Document Detail


Positive prolactin response to bromocriptine in 2 patients with cabergoline-resistant prolactinomas.
MedLine Citation:
PMID:  21324816     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe a positive prolactin response to bromocriptine treatment in 2 patients with cabergoline-resistant prolactinomas.
METHODS: We report the patients' clinical presentations, laboratory test results, imaging findings, and clinical courses.
RESULTS: Patient 1 had a 5-mm pituitary microadenoma that was initially diagnosed at age 30 years. After initial diagnosis, she was treated with transvaginal bromocriptine for 9 years and then subsequently went untreated for 2 years. After developing symptoms of amenorrhea, decreased libido, and hyperprolactinemia, oral cabergoline, 0.5 mg twice weekly, was initiated. Her prolactin concentration remained elevated at 80 ng/mL while taking cabergoline. Her prolactin concentration decreased to 13 ng/mL after her regimen was switched to bromocriptine, 5 mg daily. Patient 2 had a 17-mm pituitary macroadenoma that was initially diagnosed at age 15 years. Oral cabergoline was started at 0.5 mg twice weekly and increased to 1 mg 3 times weekly when prolactin levels continued to rise to 340 ng/mL over 18 months. After visual field defects developed, transsphenoidal surgery was performed. One year after surgery, magnetic resonance imaging showed a 6- to 7-mm pituitary adenoma, and there was a gradual rise in serum prolactin. Her serum prolactin concentration continued to rise to 212 ng/mL with increasing tumor size over 3 years. Cabergoline was discontinued and oral bromocriptine was initiated at a dosage of 10 mg daily. After 4.5 months of bromocriptine therapy, her serum prolactin concentration decreased to 133 ng/mL. However, after 2 months, the macroadenoma continued to increase in size and a visual field defect developed, so another transsphenoidal operation was performed.
CONCLUSIONS: Although cabergoline is generally preferred to bromocriptine for the treatment of patients with prolactinomas because of its better tolerance profile and greater effectiveness, in patients with cabergoline-resistant prolactinomas, a bromocriptine trial should be considered a safe, relatively inexpensive, and well-tolerated alternative.
Authors:
Pallavi Iyer; Mark E Molitch
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  17     ISSN:  1934-2403     ISO Abbreviation:  Endocr Pract     Publication Date:    2011 May-Jun
Date Detail:
Created Date:  2011-06-24     Completed Date:  2011-11-08     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e55-8     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Diabetes, and Metabolism, University of South Florida, Tampa, FL, USA. iyerp@allkids.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antineoplastic Agents / therapeutic use
Bromocriptine / therapeutic use*
Drug Resistance, Neoplasm / drug effects*
Ergolines / therapeutic use*
Female
Hormone Antagonists / therapeutic use
Humans
Pituitary Neoplasms / blood,  drug therapy*,  metabolism
Prolactin / blood,  secretion*
Prolactinoma / blood,  drug therapy*,  metabolism
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 0/Ergolines; 0/Hormone Antagonists; 25614-03-3/Bromocriptine; 9002-62-4/Prolactin; LL60K9J05T/cabergoline

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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