Endocrine Abstracts

Most macroprolactinomas are responsive to dopamine against drugs. Bromocriptine (BRC) has been available and extensively used in our country. The aims are to assess the outcome in 29 patients with macroprolactinomas who were treated with BRC.

Material and methods: A multicentric study of 29 patients with macroprolactinoma (19 female; 10 males). The mean age was 33 years. The pituitary mass was larger than 10 mm in diameter. There was no endocrinological evidence of mixed tumour or primary hypothyroidism.

Results: The primary presenting complaint included headaches and/or visual abnormalities which were present in 68% of female vs 90% in men, menstrual dysfunction (94%), impotence (57%), decreased libido (80%), gynecomastia (40%). The mean duration of symptoms before diagnosis was 43.6±33.6 months in females and 27.7±25 months in men. The mean maximal tumor diameter was 20 mm and were larger in men (25±9 mm) than in women (17±6 mm). Extra sellar extension was observed in 68.5% in female vs 80% in male. The mean pre-treatment prolactin level was 1501 ng/ml (range: 70-20476 ng/ml) and correlated significantly with tumour size (P=0.02). Apoplexy was clinically evident in one patient and silent three others diagnosed on radiologic imaging.

The cumulative radiological response to BRC seemed to be associated to a longer duration of treatment. A tumor reduction greater than 50% or a shrinkage was seen in 38% after one year of treatment, rose to 43% after two years and to 67% after three years over. Empty sella was seen in 5 patients. The mean doses needed of BRC were correlated to basal prolactin and women received lower doses than men.

Conclusion: Bromocriptine was the main dopamine against used in our patients and was safe and effective. Doses varied with the mean prolactin level and tumor size.