the great majority of patients, 16, 28 transiently or persistently reduced anterior pituitary function develops, involving growth hormone (GH), gonadotropins, adenocorticotropic hormone (ACTH), and thyroid-stimulating hormone (TSH) deficiency in decreasing frequency. 14 Posterior pituitary function is nearly always preserved, even though cases of inappropriate antidiuretic hormone secretion and diabetes insipidus have been reported. 5 We report a case of pituitary apoplexy occurring shortly after administration of bromocriptine to a patient with Wermer
Antoine Alhajje, Michel Lambert, and Jean Crabbé
Neil A. Martin, Martha Hales, and Charles B. Wilson
P ituitary adenomas characteristically grow as a mass that deforms, displaces, and compresses adjacent structures. A minority of these tumors, however, behave in a more aggressive fashion, invading surrounding structures and, rarely, metastasizing to remote areas of the central nervous system (CNS) and to extracranial sites. This case illustrates the clinical and pathological features of a cerebellar metastasis from a prolactin-secreting adenoma. It is notable, in light of recent reports of pituitary tumor regression during bromocriptine therapy, that the
Case report and review of the literature
Thomas Psarros, Alexander Zouros, and Caetano Coimbra
A kinetic mutism refers to a state in which seemingly awake patients remain motionless and silent 2, 10, 13 and has been commonly described as occurring with lesions involving the ascending dopaminergic activating system. 6, 17, 28, 42, 46 The significance of this monoamine pathway was reinforced when Ross and Steward 39 reported on a patient who had developed akinetic mutism from a hypothalamic injury following resection of a third ventricular cyst that was successfully treated with bromocriptine. Subsequently, others have described patients with acquired
Jerry L. Hubbard, Bernd W. Scheithauer, Charles F. Abboud, and Edward R. Laws Jr.
diffuse tumors with associated visual loss. 4, 23–26, 36, 37 Since its release in the United States in 1978, the dopamine agonist bromocriptine has gained widespread use for the treatment of prolactin-secreting adenomas. In some instances it is used without surgery, such as for cases occurring during pregnancy and for patients with visual field defects. 3, 5, 10, 17, 20, 22, 31, 33, 34 Bromocriptine is often the first line of therapy offered to patients with prolactinomas, and a surgical opinion is sought after failure of this medication to lower the prolactin level
Andras A. Kemeny, Jan A. Jakubowski, Emil Pasztor, Anthony A. Jefferson, and Richard Wojcikiewicz
B romocriptine (2-bromo-alpha-ergocryptine mesylate), a dopamine receptor agonist ergot derivative, is widely used in the treatment of pituitary adenomas since it is known to reduce tumor size 7–9, 13, 15, 17, 18, 25, 26, 28 Several authors have suggested a reduction of blood flow through the tumor as one of the possible mechanisms explaining this phenomenon, but this theory has hitherto been rejected on the grounds that bromocriptine lacks any vasoconstrictor effect. However, no direct measurements of blood flow in the pituitary region during bromocriptine
Michael H. Brisman, Gillian Katz, and Kalmon D. Post
M acroprolactinomas most often present with endocrinological abnormalities, visual disturbances, or headaches, and the initial treatment is usually a dopamine agonist such as bromocriptine. Macroprolactinomas rarely present with acute deterioration resulting from apoplexy; treatment in these cases is not well defined. It is not clear exactly how severe and rapidly progressing the symptoms should be to mandate an emergency surgical decompression or an initial trial of bromocriptine therapy. We describe a patient with a macroprolactinoma who presented with
A kinetic mutism is an infrequent but profound complication of recurrent obstructive hydrocephalus. 4 This case suggests that the syndrome may be secondary to rapid ventricular expansion with damage to ascending monoamine projections. In the patient presented here, the behavioral characteristics failed to improve with cerebroventricular shunting, but did respond to administration of a combination of bromocriptine and ephedrine. Case Report This 20-year-old man was evaluated at another institution for headache and diplopia. There was no relevant medical
Zhe Bao Wu, Chun Jiang Yu, Zhi Peng Su, Qi Chuan Zhuge, Jin Sen Wu, and Wei Ming Zheng
difficulties is also an important factor. Treatment is a complex issue because of the involvement of the cavernous sinus as well as other parasellar and basal forebrain structures. Pharmacological therapy with a dopamine agonist remains the mainstay of treatment. We report on a group of patients with invasive giant prolactinomas involving the cavernous sinus who had undergone long-term follow-up review after bromocriptine treatment. Clinical Material and Methods Patient Population and Inclusion Criteria Giant pituitary adenomas have been previously defined as those
Daniel L. Barrow, George T. Tindall, Kalman Kovacs, Michael O. Thorner, Eva Horvath, and James C. Hoffman Jr.
B romocriptine (2-bromo-alpha-ergocryptine), an ergot derivative with dopamine receptor agonist properties, has been shown to produce significant shrinkage of prolactin-secreting pituitary tumors (prolactinomas). 24, 25 This results from the involution of adenomatous prolactin cells with reduction in cytoplasmic, nuclear, and nucleolar areas. 21, 27 However, the drug does not have a cytotoxic effect and thus does not eradicate the tumor. 27 The effect of bromocriptine upon pituitary adenomas other than prolactinomas is uncertain. Isolated reports have
Michael H. Brisman, Gillian Katz, and Kalmon D. Post
Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine therapy, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.