[Alternative to bromocriptine (BEC) management in patients with prolactinoma and intolerance to oral BEC]

Currently, the treatment of choice in cases of prolactinoma, is oral administration of bromocriptine mesilate, (BEC*), which, in a majority of cases, obtains satisfactory results. However, there do exist patients who show a clear intolerance to the oral administration of the medication in spite of low doses and other strategies. This leaves trans-sphenoidal surgery as the sole alternative since access to other dopamine-agonists medications is usually limited and the injection preparation of BEC is still in the experimental stages. This study follows the case histories of eleven patients who showed a clear intolerance to the oral administration of BEC and who would not accept or were otherwise disqualified from having hypophyseal surgery. Instead, their cases were handled through another alternative, the vaginal administration of BEC. The patients involved had an average age of 32 ranging from 26 to 44 years of age. All showed an important reduction in prolactinemia levels after the seventh day of vaginal administration of BEC. From an initial average high of 121.3 +/- 21.2 ng/ml levels were reduced after one week to 21.2 +/- 4.7 ng/ml, after ten days to 14.7 and after one month to 15.7 ng/ml. Patients were kept under observation for a twelve month period, during which time a significant reduction was noted in six patients, four became pregnant and one, finally rejected vaginal treatment. In every case, the bothersome side effects of the medication, which led to use of the alternative method of administration, specially the gastro-intestinal problems, subsided. This may be an interesting alternative for those patients with prolactinoma and evident intolerance to oral BEC.