Serum prolactin and radiological skull examinations in infertile men with azoospermia or severe oligozoospermia

Measurements of serum prolactin, FSH, LH, testosterone, and oestradiol and radiological examinations of the skull were carried out in 142 infertile men with sperm counts below 10 millions/ml. The prolactin levels were compared to those observed in 27 fertile men. Six of the infertile men showed high levels of prolactin. Two of these men had earlier been hypophysectomized, and the sella turcica was found to be abnormal on the roentgenograms. In the remaining four men the sella turcica was normal, and serum gonadotrophins, testosterone and oestradiol were within normal range, except for one man who displayed a very high FSH. The testis biopsies from these four men showed severe hypoplasia, signalling that treatment of the infertility with bromocriptine may be of limited value.     

A case of prolactinoma presenting with CSF rhinorrhea and CSF otorrhea during bromocriptine therapy]

Cerebrospinal fluid (CSF) leakage is a rare complication of prolactinoma treated with bromocriptine (BC). BC is known to be effective for reducing the volume of a prolactinoma and for decreasing the serum level of prolactin (PRL). In cases of pituitary tumors, CSF leakage is thought to be caused by shunting between the subarachnoid and extradural spaces. We had a case presenting with CSF rhinorrhea and CSF otorrhea during BC therapy which was treated successfully. The mechanism and treatment of CSF leakage were studied. A 55-year-old woman complaining of nasal obstruction and headache was admitted to our hospital on Nov. 22, 1988. CT scan showed a huge intracranial mass lesion involving the sella and the supra-sellar region and invading the sphenoid sinus and ethmoid sinus. Serum PRL level was 18,000 ng/ml. The patient was diagnosed as having an invasive prolactinoma, and BC therapy (5.0 mg per day) was instituted. Three days later, CSF rhinorrhea developed, and BC treatment discontinued; radiation therapy was started. After 36 Gy irradiation the size of the tumor was same on CT, and serum level of PRL was still high. The patient underwent trans-sphenoidal operation. The tumor was removed partially and the presumed CSF fistula was repaired. The sella and sphenoid sinus were packed with fat. BC treatment was reinstituted, and the serum PRL level decreased gradually without recurrent CSF rhinorrhea. Two weeks later the patient returned complaining of bilateral hearing disturbance. With a diagnosis of exudative otitis media she underwent bilateral tympanostomy. Immediately after tympanostomy, pulsating discharge from the middle ear was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Results of treatment for male prolactinomas

We evaluated the results of medical treatment for male prolactinomas. We encountered eight patients with male prolactinomas. The age was 25 to 54 years old (mean 43 years) and the chief clinical symptoms were visual acuity/field defect in three patients, pituitary apoplexy in one patient, disturbance of ejection in one patient, generalized convulsion in one patient, headache in one patient and general fatigue in one patient. The serum prolactin level was 279 to 7,360 ng/ml (mean 2,832 ng/ml). The tumors in all patients were large with a mean diameter of 34.9 mm (range, 21 to 43 mm). In only one patient, the operation was performed due to pituitary apoplexy. All the patients were treated by medication, with bromocriptine being used in seven patients and terguride in one. The follow-up period was 0.8 to 13 years (mean 5.9 years) and, in all patients, the medical treatment was continued. The tumor decreased in size in all patients and the serum prolactin level at the last follow-up observation was 0.5 to 70.5 ng/ml (mean 26.9 ng/ml). All the neurological symptoms disappeared in the early stage of treatment. As for the complications of medical treatment; in one patient, orthostatic hypotension occurred during the initial administration of bromocriptine and one patient suffered CSF leakage two months after the administration of bromocriptine, so the repair of the sella floor by transsphenoidal surgery was necessary. The medical treatment for male prolactinomas is effective for a long term and should be the primary treatment for the male prolactinomas. In conclusion, patients can maintain a good quality of life for a long time by using dopamine agonists.     

