Thorner M O, Martin W H, Rogol A D, Morris J L, Perryman R L, Conway B P, Howards S S, Wolfman M G, MacLeod R M
J Clin Endocrinol Metab. 1980 Sep;51(3):438-45. doi: 10.1210/jcem-51-3-438.
Therapy for large prolactinomas remains controversial. Surgery is often unsuccessful in restoring endocrine function to normal. However, medical therapy with bromocriptine, a dopamine agonist, not only suppresses PRL levels, but may also lead to a reduction in tumor size. Previous reports have demonstrated radiographic evidence of tumor regression only after 3 or more months of bromocriptine therapy. We have now documented, for the first time, objective evidence of extremely rapid reduction in tumor size in two patients harboring large PRL-secreting pituitary tumors (mean pretreatment serum PRL levels, 2350 and 3900 ng/ml) who were prospectively treated with bromocriptine (7.5 mg/day) in preference to surgical intervention despite marked visual impairment in one of the patients. After 2 and 6 weeks of therapy, respectively, marked reduction in tumor size was demonstrated radiographically in both patients. Headache, visual acuity, and visual fields had improved after only 3 days. Although the mechanism of bromocriptine's antitumor activity is unclear, we believe that a large prospective trial to study the effects of bromocriptine therapy on the size of PRL-secreting macroadenomas is urgently needed to determine whether medical therapy should become the primary modality of treatment to reduce tumor size as well as restore endocrine function.
大泌乳素瘤的治疗仍存在争议。手术往往无法成功将内分泌功能恢复正常。然而，使用多巴胺激动剂溴隐亭进行药物治疗，不仅能抑制催乳素（PRL）水平，还可能导致肿瘤体积缩小。既往报道显示，溴隐亭治疗3个月或更长时间后才出现肿瘤缩小的影像学证据。我们首次记录到，两名患有分泌PRL的大垂体瘤（治疗前血清PRL平均水平分别为2350和3900 ng/ml）的患者，尽管其中一名患者有明显视力障碍，但优先接受溴隐亭（7.5 mg/天）治疗而非手术干预，肿瘤体积在治疗后分别于2周和6周出现显著缩小。仅3天后，头痛、视力和视野均有所改善。尽管溴隐亭抗肿瘤活性的机制尚不清楚，但我们认为迫切需要进行一项大型前瞻性试验，以研究溴隐亭治疗对分泌PRL的大腺瘤大小的影响，从而确定药物治疗是否应成为缩小肿瘤体积及恢复内分泌功能的主要治疗方式。
