Combination treatment with bromocriptine and metformin in patients with bromocriptine-resistant prolactinomas: a pilot study.

Combination treatment with bromocriptine and metformin in patients with bromocriptine-resistant prolactinomas: a pilot study.

World Neurosurg. 2018 Mar 09;:

Authors: Liu X, Liu Y, Gao J, Feng M, Bao X, Deng K, Yao Y, Wang R

Abstract
BACKGROUND: Prolactinomas are the most common functional pituitary adenomas, and dopamine agonists (DAs) are the primary therapy. However, some patients are resistant to DAs. Recently, metformin has been proposed as a cancer treatment.
CASE DESCRIPTION: This study is a retrospective review of two cases, including one patient with prolactinoma who was resistant to bromocriptine, diagnosed with impaired glucose tolerance and administered metformin. Surprisingly, combining the patient's treatment with metformin decreased prolactin (PRL) levels to 12 ng/ml and had significantly decreased the size of the tumor after one year of combination therapy. As menstruation resumed and galactorrhea resolved, the patient became pregnant and stopped using metformin, but continued taking brocriptine. She gave birth to a healthy boy in August 2016. After delivery, she decided to breastfeed the baby and only took brocriptine. After 14 months of using bromocriptine alone, her PRL level increased to 208 ng/ml and the tumor was re-appeared (7 mm×8 mm×9 mm). Interestingly, the patient's PRL level decreased from 208 ng/ml to 150 ng/ml two months after using combination treatment with bromocriptine and metformin. Based on these findings, a second bromocriptine-resistant patient was recruited. After three months of combined treatment with bromocriptine and metformin, the patient's PRL levels was decreased to 2.08 ng/ml, and testosterone levels were significantly increased, and the tumor size decreased.
CONCLUSIONS: Although more cases and investigations into the mechanisms underlying these effects are needed, these two cases support the hypothesis that the combination of metformin with bromocriptine might be a new treatment for resistant prolactinomas.

PMID: 29530699 [PubMed - as supplied by publisher]

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