Serum Prolactin and Radiological Skull Examinations in Infertile Men with Azoospermia or Severe Oligozoospermia

Measurements of serum prolactin, FSH, LH, testosterone, and oestradiol and radiological examinations of the skull were carried out in 142 infertile men with sperm counts below 10 millions/ml. The prolactin levels were compared to those observed in 27 fertile men.
Six of the infertile men showed high levels of prolactin. Two of these men had earlier been hypophysectomized, and the sella turcica was found to be abnormal on the roentgenograms. In the remaining four men the sella turcica was normal, and serum gonadotrophins, testosterone and oestradiol were within normal range except for one man who displayed a very high FSH. The testis biopsies from these four men showed severe hypoplasia, signalling that treatment of the infertility with bromocriptine may be of limited value.     

A case of male acromegaly with galactorrhea

A 43-year-old man was admitted to our clinic with complaints of headache and nasal obstruction. He has noted increasing hand and foot size with decreasing libido and pollakiuria for ten years. On admission, he showed galactorrhea. His visual symptoms were slightly decreased. Endocrinological evaluation revealed high serum levels of GH and prolactin. A plain skull X-ray showed acromegalic features with remarkable destruction of dorsum sellae. A contrast enhanced CT demonstrated an intrasellar high density mass extending to the sphenoid sinus and the right ethmoidal sinus. A cerebral angiogram was nor.al. Surgery was then performed with the transsphenoidal approach. A soft reddish brown mass was found in the sphenoid sinus and the bilateral cavernous sinus extending from the sella turcica. Histologically the tumor was eosinophilic adenoma. There were numerous cells exhibiting immunostaining for both GH and PRL in the immunocytochemical study. Postoperative course was uneventful. His visual impairment improved soon after the operation. Serum GH and PRL levels decreased to 38 and 130 ng/ml. He was treated with conventional irradiation (500 rads), so remained galactorrhea and hyperhidrosis. One year after the operation, there is no regrowth of the residual tumor.     

Prolactinoma in a child showing high MIB-1 labeling index: a case report

We report a very rare case of a prolactin secreting pituitary tumor (prolactinoma) which occurred in a 12-year-old boy. The tumor showed an extremely high MIB-1 index. The clinical implication in the postoperative management of childhood prolactinoma is discussed. The patient showed right third nerve palsy, and MRI revealed a pituitary tumor invading the right cavernous sinus. Preoperative hormonal evaluation showed a very high prolactin level (2800 ng/ml). The patient underwent transsphenoidal surgery, and the third nerve palsy disappeared just after the procedure. MIB-1 index obtained by using immunostaining was 18.9%. Postoperative prolactin level remained high (2200 ng/ml), and the patient was treated with 10 mg/day of bromocriptine. Prolactinomas in children with high MIB-1 index show resistance to treatment with bromocriptine. In the postoperative management of a childhood prolactinoma, it should be considered how to control sufficiently high serum prolactin level to expect sexual development while preserving other normal residual pituitary functions. If control with bromocriptine, fails radiation treatment should be adopted with careful observation of the increase in height and the progress of sexual development of the patient.     

Pneumocephalus induced by bromocriptine treatment in male prolactinoma--a case report

The authors reported a case of pneumocephalus induced by bromocriptine (Bc) treatment for a recurrent invasive prolactinoma. The patient was a 38-year old man, who had been treated for 12 years, with three times of craniotomies and two times of irradiation therapies. CT scan showed the recurrence of the tumor, which extended into bilateral middle fossa, left orbit and left cerebellopontine angle. Serum prolactin levels elevated to 35,200 ng/ml. Then Bc was administered in a dose of 5 mg/day. Serum PRL concentration fell to 2,090 ng/ml one month after the initiation of the treatment, when he complained of headache, nausea and vomiting. Since these symptoms were considered as the side effects of Bc, the dose was reduced to 2.5 mg/day. Three weeks later, plain craniograms showed marked pneumocephalus, while no tumor was found on CT scan. The administration of Bc was stopped and he was prescribed a complete rest for a month. The air was collected again when he began to walk around. Therefore, the transsphenoidal operation was performed in order to pack the sella turcica and sphenoid sinus with muscle pieces. Since the pneumocephalus could not be cured, the muscle, taken from the thigh, was spread throughout the left middle fossa by the front-temporal craniotomy. When Bc reduces the size of the invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. The greatest care should be taken for pneumocephalus, CSF rhinorrhea and/or meningitis during the Bc treatment of prolactinomas.     

Gangliocytoma masquerading as a prolactinoma. Case report.

