Prolactinomas Resistant to Treatment With Dopamine Agonists: Long-Term Follow-Up of Six Cases.

Introduction: Prolactinomas are preferentially treated with dopamine agonists. However, a few adenomas are resistant to this treatment. Objective: To evaluate the characteristics of patients with resistance to dopamine agonists in the long-term. Method: A retrospective study of six cases was made. Patients who did not achieve normalized prolactin blood concentrations and a reduction of more than 50% of the tumor volume with the minimum dose of 3.5 mg per week of cabergoline for 3 months or the maximum supported dose of bromocriptine for 6 months were considered resistant to dopamine agonists. Patients were followed up at the Clinic of Neurology and Endocrinology or the University Hospital of Brasilia. Results: Six patients were selected. Three patients were initially treated with bromocriptine prior to treatment with cabergoline. Four patients were men, and two were women. At the time of diagnosis, ages ranged from 9 to 62 years. Initial prolactin concentrations ranged from 430 to 14,992 ng/mL and in the last assessment ranged from 29.6 to 2,169 ng/mL. The tumor volume ranged from 0.77 to 24.0 mm3. Tumor regression occurred in all patients, ranging from 20 to 100%, but total disappearance of the adenoma with an empty sella occurred in one patient. The maximum weekly doses of cabergoline ranged from 3.0 to 4.5 mg. Follow-up time ranged from seven to 17 years. Normalization of prolactin concentrations occurred only in one woman after 17 years of treatment. Three patients also underwent surgery, but only one woman was cured of the disease. Conclusion: This study confirms that tumors resistant to dopamine agonists are more aggressive, since we did not have any microadenoma; treatment with high dose of cabergoline may reduce the size of the tumor without its disappearance, and that normalization of prolactin concentration rarely occurs. To our knowledge, this is the longest follow-up of a series of cases with resistance to dopamine agonists.

Manejo clínico de pacientes com obesidade grave tratados com cirurgia bariátrica / Clinical management of patients with severe obesity treated by bariatric surgery

A obesidade grave é uma doença de causa multifatorial, resultante da interação entre fatores genéticos complexos e o ambiente propício ao desenvolvimento da obesidade, tais como alimentação inadequada e sedentarismo. Neste artigo, faz-se uma breve revisão sobre a avaliação inicial, tratamento e acompanhamento clínico de pacientes com obesidade grave, submetidos à cirurgia bariátrica.

The severe obesity is a disease with multifactorial etiology, resulting of the interaction between complex genetic factors and the favorable environment to obesity development, such as inappropriate nutrition and sedentarism. In this paper, a concise review is made about initial evaluation, treatment and clinical monitoring of patients with severe obesity submitted to the bariatric surgery.