Advertisement

Drugs

, Volume 17, Issue 5, pp 359–364 | Cite as

Bromocriptine in the Treatment of Acromegaly

  • D. E. Bateman
  • W. M. G. Tunbridge
Evaluations on New Drug

Summary

Bromocriptine is a dopamine agonist which suppresses prolactin secretion in healthy people and in patients with prolactin secreting tumours. It increases growth hormone secretion in some normal subjects but paradoxically lowers growth hormone secretion in up to 70% of patients with acromegaly.

Reports on the efficacy of bromocriptine therapy in acromegaly vary widely. Growth hormone levels are reduced in the majority of patients but are rarely completely suppressed. Greater remission of the soft tissue features of acromegaly may occur in some patients than would be expected from changes in growth hormone levels as determined by immunoassay.

The major advantage of bromocriptine therapy in acromegaly is its lack of effect on pituitary function, other than growth hormone and prolactin secretion, and avoidance of the complications of surgical or radiation treatment. Its major disadvantages are that the majority of patients only show a partial response, and the degree of compliance required with long term therapy. It is a useful adjunct to surgical and radiation treatment. In the few large studies of bromocriptine treatment used alone the results obtained over a limited period compare favourably with those obtained by radiotherapy.

Keywords

Growth Hormone Prolactin Acromegaly Bromocriptine Dopamine Agonist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Belforte, L.; Cammani, F.; Chiodini, P.G.; Liuzzi, A.; Massara, F.; Molinatti, G.M.; Muller, E.E. and Silvertrini, F.: Long-term treatment with 2-Br-alpha-ergocryptine in acromegaly. Acta Endocrinologica 85: 235 (1977)PubMedGoogle Scholar
  2. Besser, G.M.; Parke, Lynne; Edwards, C.R.W.; Forsyth, I.A. and McNeilly, A.S.: Galactorrhoea: successful treatment with reduction of plasma prolactin levels by brom-ergocryptine. British Medical Journal 3: 669 (1972)PubMedCrossRefGoogle Scholar
  3. Besser, G.M.; Thorner, M.O. and Wass, J.A.H.: Bromocriptine treatment of acromegaly; in Proceedings of a Symposium of Royal College of Physicians, London (Sandoz, 1976)Google Scholar
  4. Boyd, A.E.; Lebowitz, H.E. and Pfeiffer, J.B.: Stimulation of human-growth-hormone secretion by L-dopa. New England Journal of Medicine 23: 1425 (1970)CrossRefGoogle Scholar
  5. Calne, D.B., Leigh, P.N.; Teycheene, P.F. and Bamji, A.N.: Treatment of parkinsonism with bromocriptine. Lancet 2: 1355 (1974)PubMedCrossRefGoogle Scholar
  6. Cammani, F.; Massara, F.; Belforte, L. and Molinatti, G.M.: Changes in plasma growth hormone levels in normal and acromegalic subjects following administration of 2-bromo-α-ergocryptine. Journal of Clinical Endocrinology and Metabolism 40: 363 (1975)CrossRefGoogle Scholar
  7. Cassar, J.; Mashiter, K. and Joplin, G.F.: Bromocriptine treatment of acromegaly. Metabolism 26: 239 (1977)CrossRefGoogle Scholar
  8. Corrodi, H.; Fuxe, K.; Hokfelt, T.; Lidbrink, P. and Ungerstedt, V.: Effect of ergot drugs on central catecholamine neurons: evidence for a stimulation of central dopamine neurons. Journal of Pharmacy and Pharmacology 25: 409 (1973)PubMedCrossRefGoogle Scholar
