos Aires, Argentina.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGES:
Eng
REGISTRY NUMBERS:
25614-03-3 (Bromocriptine)
ABSTRACT:
The evolution of prolactinomas in children and adolescents continues
to be controversial. We report on the long-term evolution (2-20 yr)
of prolactinomas in 40 patients (29 F, 11 M). In females, the age for
the onset of symptoms ranged between 8 and 16 yr and the age at which
diagnosis was made ranged from 15 to 19 yr; in males, ages ranged
from 8 to 17 yr and from 13.8 to 19 yr, respectively. In females,
there was predominance of microprolactinomas (22/ 29) and the
symptomatology resulted from functional disorders, whereas in males
there was predominance of macroprolactinomas (8/11) and symptoms were
caused by tumor mass disorders. Surgery was used as primary therapy
in nine patients and as supplemental therapy in six patients.
Twenty-four patients were treated primarily with bromocriptine and
seven with cabergoline. Of the nine patients treated primarily with
surgery, only one achieved gonadotropic axis restoration; in 25/31
patients receiving drug therapy gonadotropic function was restored to
normal. Fifteen patients showed complete resolution or substantial
shrinkage of tumor. CONCLUSION: In pediatric and adolescent age,
there seem to be age- and sex-dependent differences in the clinical
presentation of prolactinomas that cannot be accounted for only in
terms of time of evolution. Drug therapy can control the disease,
normalize prolactin levels and achieve gonadotropic axis restoration
in most patients.
NLM PUBMED CIT. ID:
10714751
SOURCE: J Pediatr Endocrinol Metab 2000 Mar;13(3):261-7
NLM CIT. ID: 20114080
TITLE: Implications of not treating hyperprolactinemia.
AUTHORS: Sanfilippo JS
AUTHOR AFFILIATION:
Department of Obstetrics and Gynecology, Medical College of
Pennsylvania Hahnemann School of Medicine, Pittsburgh, USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGES:
Eng
REGISTRY NUMBERS:
0 (Dopamine Agonists)
ABSTRACT:
When a patient with hyperprolactinemia is not treated, a number of
ramifications can result, the most significant of which is
osteoporosis. Evidence-based analysis shows that bone mineralization
also can be affected by such problems as gonadal dysgenesis and
possibly adrenal dysfunction. The hypoestrogenism associated with
hyperprolactinemia is commonly assumed to be a potential cause of
osteopenia in premenopausal women with this disorder, just as
decreased estrogen is associated with bone loss following menopause.
A number of studies also have shown that hyperprolactinemia decreases
bone density independently of the hypoestrogenic state. In most, but
not all, such women, bone density may be reestablished if one is
successful in restoring normal menstrual function with dopamine
agonists. With the availability of safe dopamine agonists like
bromocriptine and now cabergoline, it seems prudent to attempt to
normalize serum prolactin levels early on, before long-term
pathologies set in.
NLM PUBMED CIT. ID:
10649820
SOURCE: J Reprod Med 1999 Dec;44(12 Suppl):1111-5
UI - 99271794
AU - Cannavo S; Bartolone L; Blandino A; Spinella S; Galatioto S;
Trimarchi F
TI - Shrinkage of a PRL-secreting pituitary macroadenoma resistant to
cabergoline.
SO - J Endocrinol Invest 1999 Apr;22(4):306-9
AD - Cattedra di Endocrinologia, University of Messina, Italy.