The authors describe the case of a 36-year-old man who presented with bitemporal hemianopsia and a serum prolactin concentration of 1440 ng/ml. Magnetic resonance imaging of the pituitary revealed a presumed macroadenoma with suprasellar and temporal lobe extension. Although the patient's prolactin level was lowered to 55 ng/ml by bromocriptine therapy, no tumor shrinkage occurred. Fourteen months later, progression of visual field defects necessitated transsphenoidal resection, which was incomplete. Immunocytochemical analysis of the biopsy tissue was positive for prolactin and, in view of the clinical picture, more detailed analysis was not performed. External-beam radiotherapy was given 2 years later because of enlargement of residual tumor. Subsequently, despite a fall in the serum prolactin concentration to less than 20 ng/ml in response to the course of bromocriptine, the mass displayed further extension into the temporal lobe. Nine years after the patient's initial presentation, he underwent transfrontal craniotomy for sudden deterioration in visual acuity caused by hemorrhage into the mass. No adenohypophyseal tissue was identified in the resected tissue. The mass was composed of dysplastic neurons that were strongly immunoreactive for synaptophysin and neurofilament (indicating neural differentiation) and prolactin. Review of the original biopsy specimen indicated that the prolactin-positive cells had striking neuronal morphological characteristics. The final diagnosis in this case is prolactin-secreting gangliocytoma. Although exceedingly rare, this disease must be added to the differential diagnosis in cases of "prolactinoma" when bromocriptine therapy is followed by a marked decline in serum prolactin that is not accompanied by significant tumor shrinkage. Furthermore, in such instances, consideration should be given to "obtaining a biopsy sample prior to electing for radiotherapy.     

Growth hormone-producing pituitary adenoma in an 8-year-old girl: case report

A rare case of pituitary adenoma in childhood presenting as giantism is reported. A 6-year-old girl came to our attention in 1982 because of excessive growth noted since the age of 3 yr. Her appearance revealed giantism. She also had a 4 year history of genital bleeding, but no development of external genitalia nor mammary gland. Endocrinological studies revealed markedly elevated serum basal levels of both growth hormone (GH) and prolactin (PRL). She had a bromocriptine therapy for 1 year and 8 months, but it was difficult to suppress her excessive growth rate. So she was admitted at the age of 8 years to undergo the operation. Visual fields were intact. X-ray examination of the skull demonstrated a slightly enlarged sella turcica. Computerized tomography revealed an isodense mass at the pituitary fossa without extrasellar extention. Repeated endocrinological studies were carried out. Basal levels of GH and PRL were 43.8 ng/ml and 67 ng/ml. All other pituitary function were normal, except for puberal responses of luteinizing hormone (LH) and follicle stimulating hormone in LH-RH loading test. 50 g oral glucose tolerance test was normal. Transsphenoidal microsurgery was performed in August 1984. The tumor filled up the pituitary fossa with fibrous element. Histological examination disclosed a mixed adenoma, predominantly chromophobe, with a few granulated eosinophils. Immunoperoxidase staining was also performed on the adenoma. Most of the tumor cells stained for GH, and a few of them stained for PRL. Postoperatively hypopituitalism was not complicated. Surgery produced a decrease in serum PRL level under 20 ng/ml, but serum GH level was not enough reduced under 10 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of male cystic pituitary adenoma with hyperprolactinemia--clinical study of 6 cases of male prolactinoma

A case of male cystic prolactinoma is reported. And six cases of male prolactinoma including the present case were experienced in our department, and they were studied clinically. A 40-year-old male was admitted to our hospital with complaints of decreased libido and bitemporal visual depression. Physical examination revealed neither gynecomastia nor galactorrhea. Decreased visual acuity, bitemporal hemianopia, and pale optic disc were disclosed. On endocrinological study, high serum level of prolactin and hyposecretion of the other pituitary hormones were shown. Plain skull x-ray films showed ballooning of the sella turcica. CT scan revealed a low density area in the pituitary fossa extending to the suprasellar region. This was visualized as a homogeneous high signal intensity in the T1 weighted magnetic resonance imaging. Surgical treatment was made by transsphenoidal approach. A considerable amount of dark reddish fluid was suctioned through an incision of the thinned dura mater. Postoperative course was uneventful, and the bitemporal hemianopia was much improved. The serum level of prolactin was normalized after administration of bromocriptine. Male prolactinomas were thought to constitute 20% of all prolactinomas and male cystic prolactinoma was a rare clinical entity. Since the serum level of prolactin became to be measured routinely, six male prolactinomas have been experienced in our department. Their clinical feature were summarized as follows; Mean age of the patients was 33.2 +/- 9.8 years. Marked suprasellar extension and associated visual disturbance were common. All lesions except in the present case were solid tumor. Mean serum level of prolactin was 3398.3 +/- 2758.4 ng/ml. Pituitary apoplexy during the test of insulin, TRH and LH-RH simultaneous loading was noted in two cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Two cases of TSH-secreting pituitary adenoma; endocrinological, diagnostic and therapeutic approach to the disease

