[Size reduction of a nonfunctioning pituitary adenoma after bromocriptine therapy: case report]

Bromocriptine therapy may cause regression of prolactinomas and GH producing adenomas, but there is only few reports about the effect of bromocriptine against nonfunctioning pituitary adenomas and there is no reports about its histopathological changes. We report a nonfunctioning pituitary adenoma, which remarkably regressed during and following bromocriptine therapy. A 47-year-old man developed blurred vision on January 20, 1981. He was pointed out of bitemporal hemianopsia and of his left palor optic fundus. His endocrinological condition was panhypopituitarism and no hypersecreting hormones were found. Cranial computerized axial tomography showed huge dumbbell shaped high density mass extending from the enlarged intrasellar area to the floor of the third ventricle. On treatment with bromocriptine, 5 mg daily for 3 days, his visual acuity and field was remarkably improved. Treatment was continued with gradually increased doses of bromocriptine to 15 mg and so, remarkable shrinkage of tumor size about 50% was seen by computerized axial tomography by a month. In addition, by eight months, the tumor reduced to 22%. Transsphenoidal surgery revealed centrally necrotic tumor mass surrounded by peripheral fibrous one. Because of fibrous and hemorrhagic tumour, we could not remove it totally. The pathological specimen was examined by light and transmission electron microscopy. The tumor was diffuse-type chromophobe adenoma partially intersected by hypertrophied fibrous interstitial materials. Some tumor cells were stained faintly eosinophilic. The cytoplasms were shrunken and the tumor cells were clumped. The immunostaining of tumor was negative to all anterior pituitary hormones. The intracytoplasmic organellae, for example, rough endoplasmic reticulum, Golgi apparatus, were scanty but prominant deformed mitochondria and small secretary granules (the size of about 90-150 nm) were found by transmission electron microscope. We think that the tumor cells had various responsiveness to this drug and the one extreme was destruction of the nucleus, the irreversible change, and the other extreme was some cytoplasmic reduction, the reversible change. The histopathological changes were almost the same as those of prolactinomas treated with bromocriptine. In conclusion, the mechanism of shrinkage of nonfunctioning pituitary adenomas treated with bromocriptine is unclear but it is worth while treating inoperable or recurrent large nonfunctioning pituitary adenomas with bromocriptine.