Endocrine Abstracts

Introduction: Therapeutic management of clinical nonsecreting pituitary adenomas with ophthalmological manifestations is certainly limited to surgery unless IHC from previous intervention could bring up new data.

Case report: A 16-year-old patient was admitted in February 2014 in our Endocrinology Department for short stature (−3.5 S.D.), in the context of an iatrogenic pituitary insufficiency. 7 months before, he had been diagnosed with pituitary macroadenoma of 36/24/30 mm which invaded the sphenoidal sinus anteriorly and had a contact with the optic chiasm, causing left cecity. He undergone frontal adenomectomy, with a ACTH and TSH deficit that were currently substituted. Clinically: short stature (149.9 cm, −3.5 DS), underweight, BP=95/60 mm/Hg, Tanner stage P3G3, left temporal hemianopsia.Biologically: low IGF1 (−3 DS), maximum stimulated GH 0.226 during insulin induced hipoglicemia, normal testosterone, LH=1.9, normal ACTH, TSH and prolactin. The pituitary MRI showed an adenoma of 3.2/3.56/3.4 cm, the hand X-ray showed a bone age similar to the chronological age, with open growth cartilages and the visual field a left temporal hemianopsia. According to the family’s choice not to reoperate, we decided to start the treatment with cabergoline as the adenoma had IHC prolactin, LH, FSH, TSH and GH staining. We started with a dose of 1 mg/week and progressively increased the dosage up to 3 mg/week, with visual field evaluation every 1–2 months and MRI after 6 months. The left hemianopsia improved and was stable for 3–5 months, the MRI showed no evolution, but after 6 months the patient developed right hemianopsia and nausea, so surgery was recommended.

Conclusion: Cabergoline treatment of nonsecreting tumors with IHC staining for D2 receptors is a new strategy with optimist results in recent studies; however, close monitoring is mandatory during the treatment in order to identify non-responders and assure an individualised therapeutic decision.