Clinical Observation On The Treatment Of Giant Invasive Prolactinomas With Bromocriptine

ObjectiveThe purpose of this study was to observe the clinical effect of bromocriptine in the treatment of invasive giant prolactinomas.MethodsPatients with giant invasive prolactinomas who visited the outpatient department and inpatient department of neurosurgery of Ning Xia medical university general hospital from December 2011 to December 2018 and were followed up regularly were included.During the treatment,the clinical symptom relief,serum prolactin level changes,imaging tumor size reduction,drug resistance,drug side effects and disease outcome were recorded in detail,so as to judge the therapeutic effect of bromocriptine in the treatment of invasive giant prolactinomas.ResultsThere were 17 patients,13 male patients and 4 female patients,the ratio of male to female was about 3:1.Except for 2 patients who received surgery and radiotherapy due to insensitivity to bromocriptine,the remaining 15 patients were followed up regularly within19.4 months.Among the male patients,the serum prolactin level of 4 patients decreased to less than 25ng/ml(36.3%)and t 7 patients decreased to less than 200ng/ml(63.7%)after the oral treatment with bromocriptine alone.The average tumor volume of 11 male patients was318.7cm3 before treatment,and 72.5cm3 after treatment,with an average decrease of 77.2%.Among the female patients,the prolactin level dropped to 25ng/ml(25%)in 1 patient,less than 100ng/ml(50%)in 2 patients,and 150ng/ml(25%)in 1 patient when treated with bromocriptine alone.The mean tumor volume before treatment was 621.7 cm3,and the mean tumor volume after treatment was 114 cm3,with an average decrease of 80.7%.Clinical symptom remission: headache remission in 13 cases(13/14,93%),vision and visual field changes improved in 7 cases(7/10,70%),sexual dysfunction remission in 6 cases(6/8,75%),menstruation recovery in 2 cases(2/3,66.7%),and lactation cessation in 2 cases(2/2,100%).Statistical analysis was performed on the treatment effect of male patients and female patients(p=1.000 > 0.05),and there was no difference in the efficacy between male and female patients.Gender,treatment time and Knosp classification and degree of tumors in the Mann-Whitney U rank and inspection,get the P values were 0.746,0.099,0.041,it is concluded that Knosp classification statistical differences and the degree of the tumor,and then selects the Spearman correlation analysis,r = 0.501,get Knosp grading is positively correlated with the degree of tumor,namely Knosp classification is higher,the greater the degree of tumor.Conclusion1.For patients with giant invasive prolactin adenoma,if there is no clear surgical indication,bromocriptine treatment should be given priority.Bromocriptine can reduce the serum prolactin level and tumor volume of most patients and alleviate their clinical symptoms at the same time.2.If the patient is not sensitive to or resistant to bromocriptine,surgery or radiotherapy is required.3.There was no clear correlation between bromocriptine and pituitary apoplexy.