Two cases of TSH-secreting pituitary adenoma were reported. Endocrinological and immunohistochemical features of these cases were described and problems in diagnosis and treatment of the rare disease are discussed. [case 1] A 28 year-old woman suffered from hyperthyroidism with a relatively high value of serum TSH (T3; 350 ng/dl, T4; 10.0 micrograms/dl, TSH; 24.5 microU/ml). She was treated with antithyroid drug and then underwent subtotal thyroidectomy. Although the levels of serum T3 and T4 were lowered to within normal range, the level of serum TSH still remained high. One month later, she developed frontal headache, amenorrhea and bitemporal hemianopsia. A CT scan showed an enhanced mass in the sellar and suprasellar region. Preoperative endocrinological studies showed elevated values of TSH (47 microU/ml) and its alpha-subunit (9.0 ng/ml). The levels of both T3 (190 ng/dl) and T4 (10.0 micrograms/dl) were near the upper normal limit. Serum TSH was suppressed by administration of exogenous T3, but did not respond to exogenous TRH, l-Dopa nor bromocriptine. Under the diagnosis of TSH-secreting pituitary adenoma, the patient was operated on by craniotomy and received local radiation therapy (50 Gy). In 1990, 12 years after the treatment, she is well and endocrinologically normal. Immunohistochemical study revealed that most tumor cells were positive for TSH. [case 2] A 28 year-old woman visited our hospital for examination of hyperthyroidism. Serum level of TSH was detectable (4.5 microU/ml). A CT scan performed at that time disclosed no pituitary tumor. Thyroid function was normalized by antithyroid drug, but the level of TSH was still high and progressively increased.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of intrasellar meningioma with panhypopituitarism and hyperprolactinemia

A case of intrasellar meningioma is reported. A 49-year-old woman was admitted to our hospital on July 22, 1985, complaining of reduced visual acuity and visual field defect. Visual acuity was 0.6 in the right eye and 0.1 in the left eye. Visual field examination revealed upper temporal quadrantanopsia on the right side and incomplete temporal hemianopsia on the left side. Ocular fundi were normal. X-ray films of the skull showed a balloon-shaped sella turcica with "double floor". CT scan showed a isodense mass with central low density occupying the intrasellar and suprasellar region. After administration of contrast medium, almost homogenous enhancement was noted. Bilateral carotid angiographies demonstrated that horizontal portion of the right anterior cerebral artery was raised. No tumor blush was evident. Endocrinologic function tests confirmed a complete deficit of the anterior lobe hormones except for elevated serum prolactin level of 110 ng/ml. She showed no galactorrhea. On August 6, 1985, the sella turcica was reached via the transsphenoidal rhinoseptal approach. The sella floor and dura matter were intact. The grey, soft and necrotic tumor tissue was encountered and bleeding was controllable. The tumor extending to suprasellar region was firm in consistency. Pathologically, the tumor was a typical meningothelial meningioma. Postoperatively, visual field defect improved and visual acuity was recovered on the right side immediately. Postoperative CT scan showed a thin residual enhanced lesion, which was the attachment of the tumor. It seemed to be the elevated diaphragma sellae. Clinical observation, radiological and endocrinological findings of intrasellar meningioma are similar to that of non-functioning pituitary adenoma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bromocriptine and prostatic carcinoma: plasma kinetics, production and tissue uptake of 3H-testosterone in vivo