Cabergoline decreases both serum PRL levels and size of prolactinomas,
including some tumors resistant to other dopamine-agonists. It is common
observation that the shrinkage of the adenoma is preceded by suppression
of PRL levels. A minority of patients, who do not show a significant
decrease of PRL after a short trial with dopamine-agonists, undergoes
neurosurgery or radiotherapy. We report on the case of a 14-year-old girl
with a huge prolactinoma who showed, during cabergoline treatment (0.5 mg
twice a week), a significant shrinkage of the pituitary mass but no
decrease of the very high PRL values. She was referred to us after
partial removal of the suprasellar extension of the pituitary tumor. The
post-surgical evaluation showed very high PRL levels (9352 microg/l;
20941 microg/l before surgery), which did not decrease during the 2-year
treatment with cabergoline (nadir value: 8735 microg/l). However, one
month after the beginning of therapy, MRI showed a significant shrinkage
of the tumor (tumor volume 5.7 ml, compared with 45.1 ml prior to surgery
and 24.4 ml after surgery). Subsequently MRIs demonstrated a progressive
reduction of the size with a complete disappearance of the suprasellar
and parasellar tissue (tumor volume 1.8, 0.9 and 0.2 ml, at 3, 6 and 12
months, respectively). The MRI performed at the 24th month showed a
secondary empty sella, with residual tumor tissue in the right sphenoidal
sinus. Increasing cabergoline, up to 3 mg a week, failed to induce any
decrease of PRL levels. In conclusion, in such macroprolactinomas the
shrinkage of tumor is not strictly correlated with (or it is partially
dissociated from) the inhibition of PRL hypersecretion. The choice of
other therapeutic options in cabergoline-resistant macroprolactinomas
needs careful neuroradiological evaluation after a short trial of
pharmacological treatment.
UI - 99029968
AU - Colao A ; Annunziato L ; Lombardi G
TI - Treatment of prolactinomas.
SO - Ann Med 1998 Oct;30(5):452-9
AD - Department of Molecular and Clinical Endocrinology and Oncology,
Federico II University, Naples, Italy. rpivone@tin.it
The objectives of the treatment of hyperprolactinaemia are to suppress
excessive hormone secretion and its clinical consequences, to remove
tumour mass, to preserve the residual pituitary function and to prevent
disease recurrence or progression. Prior to the advent of
pharmacotherapy, therapy usually consisted of surgical resection and/or
pituitary irradiation. In microprolactinomas, trans-sphenoidal surgical
resection normalizes prolactin (PRL) levels, restores normal menses and
produces the disappearance of galactorrhoea in a great majority of
patients, but normalization of serum PRL levels varies from 35-70%. In
macroprolactinomas, trans-sphenoidal surgery is less successful with only
32% of patients appearing to be cured initially. However, the recurrence
rate is 19%, and the long-term cure rate is only 26%. In more than 80% of
the patients with microprolactinoma, suppression of PRL levels and tumour
shrinkage can be achieved with bromocriptine therapy given at doses of
2.5-5 mg per day. In 5-10% of the patients, the appearance of side-
effects (nausea, dizziness and postural hypotension) is a limiting factor
in continuing the treatment. Dopaminergic compounds cause notable tumour
shrinkage in most macroprolactinomas. Treatment with cabergoline, a
selective and long-lasting dopamine 2-receptor agonist at weekly doses of
0.5-2 mg has been shown to be effective both in normalizing PRL levels
and in inducing tumour shrinkage. Pharmacotherapy with dopamine (DA)
agonists is an appropriate first-line treatment for both micro- and
macroprolactinomas. Surgery should be recommended for those patients who
are severely intolerant of or resistant to DA agonists.
UI - 98024961
AU - Colao A; Di Sarno A; Landi ML; Cirillo S; Sarnacchiaro F; Facciolli G;
Pivonello R; Cataldi M; Merola B; Annunziato L; Lombardi G
TI - Long-term and low-dose treatment with cabergoline induces macroprolactin-
oma shrinkage.
SO - J Clin Endocrinol Metab 1997;82(11):3574-9
AD - Department of Molecular and Clinical Endocrinology and Oncology, Federico
II University of Naples, Italy.
AB - Cabergoline (CAB), a long-lasting dopamine-agonist, specific for the
D2 receptor, is effective in normalizing serum PRL levels in most
patients with microprolactinoma or idiopathic hyperprolactinemia.
