Prolactinomas

Pulmonary disease, small-cell lung cancer, head trauma, stroke, central nervous system infections, pituitary surgery, prolactinoma, severe nausea, psychiatric disease, and postoperative state... 

Plasma cell disorders Plasma cell disorders Inflammation-associated, familial Mediterranean fever Familial amyloidotic neuropathy, systemic senile amyloidosis Dialysis-associated amyloidosis Familial amyloidotic neuropathy, aortic amyloidosis Familial systemic amyloidosis Familial systemic amyloidosis Familial systemic amyloidosis Familial cerebral hemorrhage with amyloidosis Sporadic and familial Alzheimer s disease, familial cerebral hemorrhage with amyloidosis Spongiform encephalopathies C-cell thyroid tumors Insulinoma, type II diabetes Atrial amyloidosis Prolactinomas pituitary amyloidosis Iatrogenic amyloidosis Corneal amyloidosis ... 

Hyperprolactinemia PO Initially, 1.25-2.5mgatbedtime.Mayincreaseby2.5mgq3-7days up to 5-7.5 mg/day in divided doses. Maintenance 2.5 mg 2-3 times a day. Pituitary prolactinomas PO Initially, 1.25 mg 2-3 times a day. May gradually increase over several weeks to 10-20 mg/day in divided doses. Maintenance 2.5-20 mg/day in... 

Mectianism of Action Agonist at dopamine Dj receptors suppressing prolactin secretion. Therapeutic Effect Shrinks prolactinomas, restores gonadal function, improves symptoms of Parkinson s disease. 

Bromocriptine, pergolide Ergot derivatives used in Parkinson s disease (see Chapter 28) and prolactinoma (see Chapter 37) ... 

The risk of prolactinoma in patients taking risperidone and other neuroleptic drugs, accompanied by... 

A 35-year-old woman who had taken lithium carbonate 800 mg/day for 2 years was also given risperidone 6 mg/ day for a manic relapse. She missed two menstrual periods and had galactorrhea. A head CT scan showed a pituitary microadenoma and the prolactin concentration was 125 pig/l (reference range up to 20 pg/1). Risperidone withdrawal resulted in disappearance of the prolactinoma. Her other symptoms persisted and did not change with olanzapine 2.5 mg/day however, bromocriptine 12.5 mg/day for 2 weeks relieved her symptoms and the prolactin concentration normalized. 

Perroud N, Huguelet P. A possible effect of amisulpride on a prolactinoma growth in a woman with borderline personality disorder. Pharmacol Res 2004 50 377-9. 

Mendhekar DN, Jiloha RC, Srivastava PK. Effect of risperidone on prolactinoma. A case report. Pharmacopsychiatry 2004 37 41-2. 

Frieboes RM, Murck H, Stalla GK, Antonijevic LA, Steiger A. Enhanced slow wave sleep in patients with prolactinoma. J Clin Endocrinol Metab 1998 83 2706-2710. 

A dopamine agonist is the usual initial treatment for prolactinomas. Significant reduction in both tumor size and serum prolactin levels occurs in about 85% of those receiving these drugs for 6 months or longer. 

Quinagolide (CV 205-502, Norprolac) in doses of 0.15-0.6 mg/d orally, suppresses prolactin and shrinks most prolactinomas. It also decreases cyclic mastodynia. Quinagolide is sometimes better tolerated than ergot-derived dopamine agonists. It is not available in the USA. 

As much as higher concentrations of dopamine are required to stimulate striatal adenylate cyclase activity as compared to the affinity of the drug for the agonistic sites of the receptor, the sensitivity of the anterior pituitary adenylate cyclase to dopamine agonists in both human prolactinoma (26) and rat adenohypophysial homogenate (31) is lower than the potency of the compounds to inhibit prolactin secretion in intact cells (2). This variable loss of sensitivity upon cell homogeneization is a phenomenon frequently observed in other systems (32). 

Although earlier studies failed to find consistent effects of DA on cAMP levels or adenylate cyclase activity in anterior pituitary cells [13], intact pituitary gland [14,15] or homogenates [13,16], a functional connection between the two is now supported by many experimental approaches. DA and DA agonists inhibit cAMP levels in cultured rat pituitary cells at concentrations in the nanomolar range, comparable to those which inhibit PRL release [17-21], DA also inhibits cAMP accumulation stimulated by VIP or TRH [20]. Inhibition is also seen in human prolactinoma cells [22]. 

The risk of prolactinoma in patients taking risperidone and other neuroleptic drugs, accompanied by hyperprolactinemia, amenorrhea, and galactorrhea has been discussed in the light of a case of hyperprolactinemia (160). 

Three Italian men aged 39, 42, and 53 years with invasive prolactinomas took cabergoline 1.0-3.0 mg/week and all developed CSF rhinorrhea after 2-7 months (111). This was clearly a consequence of loss of the stopper effect of the tumor, owing to shrinkage, and in each case was successfully treated by endoscopic trans-sphenoidal surgery. 

A 42-year-old Spanish man took cabergoline (up to 3 mg/day) for a large prolactinoma causing hypopituitarism and symptomatic chiasmal compression (112). After 18 months there was only a minimal tumor remnant on the floor of the sella turcica, but there was chiasmal herniation. However, there were no clinical effects of this, and in particular the visual fields were normal. 

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