The influence of the anti-prolactin bromocriptine on plasma kinetics, production rate and tissue uptake of testosterone was investigated in 15 patients with newly diagnosed stages C and D prostatic carcinoma. Bromocriptine was given for 5 days in a daily dose of 15 mg. orally. The studies were performed with the single injection technique using the 2-compartment model. Plasma testosterone, serum prolactin, and luteinizing and follicle-stimulating hormones were determined initially. Blood samples were drawn up to 5 hours after the injection of 3H-testosterone. For tissue studies a transrectal needle biopsy was done 3 hours post-injection. Bromocriptine suppressed prolactin and the endogenous testosterone level. Furthermore, it favored the elimination of 3H-testosterone, lowered the production rate of testosterone and hampered the in vivo uptake of the 3H-label into prostatic carcinoma tissue. Finally, the grading of the tumor lesions affected only the pre-bromocriptine uptake of radioactive androgens and not the uptake in response to bromocriptine. The potential clinical impliications of these observations are discussed.     

A case of growth hormone-producing adenoma presenting as a non-functioning tumor at recurrence

The authors report a case of recurrent pituitary adenoma, which changed its endocrinological function from GH producing to non-functioning. A 37-year-old woman was admitted to our hospital complaining of headaches, amenorrhea and acromegalic features. Skull X-rays showed marked ballooning of the sella turcica and mild thickening of the calvarium. X-rays of the hands and feet revealed moderate acromegalic changes. On pneumoventriculography, the tumor elevated the floor of the third ventricle. The serum GH level was 29.3 ng/ml, which did not respond to insulin induced hypoglycemia. Radical removal of the tumor was performed through a right frontal craniotomy. Histologically, it was diagnosed as a pituitary eosinophilic adenoma. Immunostains revealed the presence of many GH positive cells in the adenoma. Since the post-operative GH levels were still high (12-16 ng/ml), irradiation to the sellar region was carried out. The serum GH concentration gradually decreased to the normal level in one year after the irradiation. At that time no sellar tumor could be found on CT scans. The patient had been well for six years until she noticed hearing impairment of her right ear. She was re-admitted about seven years after the first admission because of cerebellar ataxia and hearing loss. CT scans revealed a recurrent tumor extending from the sellar region to the right cerebello-pontine angle. Serum GH levels on admission were within normal range (3-4 ng/ml). The tumor was partially removed by suboccipital craniectomy. Pathologically, the tumor was reported as a pituitary chromophobe adenoma. With immunostains, no GH positive cells could be found in the adenoma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hyperprolactinemia in patients with non-functioning adenoma: analysis of 85 patients treated by transsphenoidal operation

Today, many gynecologists consider that the first choice of the treatment of prolactinomas is bromocriptine therapy. Because bromocriptine not only decreases the levels of serum prolactin but also reduces the tumor size. On the other hand, the patients with non-functioning adenoma sometimes show hyperprolactinemia, probably because PIF (prolactin inhibiting factor) cannot reach the normal prolactin-producing cells of the adenohypophysis. Therefore non-functioning adenoma with elevated serum prolactin levels should be distinguished from prolactinoma. Eighty five patients with non-functioning adenoma were treated with transsphenoidal operation at Hiroshima University Hospital, and Kansai Rosai Hospital from May, 1978 to March, 1981 and at Osaka University Hospital, The Center for Adult Diseases, and Kansai Rosai Hospital from April, 1981 to May, 1986. Non-functioning adenomas were diagnosed by clinical feature, endocrinologic examination, and immunohistochemical study. There were 42 male and 43 female patients, whose age ranged from 17 to 76 years (mean: 49). The most frequent chief complaint was visual disturbance (86%). Amenorrhea-galactorrhea was complained by 9 female patients. However, 7 of them had visual disturbance at the same time. Hyperprolactinemia was seen in 21 patients (30%). The highest serum level of prolactin was 163.2 ng/ml. All of the patients had macroadenomas. There were 2 invasive adenomas and 83 expensive adenomas in them. After operation, cure or improvement of the visual disturbance was noted in almost all the patients. The serum levels of prolactin were normalized in 16 of 17 hyperprolactinemic patients. In conclusion, transsphenoidal operation is the best treatment of non-functioning adenomas. However, it is difficult to decide before operation whether the macroadenoma with serum prolactin level between 100 and 200 ng/ml is non-functioning adenoma or prolactinoma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Malignant prolactinoma with multiple intracranial metastases studied with positron emission tomography

