Dopaminergic resistance in a case of invasive macroprolactinoma

Schwarzstein, Diego; García‐Patterson, Apolonia; Giménez, G.; Calaf, Joaquím; Puig-Domingo, Manel; Caixàs, Assumpta; Matías‐Guiu, Xavier; Webb, Susan M.

doi:10.1007/bf03348879

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…3) Fibrous change occurs after administration of BC for more than 3 months, which makes surgical intervention difficult. 4) BC resistant prolactinomas are encountered in about 10% of cases [4,6,8,10,11]. 5) Even though the total removal is not achieved, the dose of BC can be decreased by surgically lowering the PRL level.…”

Section: Discussionmentioning

confidence: 99%

“…Several cases have been reported in which prolactinomas failed to respond to dopamine agonist medication, [2,4,6,9,11] but, criteria for recognizing dopamine agonist resistance have not been clearly formulated, since patients were treated with different doses [6,10]. Furthermore the duration of treatment has not been the same and the evaluation has not been uniform.…”

Section: Discussionmentioning

confidence: 99%

“…This may mean that a deficit in functioning D2 receptors accounts for the failure to respond. In addition, the fact that a more potent dopamine agonist such as CV 205-502 was able to overcome this resistance phenomenon in only a fraction of such patients suggests that postreceptor defects are also involved [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…there are several problems such as presence of BC resistant prolactinomas, tumor regrowth after cessation of BC, intolerable side effects and CSF leakage [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. A number of articles on BC therapy for prolactinomas have been published [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”

mentioning

confidence: 99%

“…A number of articles on BC therapy for prolactinomas have been published [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. However, few reports focused on a large number of patients with BC therapy on giant prolactinomas and its long-term results [5,6,8].…”

mentioning

confidence: 99%

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Surgical Indication after Bromocriptine Therapy on Giant Prolactinomas: Effects and Limitations of the Medical Treatment.

et al. 1998

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Abstract.Bromocriptine (BC) is now an accepted primary therapeutic agent for patients with microadenoma. But, for patients with large or giant prolactinomas, the treatment choice is controversial. This report focuses on long-term results of the BC effect on 10 giant prolactinomas (maximum diameter more than 40 mm and the serum PRL level more than 1000 ng/mi) with particular emphasis on cases that needed surgical intervention due to unsatisfactory results from BC therapy alone. BC was effective in 6 cases (60%). They had the serum PRL level normalized in less than one year, with BC maintenance doses between 5-15 mg/day.MRI revealed complete or nearly total disappearance of the tumor. Discontinuation of the medicine was achieved in one patient. In the remaining 4 cases, surgery was needed for various reasons: l) BC resistant prolactinomas in 2 cases, 2) large hematomas in one of the previous cases, 3) regrowth of tumor size, despite the nearly normalized PRL level due to bulk increase in non-secretory adenomatous portion in 1 case, and 4) intolerable side effect in 1 case. BC is effective even for giant prolactinomas in 60% of cases. But, this therapy needs surgical intervention more often than microadenomas.Surgical indications and timing should be decided on based on closer follow-up of neuroimaging and visual evaluation as well as the serum PRL level.

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