  9. Clark, B.J.; Fluckiger, E.; Loew, D.M. and Vigouret, J.M.: How does bromocriptine work? Triangle 17: 21 (1978)Google Scholar
  10. Eddy, R.L.; Jones, A.L.; Chakmakjian, Z.H. and Silverthorne, M.C.: Effect of levodopa (L-dopa) on human hypophyseal tropic hormone release. Journal of Clinical Endocrinology and Metabolism 33: 709 (1971)PubMedCrossRefGoogle Scholar
  11. Faglis, G.; Paracchi, A.; Beck-Peccoz, P. and Ferrari, C.: An explanatory hypothesis for plasia GH response to non-specific releasing hormones and pr ‘paradoxical’ GH inhibition after dopaminergic drugs in acromegaly. Acta Endocrinologica Suppl. 199: 323 (1975)Google Scholar
  12. Fluckiger, E.; Doepfner, W.; Marko, M. and Niederer, W.: Effects of ergot alkaloids on the hypothalmic-pituitary axis. Postgraduate Medical Journal 52(Suppl. 1): 57 (1976)PubMedGoogle Scholar
  13. Fraser, R.: The assessment of the endocrine effects and the effectiveness of ablative pituitary treatment by 90Y and 198Au implantation; in Kohler and Ross (Eds) Diagnosis and Treatment of Pituitary Tumours, p.35 (Excerpta Medica, Amsterdam 1973)Google Scholar
  14. Gordon, P.; Lesniak, M.A.; Eastman, R.; Hendricks, C.M. and Roth, J.: Evidence for higher proportion of ‘Little’ growth hormone with increased radioreceptor activity in acromegalic plasma. Journal of Clinical Endocrinology and Metabolism 43: 364 (1976)CrossRefGoogle Scholar
  15. Gordon, P. and Roth, J.: The treatment of acromegaly by conventional pituitary irradiation; in Kohler and Ross (Eds) Diagnosis and Treatment of Pituitary Tumours p.230 (Excerpta Medica, Amsterdam 1973)Google Scholar
  16. Halse, J.; Haughen, H.N. and Gohmer, T.: Bromocriptine treatment in acromegaly: clinical and biochemical effects. Acta Endocrinologica 86: 464 (1977)PubMedGoogle Scholar
  17. Holdaway, I.M.; Fregley, P.A.; Scott, D.J. and Ibbertsen, H.K.: Bromoergocryptine treatment of acromegaly persisting following conventional therapy. Clinical Endocrinology 8: 45 (1978)PubMedCrossRefGoogle Scholar
  18. Kjellberg, R.N. and Kliman, B.: A system for therapy of pituitary tumours; in Kohler and Ross (Eds) Diagnosis and Treatment of Pituitary Tumours p.234 (Excerpta Medica, Amsterdam 1973)Google Scholar
  19. Lal, S.; Vega, C.E.; Saukes, T.L. and Friesen, H.G.: Effect of apomorphine on human-growth-hormone secretion. Lancet 2: 661 (1972)PubMedCrossRefGoogle Scholar
  20. Liuzzi, A.; Chiodini, P.G.; Botalla, L.; Cremascoli, G. and Silvestrini, F.: Inhibitory effect of L-dopa on GH release in acromegalic patients. Journal of Clinical Endocrinology and Metabolism 35: 941 (1972)PubMedCrossRefGoogle Scholar
  21. Liuzzi, A.; Chiodini, P.G.; Botalla, L.; Cremascoli, G.; Muller, E.E. and Silvestrini, F.: Decreased plasma growth hormone (GH) levels in acromegalics following CB-154(2-Br-alpha-ergocryptine) administration. Journal of Clinical Endocrimgy and Metabolism 38: 910 (1974)aCrossRefGoogle Scholar
  22. Liuzzi, A.; Chiodini, P.G.; Botalla, L.; Silvestrini, F. and Muller, E.E.: Growth hormone (GH) — releasing activity of TRH and GH-lowering effect of dopaminergic drugs in acromegaly: homogenecity in the two responses. Journal of Clinical Endocrinology and Metabolism 39: 871 (1974)bPubMedCrossRefGoogle Scholar
