Bromocriptine treatment of invasive giant prolactinomas involving the cavernous sinus: results of a long-term follow up
- 1 January 2006
- journal article
- clinical trial
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 104 (1), 54-61
- https://doi.org/10.3171/jns.2006.104.1.54
Abstract
The aim of this study was to observe long-term clinical outcomes in a group of patients treated with bromocriptine for invasive giant prolactinomas involving the cavernous sinus. Data from 20 patients with invasive giant prolactinomas at the authors' institutions between July 1997 and June 2004 were retrospectively reviewed. The criteria to qualify for study participation included: (1) tumor diameter greater than 4 cm, invading the cavernous sinus to an extent corresponding to Grade III or IV in the classification scheme of Knosp and colleagues; (2) serum prolactin (PRL) level greater than 200 ng/ml; and (3) clinical signs of hyperprolactinemia and mass effect. Among the 20 patients who met the criteria, six had undergone unsuccessful transcranial or transsphenoidal microsurgery prior to bromocriptine treatment and 14 patients received bromocriptine as the primary treatment. Eleven of the 20 patients underwent adjuvant radiotherapy. After a mean follow-up period of 37.3 months, the clinical symptoms in all patients improved by different degrees. Tumor volume on magnetic resonance images was decreased by a mean of 93.3%. In 11 patients, the tumor had almost completely disappeared; in the other nine patients, residual tumor invaded the cavernous sinus. Visual symptoms improved in 13 of the patients who had presented with visual loss. Eight patients had normal PRL levels. The postoperative PRL level was more than 200 ng/ml in seven patients. During the course of drug administration, cerebrospinal fluid leakage occurred in one patient, who subsequently underwent transsphenoidal surgery. No case of apoplexy occurred during bromocriptine treatment. Dopamine agonist medications are effective as a first-line therapy for invasive giant prolactinomas, because they can significantly shrink tumor volume and control the PRL level. Tumor mass vanishes in some patients after bromocriptine treatment; in other patients with localized residual tumor, stereotactic radiosurgery is a viable option so that unnecessary surgery can be avoided. The application of radiotherapy does not reliably shrink tumor volume.Keywords
This publication has 52 references indexed in Scilit:
- Surgical Treatment of Prolactin-Secreting Pituitary Adenomas: Early Results and Long-Term OutcomeJournal of Clinical Endocrinology & Metabolism, 2002
- Resistance to Cabergoline as Compared with Bromocriptine in Hyperprolactinemia: Prevalence, Clinical Definition, and Therapeutic StrategyJournal of Clinical Endocrinology & Metabolism, 2001
- Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumorsJournal of Neurosurgery, 2001
- Prolactin Secreting Pituitary Adenomas: Analysis of 429 Surgically Treated Patients, Effect of Adjuvant Treatment Modalities and Review of the LiteratureActa Neurochirurgica, 1999
- Long-Term and Low-Dose Treatment with Cabergoline Induces Macroprolactinoma ShrinkageJournal of Clinical Endocrinology & Metabolism, 1997
- Symptoms of pituitary apoplexy rapidly reversed with bromocriptineJournal of Neurosurgery, 1996
- Endoscopic endonasal transsphenoidal surgery: experience with 50 patientsNeurosurgical Focus, 1996
- Diagnosis and Drug Therapy of ProlactinomaDrugs, 1996
- Extrasellar Prolactinomas: Successful Management of 24 Patients Using BromocriptineHormone Research, 1986
- Prolactinomas and Optic Nerve Compression: Disappearance of a Suprasellar Extension and Visual Recovery after Two Weeks Bromocriptine TreatmentHormone Research, 1981