Therapy For Prolactinomas Research Articles

Cabergoline and quinagolide therapy for prolactinomas.

Cabergoline and quinagolide therapy for prolactinomas.

Mucocele-like formation leading to neurological symptoms in prolactin-secreting pituitary adenomas under dopamine agonist therapy

BACKGROUND Mucocele-like formation associated with pituitary adenomas, to the best of our knowledge, has been paid little attention. We report three adult male patients with a mucocele-like formation that developed behind the tumor and led to neurological symptoms in prolactin-secreting pituitary adenomas (prolactinomas) under dopamine agonist therapy. CLINICAL PRESENTATION Three adult male patients with prolactinomas developed hyperprolactinemia and new neurological symptoms during dopamine agonist treatment. In each case, the pathogenesis of these symptoms was due in part to a mass enlargement with development of a mucocele-like formation behind a prolactinoma. In our patients, a prolactinoma with a suprasellar extension originally filled the sphenoid sinus. When dopamine agonist therapy became ineffective, new symptoms, such as progressive visual impairment other than typical hemianopsia or headache, developed and mass enlargement was found on MRI. MRI demonstrated two different components: an enhancing prolactinoma and a nonenhancing mucocele-like formation behind the tumor. Two patients had compression of the optic nerves by a mass. Transnasal removal of mucoceles and adenomas led to resolution of the neurological symptoms. CONCLUSION Early suspicion of a mucocele-like formation under dopamine agonist therapy for prolactinomas is important in order to avoid a delay in surgery, because a change in medical treatment will be ineffective.

Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results.

Prolactinomas are frequently treated primarily with dopamine agonists; however, these agents have disadvantages and require life-long therapy. We therefore reassessed transsphenoidal microsurgery as an alternative therapy. We reviewed the data for 121 female patients treated surgically for prolactinomas between 1976 and 1979 (Group 1) and 98 patients treated between 1988 and 1992 (Group 2). Of 219 women, 92% with preoperative prolactin (PRL) values of < or = 100 ng/ml and 91% with intrasellar microadenomas experienced initial remission; 80 to 88% of patients with intrasellar macroadenomas or macroadenomas showing moderate suprasellar extension or focal sphenoid sinus invasion experienced remission. Women with PRL values of > 200 ng/ml and those with larger and more invasive adenomas experienced poorer outcomes (37-41% remission). Lower preoperative PRL values and adenoma stage were the best predictors of initial surgical outcomes. At the most recent evaluations, 89% of women who experienced initial remission continued to experience clinical remission; 85% exhibited normal PRL values, and 5% demonstrated mild, asymptomatic, recurrent hyperprolactinemia (PRL values of < 34 ng/ml). In Group 1, 84% of patients continued to experience remission (82% with normal PRL values) after a median follow-up period of 15.6 years. In Group 2, 97% of patients continued to experience remission (88% with normal PRL values) after a median follow-up period of 3.2 years. Lower postoperative PRL values were the best predictors of long-term remission. Transsphenoidal microsurgery is an effective alternative to long-term medical therapy for selected patients with prolactinomas. Successful outcomes and long-term remission were achieved in patients with microadenomas and noninvasive macroadenomas.

Pneumocephalus and Cerebrospinal Fluid Rhinorrhea after Bromocriptine Therapy of an Invasive Prolactinoma

It is exceedingly rare to observe the complications of cerebral spinal fluid (CSF) rhinorrhea and pneumocephalus after initiating bromocriptine therapy of prolactinomas that have not previously undergone surgical or radiotherapy treatment. We describe a patient with a 25-year history of an untreated invasive prolactinoma who responded dramatically to bromocriptine therapy with a reduction in the size of the tumor and normalization of prolactin levels. Her course was complicated by CSF rhinorrhea after 6 days and pneumocephalus after 29 days of bromocriptine therapy. This is the first patient reported with both CSF rhinorrhea and pneumocephalus after only bromocriptine therapy. Review of the literature revealed that all reported cases of bromocriptine-induced rhinorrhea were associated with sellar erosion and required surgical repair or CSF shunt placement to halt the CSF leak. The significant risk of morbidity and mortality from CSF rhinorrhea pneumocephalus, and meningitis makes it necessary to consider these complications during bromocriptine therapy of patients with invasive prolactinomas.

Bromocriptine remains as first-line therapy for prolactinoma

Bromocriptine remains as first-line therapy for prolactinoma

Bilateral Aseptic Femoral Head Necrosis associated with Steroid Therapy for Prolactinoma

The authors report a recent case of prolactin-secreting pituitary adenoma in a young male who had earlier received treatment for infertility. Following partial adenomectomy, he was placed on postoperative steroid substitution among other treatments, but developed femoral head necrosis several months later. Hormone studies at the time showed significant findings, including an elevated serum cortisol level. The authors conclude that this complication resulted from prolonged steroid therapy and offer suggestions as to how a similar situation may be avoided.

Treatment of Pituitary Adenomas

Pituitary adenomas are the most common tumours of the sellar region. A combination of neurosurgery, radiation and pharmacological approaches are applied for the treatment of pituitary adenomas. In certain cases, patient observation is another option. Neurosurgery is the first-choice treatment for acromegaly, Cushing´s disease and TSH secreting adenomas. Leksell gamma knife irradiation is used in the treatment of tumour residues. Until the effect of the irradiation is evident, pharmacological treatment must be administered. Large and/or growing non-functioning pituitary adenomas are operated. Irradiation is possible if there is sufficient distance between the margin of the adenoma and the optic pathway. The primary therapy for prolactinomas is pharmacological treatment with dopamine agonists. Multidisciplinary collaboration among endocrinologists, neurosurgeons and radiosurgeons is necessary in the treatment of pituitary adenomas.