Because few data are presently available on the effects of CAB
treatment in macroprolactinomas, the aim of this open-label study was
to investigate whether this drug was effective in producing tumor
shrinkage, as well as in normalizing PRL levels. Twenty-three
patients with macroprolactinoma entered this study 15 patients had
had no treatment, whereas the remaining 8 patients had been
previously treated with bromocriptine, which was with-drawn because
of intolerance. Three of 23 patients had undergone unsuccessful
surgery. Pretreatment serum PRL levels ranged from 100-3860
micrograms/L. CAB was administered at a dose of 0.5-3 mg once or
twice a week for 12-24 months. Magnetic resonance imaging (MRI) scans
were performed before and 3, 6, 12, and 24 months after the beginning
of treatment, to evaluate tumor shrinkage, defined as a decrease of
at least 80% of baseline tumor volume. After 3-6 months of treatment
with a low dose (0.5-1 mg/week), serum PRL levels normalized in 18
patients. In the remaining 5 patients, whose serum PRL levels were
not normalized, the dose was increased to 2-3 mg/week. This schedule
caused the normalization of PRL levels in 1 patient, whereas in the
remaining 4 patients, PRL levels were reduced to 30-82 micrograms/L.
A tumor volume reduction greater than 80% at MRI occurred in 14 of 23
patients (61%) after CAB treatment (from 2609.4 +/- 534.7 to 530.1
+/- 141.3 mm3 at the 12-24th month follow-up, P < 0.001). A volume
reduction of 41.8 +/- 3.4% was already evident after 3 months (1436
+/- 285.9 mm3; P < 0.001). The complete disappearance of the tumor
mass at MRI occurred after 6 months of treatment with CAB in 1
patient, and in 5 patients after 1 yr of treatment. An improvement of
visual field defects was obtained in 9 of the 10 patients presenting
visual impairment before CAB treatment. The drug was tolerated well
by all patients. Only 1 patient experienced mild nausea, which
disappeared spontaneously after the 2nd day of treatment. Long-term,
a low dose of the D2 receptor agonist CAB significantly reduced tumor
volume and normalized serum PRL levels in a great majority of
patients bearing macroprolactinoma. This treatment met with excellent
patient compliance. This study suggests that CAB can be used as a
first choice drug treatment in macroprolactinomas, as already shown
for microprolactinomas and idiopathic hyperprolactinemia.
UI - 97216243
AU - Colao A; Di Sarno A; Sarnacchiaro F; Ferone D; Di Renzo G; Merola B;
Annunziato L; Lombardi G
TI - Prolactinomas resistant to standard dopamine agonists respond to chronic
cabergoline treatment.
SO - J Clin Endocrinol Metab 1997;82(3):876-83
AD - Department of Molecular and Clinical Endocrinology, University Federico
II, Naples, Italy.
AB - Cabergoline (CAB), a new, potent, and long-lasting PRL-lowering
agent, was shown to be effective in tumoral hyperprolactinemia. The
aim of this study was to investigate the effectiveness of CAB in
patients with prolactinoma proven to be resistant to bromocriptine
(BRC) and quinagolide (CV 205-502). Twenty-seven patients (19 macro-
and 8 microprolactinomas) were treated with CAB at a weekly dose of
0.5-3 mg for 3-22 months. All patients were previously shown to be
resistant to BRC, and 20 of them were resistant to CV 205-502 as
well. Basal serum PRL levels before CAB treatment ranged from
108-3500 micrograms/L in macroprolactinomas and from 64-205
micrograms/L in microprolactinomas. Gonadal failure was present in
all patients, whereas symptoms of tumor expansion, such as visual
field defects and headache, were present in 10 of 27 patients. Eight
macroprolactinomas had previously undergone surgery and/or radiother-
apy. CAB treatment normalized serum PRL levels in 15 of 19 macroprol-
actinomas and in all 8 microprolactinomas. In 3 of the remaining 4
patients it caused a notable decrease in prolactinemia (89%, 80.5%,
and 68.7% of the baseline). Only 1 patient was withdrawn from CAB
therapy after 3 months at the weekly dose of 2 mg due to the absence
of any significant clinical, hormonal, or radiological improvement.