A rare case of a patient with multiple intracranial metastases from a prolactin-secreting pituitary neoplasm is described. At the age of 14 years, the patient had been operated on for a sellar tumor; he presented 12 years later with severe headache, at which time computed tomographic and magnetic resonance imaging scans revealed multiple intracranial metastases. Histopathology examination showed pituitary neoplastic cells with positive immunostaining for prolactin. The patient was investigated with positron emission tomography (PET) and dopamine D2-receptor binding, and the amino acid metabolism of the tumor was characterized in vivo. High dopamine D2-receptor binding and high amino acid metabolism were found in the tumor. The patient was subsequently treated with bromocriptine injections that resulted in a decrease in serum prolactin levels, decreased dopamine D2-receptor binding, reduced amino acid metabolism, and a reduction in tumor volume. This case demonstrates a beneficial effect of bromocriptine treatment in a patient with prolactinoma with multiple intracranial metastases. It also illustrates the great potential of PET in the in vivo characterization of the D2-binding and the high sensitivity of 11C-labeled L-methionine in the follow-up of treatment in patients with pituitary adenomas.     

Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report

OBJECTIVE: We report a case of a patient with a prolactin (PRL) producing ectopic pituitary adenoma presenting a unilateral exophthalmos. CASE: This 70-year-old woman presented an ophthalmologist with progressive left-sided exophthalmos over the previous 2 months. Bone window CT scan revealed extensive bony destructions of the skull base including the clivus, sphenoid sinus and medial aspect of the middle cranial fossa. Gd-DTPA MRI revealed an abnormal enhancement lesion in the sphenoid sinus, but no abnormal enhancement was seen in the sella turcica. Since these findings suggested malignant tumors of the cranial base, several biopsies through the transnasal route were carried out to confirm the diagnosis. This procedure caused the complication of cerebrospinal fluid (CSF) leakage. Because the biopsy specimen revealed a PRL producing adenoma (serum PRL-level 645.7 ng/ml), the patient was admitted to our department. On admission neurological examination showed an exophthalmos with external ocular movement disorders and disturbance of visual acuity on the left side. She underwent transsphenoidal surgery to remove the tumor and to reconstruct the sphenoid sinus and the sellar floor. Surgical exploration revealed a yellowish and soft tumor underneath the normal mucous membrane in the sphenoid sinus. The sellar floor was destructed extensively, but the dura mater of the pituitary fossa was intact except for a small pin-hole which was thought to be produced during the several biopsy procedures. No surgical procedure was applied to the intrasellar region. The sphenoid sinus was packed with a piece of fascia and fat applied with the aid of fibrin glue to prevent CSF leakage. RESULT: The patient followed a satisfactory postoperative course. Her visual acuity disturbance and exophthalmos disappeared one year after surgery. Postoperative serum PRL level remained high (66.9 ng/ml), but, subsequently, was normalized (9.5 ng/ml) with a bromocriptine therapy (15 mg daily). CONCLUSION: As far as we are aware, this is the first case report of an ectopic pituitary adenoma causing unilateral exophthalmos. Although it is extremely rare, pituitary adenomas should be kept in mind in a differential diagnosis of exophthalmos.     

Induced hypoprolactinemia and testicular steroidogenesis in man

The effects of short-term hypoprolactinemia on the pituitary-gonadal axis were evaluated in a group of patients with untreated prostatic carcinoma. Each patient was studied prior to and during 7-day oral administrations of bromocriptine (2.5 mg q.i.d.). Serum LH, prolactin (PRL), androst-4-ene-3,17 dione (androstenedione), testosterone, and 5 alpha-androstane-3 alpha, 17 beta-diol (5 alpha-Diol) levels, as well as intra-testicular testosterone, dihydrotestosterone (DHT), 5 alpha-Diol and zinc (Zn) concentrations, were determined. Daily administration of bromocriptine caused a marked suppression of serum PRL (mean +/- SEM, 23.8 +/- 2.5 vs. 6.4 +/- 1.0 ng/ml) without concomitant changes in serum LH levels (mean +/- SEM, 8.3 +/- 1.6 vs. 8.9 +/- 2.1 ng/ml). Hypoprolactinemia induced a significant decrease (P less than 0.05) in the mean peripheral testosterone levels; but 5 alpha-Diol and androstenedione remained unchanged. However, in testicular tissues, bromocriptine treatment resulted in significant increases in mean concentrations of total androgens (P less than 0.001), testosterone (P less than 0.001) and DHT (P less than 0.02). Testicular levels of 5 alpha-Diol were not significantly altered. There was no change in Zn levels in basal conditions and during bromocriptine administration. These results indicate that short-term suppression of serum PRL levels in man affects basal testicular function without altering serum LH. However, a direct action of bromocriptine on the human gonad cannot be excluded.     

