YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE ==MACROPROLACTINOMA== 3 AUTHOR Garcia MM AUTHOR Kapcala LP TITLE Growth of a microprolactinoma to a macroprolactinoma during estrogen therapy. SOURCE J Endocrinol Invest; VOL 18, ISS 6, 1995, P450-5 ABSTRACT Following presentation and diagnosis, microprolactinomas usually follow a benign course and rarely progress to macroprolactinomas. However, clinically significant enlargement of prolactinomas during pregnancy, presumably related to estrogen stimulation, has been reported. This report describes a patient with amenorrhea and hyperprolactinemia and a microadenoma by computed tomography scan who developed a macroprolactinoma within 10 months after being placed on estrogen therapy. We propose that exogenous estrogen administration in this patient most likely promoted growth from a microprolactinoma to a macroprolactinoma. This case emphasizes the primary role of dopaminergic agonist therapy in the management of pathological hyperprolactinemia and suggests that estrogen therapy should not be casually given to patients with known prolactinomas to avoid the possibility of promoting tumor growth. A correlate of this approach is that caution regarding estrogen therapy should also be exercised in patients with idiopathic hyperprolactinemia who might have an occult microprolactinoma which could grow following estrogen stimulation. If estrogen treatment is deemed necessary, dopaminergic agonist therapy should also be used prophylactically to prevent potential tumor growth due to estrogen. The patient should then be carefully monitored with periodic serum PRLs and for the development of clinical manifestations suggesting pituitary growth. An imaging study should be performed when there is a significant increase in serum PRL or the development of new clinical manifestations. 5 AUTHOR Ciccarelli E AUTHOR Miola C AUTHOR Grottoli S AUTHOR Avataneo T AUTHOR Lancranjan I AUTHOR Camanni F TITLE Long term therapy of patients with macroprolactinoma using repeatable injectable bromocriptine. SOURCE J Clin Endocrinol Metab; VOL 76, ISS 2, 1993, P484-8 ABSTRACT The efficacy and tolerability of a long term treatment (21-53 months; mean, 36) with a new injectable form of bromocriptine (Parlodel LAR, Sandoz) was assessed in 13 patients (9 males and 4 females, aged 14-68 yr) with macroprolactinoma. Parlodel LAR was administered deeply im once monthly, with 50 mg as the first dose. Depending on the patient's tolerability to the drug and the PRL levels, the dose was individually progressively increased to 100 mg (2 patients), 150 mg (3 patients), or 250 mg (4 patients). Persistently normal PRL levels were recorded in 4 patients even after the first injection and in 5 other patients treated with higher doses of Parlodel LAR (2 patients with 100 mg/month; 3 patients with 150 mg/month). The remaining 4 patients who were treated with 250 mg/month had a marked reduction of PRL levels (72-94%), but did not reach normalization. Two patients treated with 150 mg/month maintained normoprolactinemia in spite of subsequent dose reduction of Parlodel LAR to 50-100 mg/month. In 1 patient PRL plasma concentrations remained within normal range for 3 months after the transitory discontinuation of Parlodel LAR at the end of the first year of therapy. Regular menses were resumed in 1 of 3, and galactorrhea disappeared in 2 of 3 women. All male patients had a return of libido and potency; gynecomastia disappeared in both male patients, and galactorrhea disappeared in 1 of 2 male patients. Visual fields improved in all 5 patients; complete normalization occurred in 2 of them. A consistent shrinkage of the macroadenoma (23-100%) at different times after therapy was shown by magnetic resonance imaging and/or computed tomography in 12 of 13 patients. Six patients reported mild/moderate side-effects (nausea, vomiting, orthostatic hypotension, or dizziness) within 24 h after the first injection. In 2 of these patients, mild side-effects persisted for 1-2 days after the first 3-6 injections, and in one patient, mild nausea was reported after each injection. In conclusion, in patients with macroprolactinoma, Parlodel LAR is an effective and well tolerated preparation of bromocriptine when administered once a month. 11 AUTHOR Breidahl HD AUTHOR Topliss DJ AUTHOR Pike JW TITLE Failure of bromocriptine to maintain reduction in size of a macroprolactinoma SOURCE Br. Med. J.; VOL 287 ISS Aug 13 1983, P451-452, (REF 5) ABSTRACT IPA COPYRIGHT: ASHP The case of a 47-yr-old patient with macroprolactinoma whose tumor decreased initially with 15 mg/day bromocriptine (I) but subsequently increased despite continuing treatment is reported. The dose of I was increased to 40 mg/day but tumor growth continued. Production of prolactin by cultured cells was not inhibited by high concentrations of I, suggesting that regrowth of the tumor was due to cells resistant to dopamine agonist action. It was concluded that regrowth of prolactinoma during I treatment after initial reduction in size indicates the need for close surveillance especially of patients whose serum prolactin concentration fails to fall into the normal range with I treatment. 7 AUTHOR Liuzzi A AUTHOR Dallabonzana D AUTHOR Oppizzi G AUTHOR Verde GG AUTHOR Luccarelli G AUTHOR et al TITLE Low doses of dopamine agonists in the long term treatment of macroprolactinomas SOURCE N. Engl. J. Med.; VOL 313 ISS Sep 12 1985, P656-659, (REF 18) ABSTRACT IPA COPYRIGHT: ASHP To evaluate the long term effects of dopamine agonists in the treatment of macroprolactinoma, prolactin levels and tumor size were studied for 30 to 88 months in 38 patients treated with bromocriptine (I) or lisuride (II). Elevated prolactin levels became normal in 30 patients, and the tumor shrank in 29. After 2 yr of treatment, the maintenance doses (5 to 20 mg of I/day or 0.4 to 0.8 mg of II/day) were reduced; in 21 patients no changes in prolactin levels or tumor size were observed over 6 to 52 months with 0.625 to 10 mg of I/day or 0.05 mg of II/day. However, it was possible to withdraw the drug in only one patient. It was concluded that dopamine agonists are usually effective treatment for macroprolactinoma and that after a response is obtained, it can be maintained in many patients with a greatly reduced dose.