Gonadal function was restored in 18 of 27 patients, galactorrhea
disappeared in 5 of 6 women, and headache improved in 7 of 8
patients. A significant tumor shrinkage was detected by computed
tomography and/or magnetic resonance imaging in 9 macroprolactinomas
and 4 microprolactinomas. CAB was well tolerated by all patients,
except 6 who referred slight and short-lasting nausea, postural
hypotension, abdominal pain, dizziness, and sleepiness at the
beginning of treatment. In particular, CAB was well tolerated by 19
patients previously shown to be poorly tolerant to BRC and CV
205-502. In conclusion, CAB may represent, at the moment, the only
successful therapy for prolactinoma-bearing patients resistant to BRC
and CV 205-502, as it normalized PRL levels in 22 of 27 patients,
reduced tumor size in 13 of 27 patients, and improved clinical
symptoms in 25 of 27 patients in the present study.
UI - 97340092
AU - Ferrari CI; Abs R; Bevan JS; Brabant G; Ciccarelli E; Motta T; Mucci M;
Muratori M; Musatti L; Verbessem G; Scanlon MF
TI - Treatment of macroprolactinoma with cabergoline: a study of 85 patients.
SO - Clin Endocrinol (Oxf) 1997;46(4):409-13
AD - Department of Medicine, S. Pio X Hospital, Milan, Italy.
AB - OBJECTIVE: Cabergoline is now established as an effective and
well-tolerated treatment for prolactinoma. However, there are
relatively few published data on the treatment of macro-, as opposed
to micro-, prolactinoma. We have therefore reviewed the efficiency
and safety of cabergoline in the treatment of patients with
prolactin-secreting macroadenomas treated on a compassionate basis.
STUDY DESIGN AND PATIENTS: Eighty-five patients with prolactin-
secreting macroadenomas were treated with cabergoline 0.25 to 10.5 mg
per week (median 1 mg) given to one to seven doses. Treatment
durations ranged between 3 months and 8 years. Sixty-five patients
(32 intolerant, 16 resistant) had been treated previously with other
dopamine agonists. Pretreatment prolactin levels ranged between 80
and 8300 micrograms/I and tumour maximum diameters were between 11
and 42 mm. MEASUREMENTS: Serum prolactin, visual fields if initially
abnormal, occurrence of menses or return of libido and potency, blood
chemistry and adverse events were assessed at 1 month and then at
3-month intervals during treatment. Pituitary computed tomography or
magnetic resonance imaging was usually repeated at 3 months and 1
year, then yearly, in most patients (n = 62). RESULTS: Normalization
of prolactin levels was achieved in 52 patients (61.2%) and a
prolactin decrease of at least 75% of pretreatment values occurred in
24 others (28.2%). Of the 20 de novo patients, 17 had prolactin
normalized and the remainder had at least 75% reduction. Disappearan-
ce of tumour image was found in eight of 62 evaluable patients
(12.9%) and reduction of the largest diameter by at least 25% in
another 33 (53.2%), with an overall success rate of 66.1%; among the
17 evaluable de novo patients the success rate was 82.3%. Fifteen of
21 patients who failed to show tumour shrinkage had previously
demonstrated resistance/intolerance to other prolactin-lowering
treatments. Of the 12 patients with visual field defects at baseline,
six normalized and two showed an improvement. Menses resumed during
cabergoline treatment in 79.5% of premenopausal women. Restoration of
potency was reported by seven of eight evaluable men. Adverse events
were recorded in 24.7% of cases, four of whom (4.7%) discontinued
treatment. CONCLUSIONS: Although the present data were not obtained
in a formal study we conclude that cabergoline is an effective and
well-tolerated treatment for macroprolactinoma patients.
Return to my Treatment of Prolactinomas page
This Page Last Updated on 6th. July, 2000