The long-acting dopamine agonist bromocriptine mesylate as additive immunosuppressive drug after kidney transplantation

BACKGROUND: Acute rejection is an important risk factor for kidney graft loss. As evidence suggests that prolactin has important immunostimulatory properties, we conducted a randomized, prospective open trial in which bromocriptine, a drug suppressing prolactin secretion, was administered as an additive immunosuppressive drug after first cadaver kidney transplantation. METHODS: In the treatment group bromocriptine was given intramuscularly to 22 patients after their first kidney transplantation along with conventional immunosuppression (cyclosporin A, glucocorticoids). Twenty-three patients receiving only conventional immunosuppression served as control subjects. The incidence of acute graft rejections, graft losses, and infections was evaluated. RESULTS: Serum prolactin concentrations were slightly elevated above normal values before transplantation (32 +/- 5.3 ng/ml) and decreased to values between 13 and 16 ng/ml in the control group and were totally suppressed in the bromocriptine group. After 6 months of follow-up overall patient and allograft survival was 97.7% and 91% respectively. Acute rejection episodes occurred in 31 patients (77.5%): 15 in the bromocriptine group vs 20 in the control group (n.s.). In each group eight patients experienced a cytomegalovirus infection. The incidence of severe bacterial infections (i.e. pneumonia and sepsis) was five and six respectively. The necessity of haemodialysis after transplantation was 3.1% in the patients on bromocriptine and 23% in those without. CONCLUSIONS: Suppression of circulating prolactin concentration by bromocriptine did not improve the clinical outcome of patients after kidney transplantation receiving cyclosporin and prednisolone.      

Bromocriptine treatment of invasive giant prolactinomas involving the cavernous sinus: results of a long-term follow up

OBJECT: The aim of this study was to observe long-term clinical outcomes in a group of patients treated with bromocriptine for invasive giant prolactinomas involving the cavernous sinus. METHODS: Data from 20 patients with invasive giant prolactinomas at the authors' institutions between July 1997 and June 2004 were retrospectively reviewed. The criteria to qualify for study participation included: (1) tumor diameter greater than 4 cm, invading the cavernous sinus to an extent corresponding to Grade III or IV in the classification scheme of Knosp and colleagues; (2) serum prolactin (PRL) level greater than 200 ng/ml; and (3) clinical signs of hyperprolactinemia and mass effect. Among the 20 patients who met the criteria, six had undergone unsuccessful transcranial or transsphenoidal microsurgery prior to bromocriptine treatment and 14 patients received bromocriptine as the primary treatment. Eleven of the 20 patients underwent adjuvant radiotherapy. After a mean follow-up period of 37.3 months, the clinical symptoms in all patients improved by different degrees. Tumor volume on magnetic resonance images was decreased by a mean of 93.3%. In 11 patients, the tumor had almost completely disappeared; in the other nine patients, residual tumor invaded the cavernous sinus. Visual symptoms improved in 13 of the patients who had presented with visual loss. Eight patients had normal PRL levels. The postoperative PRL level was more than 200 ng/ml in seven patients. During the course of drug administration, cerebrospinal fluid leakage occurred in one patient, who subsequently underwent transsphenoidal surgery. No case of apoplexy occurred during bromocriptine treatment. CONCLUSIONS: Dopamine agonist medications are effective as a first-line therapy for invasive giant prolactinomas, because they can significantly shrink tumor volume and control the PRL level. Tumor mass vanishes in some patients after bromocriptine treatment; in other patients with localized residual tumor, stereotactic radiosurgery is a viable option so that unnecessary surgery can be avoided. The application of radiotherapy does not reliably shrink tumor volume.