Yarman Sema, Kurtulmus Neslihan, Bilge Ahmet
Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Istanbul, Turkey.
Neuro Endocrinol Lett. 2012;33(3):340-6.
Prolactinoma is the most common pituitary adenoma, and dopamine agonists( BRC, and CAB) is the primary therapy. Recently, the increased prevalance of cardiac valvular disease in patients treated with DAs for Parkinson's disease has raised concerns about the safety of this drug in patients with prolactinoma. CAB and pergolide are frequently reported to cause valvulopathy, there are very few studies showing this side effect in BRC administiration which has less potent agonism of 5-HT2B receptors. Male patients who are known to have higher prevalance of macroadenomas compared to women. The dosage of DAs administered were rarely evaluated.
We performed a retrospective chart to evaluate the medical management and treatment outcomes of male patients with macro/giant prolactinomas. We evaluated 22 patients with prolactinoma managed with DAs therapy alone for at least 1 year. All patients were followed for a mean of 61 months. Pretreatment echocardiographic examination were not available at that time.
None of them had any resistance or intolerance to DAs. The mean tumor shrinkage was 62%. In three patients the macroprolactinoma disappeared, in two patients the tumor shrinkage was 93% and 70%. The DAs therapy was discontinued in these patient. After a follow up neither MRI showed a recurrence or enlargement of the adenoma, nor prolactin levels showed any elevation. The echocardiography were performed at the last visit of each patient and no valvulopathy in any of the patients on DAs therapy were detected.
DAs are effective, and safe for valve morphology with mean cumulative doses of 155 mg CAB, and 7 301 mg BRC in patients with macroprolactinoma.
泌乳素瘤是最常见的垂体腺瘤，多巴胺激动剂（卡麦角林、溴隐亭）是主要治疗方法。最近，帕金森病患者接受多巴胺激动剂治疗后心脏瓣膜病患病率增加，引发了对该药物在泌乳素瘤患者中安全性的担忧。卡麦角林和培高利特经常被报道会导致瓣膜病，而关于溴隐亭（对5-HT2B受体激动作用较弱）给药时出现这种副作用的研究很少。已知男性大腺瘤的患病率高于女性。很少评估多巴胺激动剂的给药剂量。
我们进行了一项回顾性图表分析，以评估男性大/巨大泌乳素瘤患者的药物治疗及治疗效果。我们评估了22例仅接受多巴胺激动剂治疗至少1年的泌乳素瘤患者。所有患者平均随访61个月。当时无法获得治疗前的超声心动图检查结果。
他们中没有人对多巴胺激动剂有任何抵抗或不耐受。肿瘤平均缩小62%。3例患者的大泌乳素瘤消失，2例患者的肿瘤缩小分别为93%和70%。这些患者停用了多巴胺激动剂治疗。随访后，磁共振成像既未显示腺瘤复发或增大，泌乳素水平也未显示任何升高。在每位患者的最后一次就诊时进行了超声心动图检查，未在任何接受多巴胺激动剂治疗的患者中检测到瓣膜病。
对于大泌乳素瘤患者，多巴胺激动剂有效且对瓣膜形态安全，卡麦角林平均累积剂量为155mg，溴隐亭为7301mg。
