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Suggest Treatment For Macroadenoma
Question: Hi,
Last 7 months I diagnosed with macroedimoma 5cm, the prolatine was 84000, I treated with dostinex 0.5 twice a week, the tumor shrinking to 0.8cm and proctaline dropped to 496 in the first 6 months of treatment.
Last a few days I checked the proctalin level and found high again (2700)
My question is what cause of elevated proctalin go high again although I'm stil under the treatment.
Thank you
Last 7 months I diagnosed with macroedimoma 5cm, the prolatine was 84000, I treated with dostinex 0.5 twice a week, the tumor shrinking to 0.8cm and proctaline dropped to 496 in the first 6 months of treatment.
Last a few days I checked the proctalin level and found high again (2700)
My question is what cause of elevated proctalin go high again although I'm stil under the treatment.
Thank you
Brief Answer:
The treatement may not be effective .
Detailed Answer:
Hello
I have gone through your question and understood your concern.
Generaly,the Prolactin-secreting macroadenomas respond to dopaminergic agonists like bromocriptine, cabergoline and, previously, pergolide.
Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinoma because of its long track record and safety.
It decreases the synthesis and secretion of PRL, also decreases the rate of tumor cell division and results in some reduction of tumor size in up to 80-85% of the patients.
Cabergoline is usually better tolerated than BEC, and its efficacy profiles are somewhat superior to those of BEC.But In your specific case, the prolactin level is high again and this means that the treatement is not effective any more.
If you were my patient,i will ask you to repeat the prolactin test in another lab ,to confirm that the level is high again.
If the second result is high than i will considet to shange the treatement and i will choice Bromcriptine.(I suggest to talk with your treating endocrinologist about your last prolaction level and the possible solution in your case.)
Hope my information is helpful.
Best regards.
The treatement may not be effective .
Detailed Answer:
Hello
I have gone through your question and understood your concern.
Generaly,the Prolactin-secreting macroadenomas respond to dopaminergic agonists like bromocriptine, cabergoline and, previously, pergolide.
Bromocriptine (BEC) is generally considered to be the agent of choice in the treatment of prolactinoma because of its long track record and safety.
It decreases the synthesis and secretion of PRL, also decreases the rate of tumor cell division and results in some reduction of tumor size in up to 80-85% of the patients.
Cabergoline is usually better tolerated than BEC, and its efficacy profiles are somewhat superior to those of BEC.But In your specific case, the prolactin level is high again and this means that the treatement is not effective any more.
If you were my patient,i will ask you to repeat the prolactin test in another lab ,to confirm that the level is high again.
If the second result is high than i will considet to shange the treatement and i will choice Bromcriptine.(I suggest to talk with your treating endocrinologist about your last prolaction level and the possible solution in your case.)
Hope my information is helpful.
Best regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I did second blood test and came out with higher level.But how come the treatment was very effective in the first 2 months and now not anymore?Doctor,
Do you think that increase the treatment to 1.5 mg of dostinex will be not enough to lower the proctalin level.
Thank you
Do you think that increase the treatment to 1.5 mg of dostinex will be not enough to lower the proctalin level.
Thank you
Brief Answer:
Maximum dose is 1 mg twice a week.
Detailed Answer:
Hi again.
It is difficult to explain why the treatment was effective within the first months and now it is not any more.
About the dosis ,you should know that the maximum dose of carbegoline or Dostinex is 1 mg twice a week.So increasing the dosis to 1,5 mg is not helpful and at the other side it can be harmful with a lot of side effects.
So,as i said i will try to change your treatement with Dostinex and start the treatement with Bromcriptine.
I suggest to talk with your treating endocrinologist about this possible treatement.
Hope i have answered to all your questions.
If you have other doubts,feel free and ask.
Take care.
Maximum dose is 1 mg twice a week.
Detailed Answer:
Hi again.
It is difficult to explain why the treatment was effective within the first months and now it is not any more.
About the dosis ,you should know that the maximum dose of carbegoline or Dostinex is 1 mg twice a week.So increasing the dosis to 1,5 mg is not helpful and at the other side it can be harmful with a lot of side effects.
So,as i said i will try to change your treatement with Dostinex and start the treatement with Bromcriptine.
I suggest to talk with your treating endocrinologist about this possible treatement.
Hope i have answered to all your questions.
If you have other doubts,feel free and ask.
Take care.
Above answer was peer-reviewed by :
Dr. Kampana
Hi again,
I think that was unprofessional answer and even if I ask anybody in the street he will tell to try another medicine, but explain to me how the tumor shrink from 5.3.3
To only 0.8 cm and prolatin from 84000 to 496 in the first 4 month and then start to
Increase to 3700 in the 7th month ?
I think that was unprofessional answer and even if I ask anybody in the street he will tell to try another medicine, but explain to me how the tumor shrink from 5.3.3
To only 0.8 cm and prolatin from 84000 to 496 in the first 4 month and then start to
Increase to 3700 in the 7th month ?
Brief Answer:
Two possible explanations.
Detailed Answer:
Hi
There are two possibilities why (in my opinion) you do not have a good response to carbegoline any more:
1.These drug act on dopamine receptors which are on the surface of the tumor. A receptor can be visualized as a keyhole, the drug is the key – in order for the drug key to be effective, the tumor must have an adequate number of receptors and the drug must be able to bind to the receptor.
In your case,now there are not enough receptors on the tumor surface or the binding to the receptors is not adequate and this can be an explanation why the treatement is not effective any more.
2.The medications are only effective as long as they are taken. If the medication is stopped, the prolactin will usually increase and the tumor will also increase in size.If you have stoped the drug,even for small periods of time,this can explain why your prolactine has started to increase again.
With a large tumor and very high prolactin level (like in your case), the medication may lower prolactin but this is not a cure.
The medications do not destroy the tumor.
Anyway i can say that an elevated prolactin may be acceptable if there are no other ill effects of the tumor such as headache or loss of vision.You should discuss with your treatin g endocrinologist about this.
In circumstancen when the drugs are not effective, alternative treatments such as surgery and/or radiation therapy may be necessary.
Hope this helps.
Regards.
Two possible explanations.
Detailed Answer:
Hi
There are two possibilities why (in my opinion) you do not have a good response to carbegoline any more:
1.These drug act on dopamine receptors which are on the surface of the tumor. A receptor can be visualized as a keyhole, the drug is the key – in order for the drug key to be effective, the tumor must have an adequate number of receptors and the drug must be able to bind to the receptor.
In your case,now there are not enough receptors on the tumor surface or the binding to the receptors is not adequate and this can be an explanation why the treatement is not effective any more.
2.The medications are only effective as long as they are taken. If the medication is stopped, the prolactin will usually increase and the tumor will also increase in size.If you have stoped the drug,even for small periods of time,this can explain why your prolactine has started to increase again.
With a large tumor and very high prolactin level (like in your case), the medication may lower prolactin but this is not a cure.
The medications do not destroy the tumor.
Anyway i can say that an elevated prolactin may be acceptable if there are no other ill effects of the tumor such as headache or loss of vision.You should discuss with your treatin g endocrinologist about this.
In circumstancen when the drugs are not effective, alternative treatments such as surgery and/or radiation therapy may be necessary.
Hope this helps.
Regards.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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