  23. Liuzzi, A.; Verde, G. and Chiodini, P.G.: Dopaminergic control of growth hormone secretion in acromegaly. Triangle 17: 41 (1978)Google Scholar
  24. Loew, D.; Vigouret, J. and Jaton, A.: Neuropharmacological investigations with two ergot alkaloids, hydergine and bromocriptine. Postgraduate Medical Journal 52(Suppl. 1): 40 (1976)PubMedGoogle Scholar
  25. Macleod, R.M. and Lehymeyer, J.E.: Studies on the mechanism of the dopamine-mediated inhibition of prolactin secretion. Endocrinology 94: 1077 (1974)PubMedCrossRefGoogle Scholar
  26. Mashiter, K.; Adams, E.; Brand, M. and Holly, A.: Bromocriptine inhibits prolactin and growth-hormone release by human pituitary tumours in culture. Lancet 2: 197 (1977)PubMedCrossRefGoogle Scholar
  27. Sachdev, Y.; Gomez-Pan, A.; Tunbridge, W.M.G.; Weightman, D.K.; Duns, A. and Hall, R.: Bromocriptine therapy in acromegaly. Lancet 2: 1164 (1975)PubMedCrossRefGoogle Scholar
  28. Schwinn, G.; Dirks, H.; Mclntosh, C. and Kobberling, J.: Metabolic and clinical studies on patients with acromegaly treated with bromocriptine over 22 months. European Journal of Clinical Investigation 7: 101 (1977)PubMedCrossRefGoogle Scholar
  29. Sobrinho, L.G.; Nunes, M.C.P.; Santos, M.A. and Mauricio, J.L.: Radiological evidence for regression of prolactinoma after treatment with bromocriptine. Lancet 2: 257 (1978)PubMedCrossRefGoogle Scholar
  30. Summers, V.K.; Hipkin, L.J.; Diver, M.J. and Davis, J.L.: Treatment of acromegaly with bromocriptine. Journal of Clinical Endocrinology and Metabolism 40: 904 (1975)PubMedCrossRefGoogle Scholar
  31. Takahara, J.; Akimura, A. and Schally, A.V.: Suppression of prolactin release by a purified porcine PIF preparation and catecholamines infused into a rat hypophysial portal vessel. Endocrinology 96: 462 (1974)CrossRefGoogle Scholar
  32. Thorner, M.O.; Chait, A.; Aitken, M.; Benker, G.; Bloom, S.R.; Mortimer, C.H., Sanders, R.; Stuart Mason, A. and Besser, G.M.: Bromocriptine treatment of acromegaly. British Medical Journal 1: 299 (1975)PubMedCrossRefGoogle Scholar
  33. Thorner, M.O.: Dopamine is an important neurotransmitter in the autonomic nervous system. Lancet 1: 662 (1975)PubMedCrossRefGoogle Scholar
  34. Vaidya, R.; Alookar, S. and Sheth, A.: Therapeutic regression of putative pituitary hyperplasia and/or microadenoma with CB-154. Fertility and Sterility 28: 363 (1977)Google Scholar
  35. Wass, J.A.H.; Thorner, M.O.; Morris, D.V.; Rees, L.H.; Stuart Mason, A.; Jones, A.E. and Besser, G.M.: Long-term treatment of acromegaly with bromocriptine. British Medical Journal 1: 875 (1977)PubMedCrossRefGoogle Scholar
  36. Williams, R.A.; Jacobs, H.S.; Kurtz, A.B.; Millar, J.G.B.; Oakley, N.W.; Spathis, G.S.; Sulway, M.J. and Nabarro, J.D.N.: The treatment of acromegaly with special reference to transsphenoidal hypophysectomy. Quarterly Journal of Medicine 44: 79 (1975)PubMedGoogle Scholar

Copyright information

© ADIS Press Australasia Pty Ltd 1979

Authors and Affiliations

  • D. E. Bateman
    • 1
  • W. M. G. Tunbridge
    • 1
  1. 1.Newcastle General HospitalNewcastle-upon-TyneEngland

Personalised recommendations