Fonseca Me

Long-acting bromocriptine for the acute treatment of large macroprolactinomas

Six patients with hyperprolactinemia, visual impairment and large macroprolactinoma were treated with a long-acting bromocriptine, in dosage of 50 mg as a single im injection. All patients underwent a full assessment of pituitary prolactin (PRL) secretion before treatment and the studies were repeated about every week during 40 days. Following bromocriptine injection a rapid amelioration of the clinical and visual defects occurred in all patients. Likewise, a significant reduction of the hyperprolactinemia was documented in all six patients and in three of them serum PRL levels reached values as low as 20 ng/ml, and a tumor size reduction was demonstrated by cranial computerized tomography in three of the six cases. No side effects were associated with the administration of bromocriptine. From this study we conclude that the long-acting bromocriptine represents an additional option for the initial management of large prolactinomas in particular when they are associated with severe visual impairment.

Heterogeneous pituitary secretion in familial hypogonadotropic hypogonadism.

Dynamic testing of the hypothalamic pituitary system in familial hypogonadotropic hypogonadism has suggested the possibility of a central nervous disorder associated with variable pituitary secretory secretion. In order to investigate this issue further 7 patients of two families were studied. Male patients exhibited two types of FSH responses to LHRH administration. Two patients had a small response, and the other exhibited a normal response. The LH response was absent or small in both male and female patients. One month therapy with daily injections of LHRH did not improve pituitary responsiveness to a second LHRH test. Estrogen treatment given to females during one month had no improvement effect on another LHRH test. Estradiol benzoate produced a surge in both LH and FSH in half of patients tested which is surprising in the presence of a previous clomiphene negative response. Two of four women had elevated prolactin levels which increased defectuosly after metoclopramide administration which could suggest an abnormal hypothalamic status. On the basis of these results it seems that familial hypogonadotropism is originated by an abnormality at two levels, the anterior pituitary and the hypothalamus as well.