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Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist

 Moon Sool Yang  ;  Jae Won Hong  ;  Seung Koo Lee  ;  Eun Jig Lee  ;  Sun Ho Kim 
 JOURNAL OF NEURO-ONCOLOGY, Vol.104(1) : 195-204, 2011 
Journal Title
Issue Date
Adult ; Bromocriptine/therapeutic use* ; Dopamine Agonists/therapeutic use* ; Female ; Headache/drug therapy ; Humans ; Longitudinal Studies ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Perceptual Disorders/drug therapy ; Perceptual Disorders/etiology ; Pituitary Neoplasms/drug therapy* ; Pituitary Neoplasms/physiopathology ; Prolactin/metabolism ; Prolactinoma/complications ; Prolactinoma/drug therapy* ; Retrospective Studies ; Sexual Dysfunction, Physiological/drug therapy ; Sexual Dysfunction, Physiological/etiology ; Visual Fields/drug effects ; Young Adult
Bromocriptine ; Cabergoline ; Dopamine ; Hyperprolactinemia ; Invasive prolactinoma
Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome. Herein, we document the results of bromocriptine administration as initial treatment during average 44 months follow-up (up to 12 years) period. We retrospectively categorized 36 patients into four groups according to the results of 3 months of bromocriptine treatment: group 1, tumor volume reduction (TVR) >25% with normalized serum prolactin (NP) (n = 24); group 2, TVR >25% without NP (n = 4); group 3, TVR <25% with NP (n = 5); and group 4, TVR <25% without NP (n = 3). During follow-up, 22 patients (91.7%) in group 1 achieved TVR >50% with NP. Three patients (75%) in group 2 achieved TVR >50% with NP after treatment for 8 months. In group 3, four patients (80.0%) continued medication because of improvement of symptoms and achieved additional TVR (18.8-46.4%). Surgery was performed on five patients (one in group 2, one in group 3, and all three in group 4), and complete resection was achieved in four (80.0%). Overall, 25 (69.4%) of the 36 patients treated with bromocriptine had complete response and 6 (16.7%) had partial response but did not require surgery. Thus, the overall response rate was 86%, with only five patients (14%) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor. Patients who achieve TVR >25% with NP with 3 months of bromocriptine administration had a high possibility of showing good long-term response (TVR >50% with NP) to bromocriptine. A higher dose of dopamine agonist (DA) or other DA should be considered for patients who achieve TVR >25% without NP.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Yang, Moon Sool(양문술)
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Hong, Jae Won(홍재원)
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