Ioana Lancranjan and O. Florea
Lucienne Dubey, Ioana Lancranjan, J. Rousselle and J.P. Felber
H. I. Popescu, Ioana Lancranjan, Madeleine Mäicänescu-Georgescu and Iulia Klepsch
Andreja Kocijancic, Janez Prezelj, Ivan Vrhovec and Ioana Lancranjan
Eight patients with macroprolactinomas were treated with a long-acting injectable form of bromocriptine, depot-bromocriptine (Parlodel LAR). With the exception of one male patient who had partial and shortlasting suppression of PRL levels after two injections and who underwent a second adenomectomy, the patients were given Parlodel LAR injections at 28-day intervals for six months. In all patients, there was a significant fall in serum PRL levels after the first injection. PRL secretion was suppressed to within the normal range in 3 of 7 patients on long-term treatment. PRL was consistently within the normal range in 2 patients from the sixth week and in one, from the 14th week onwards. In the other 4 of 7 patients, a marked suppression of PRL secretion, resumption of menses, and normal libido and potency were recorded. In 3 of 8 patients, no adverse effects were noted. Two patients reported short-lasting nausea, one vomiting, one constipation and in 2 patients, orthostatic dizziness occurred after the first injection. Subsequent injections, however, were well tolerated systematically and locally. Five patients had CT scan evidence of tumour shrinkage. A very large tumour virtually disappeared after the first injection of 50 mg depot-bromocriptine in one patient. The decrease of serum PRL secretion within the first 12 hours after injection did not predict normalization of serum PRL levels during long-term treatment, whereas the fall of serum PRL levels to below 5% of the basal values within the first months of treatment could be a good indicator for the final outcome.
Johanna W. van 't Verlaat, Ioana Lancranjan, Martin J. Hendriks and Ronald J. M. Croughs
Abstract. Five patients, 3 women and 2 men, with macroprolactinomas characterized by extrasellar extension and basal plasma prolactin levels ranging from 4.6 to 102 U/I received six monthly injections of 50–100 mg Parlodel LAR®, an injectable long-acting repeatable form of bromocriptine. The following observations were made: 1. Plasma prolactin levels fell dramatically in all patients and values in the normal range were obtained in 3 patients. 2. In all patients, the onset of tumour reduction was visible on CT scans made one week after the first Parlodel LAR injection. After six Parlodel LAR injections, tumour size was reduced by more than 75% in 3 patients and by 50–75% in two patients. 3. Diminished visual acuity (one patient), bitemporal hemianopia (2 patients), and oculomotor and trochlear nerve dysfunction (one patient) were restored to normal after the first Parlodel LAR injection. 4. Hypogonadism normalized in 2 patients and improved in one patient, whereas plasma gonadotropins remained low in the 2 postmenopausal women. In one patient with hypothyroidism and hypocorticism, thyroid and adrenal functions normalized. It is concluded that bromocriptine retard (50–100 mg monthly) is a useful alternative for oral treatment of patients with prolactinomas, especially in those patients with compliance problems on oral bromocriptine therapy.
Caterina Maraschini, Mirella Moro, Antonio Masala, Paola Toja, Sergio Alagna, Amelia Brunani, Pier Paolo Rovasio, Anna Ginanni, Ioana Lancranjan and Francesco Cavagnini
Forty-one patients with prolactinoma (25 micro-, 16 macroprolactinomas) were treated with a long-acting injectable preparation of bromocriptine (Parlodel LAR®, Sandoz), 25-100 mg (mostly 50 mg) im every 4-8 weeks for as long as 43 months (median 19 months). The first injection caused a prompt fall of plasma PRL which reached its nadir value after 3 days. Thereafter, hormone levels remained well below initial values for 4 weeks or longer, though with the tendency, more pronounced in microprolactinoma patients, to rise again toward baseline. The prevalence of PRL normalization was greater in the macro- than in the microprolactinoma group. By repeated injections plasma PRL could be kept close to or within the normal limits in most of the patients. However, the extent of PRL inhibition was significantly greater in macro- than in microprolactinoma patients (p<0.01). Clinical improvement occurred in the majority of the patients, shrinkage of the tumour in 50% of them. Adverse reactions were generally mild or of moderate severity and subsided spontaneously in 24 h. They were less frequent (NS) and less severe (p<0.05) in macro- than in microprolactinoma patients. In conclusion: a. injectable bromocriptine (Parlodel LAR) is a highly effective preparation particularly suitable for the long-term treatment of tumourous hyperprolactinemia; b. patients with macroprolactinoma exhibit, compared with microprolactinoma patients, better responsiveness and better tolerability to injectable bromocriptine.