Follow-up of patients with prolactinomas after discontinuation of long-term therapy with bromocriptine

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Abstract
The effects of bromocriptine discontinuation after a 2 yr course of therapy on prolactin (Prl) serum levels and the radiological size of the sella turcica were investigated in 16 women with amenorrhea-galactorrhea due to prolactinoma. During therapy, all but 2 patients had normalized serum Prl levels, and 4 women with macroiprolactinomas exhibited a reduction in the size of the tumor as documented by CT[computed tomography]-scanning and tomography of the sellae. After bromocriptine withdrawal and follow-up during 2 additional yr, Prl levels remained normal in 6 patients, 2 of them with microprolactinomas and 4 with macroprolactinomia. The remaining 10 women developed hyperprolactinemia associated with amenorrhea and galactorrhea within 3 mo. after discontinuation of therapy. No tumor expansion was observed in any case during the 4 yr observation period. Bromocriptine treatment seemed to result in permanent cure in 6 of 16 cases of prolactinomas; nevertheless it is difficult to justify an indefinite medical treatment since the natural history of prolactinoma remains unknown. Bromocriptine is apparently more appropriate than neurosurgical transsphenoidal exploration for the primary treatment of prolactinomas. Further investigation is needed before a more definitive conclusion regarding the management of prolactinomas can be reached.

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