DRAMATIC AND RAPID SHRINKAGE OF A MASSIVE INVASIVE PROLACTINOMA WITH BROMOCRIPTINE: A CASE REPORT

Abstract

Shrinkage of a massive, highly invasive, longstanding (probably 40 yr) prolactin-secreting pituitary tumor is described in which tumor volume was reduced by 40% 8 d [days] after beginning bromocriptine treatment. After 4 mo. of treatment the tumor was only 11% of the pretreatment volume and by 8 mo. it was further reduced in size being confined to the pituitary fossa, which was partially empty. Reduction in tumor volume was accompanied by a gradual reduction in serum prolactin concentrations to normal values at 4 mo. Between 4 and 18 mo. serum prolactin has remained normal on 5 mg of bromocriptine daily. Visual function improved within 48 h of starting bromocriptine and was almost normal by 6 d. CSF rhinorrhoea developed as the tumor shrank and was successfully managed with the relatively minor procedure of a diversionary lumbo-peritoneal shunt. Bromocriptine should be considered as the initial treatment of choice for massive invasive prolactinomas because of the significant risk of morbidity from neurosurgical treatment.