Endocrine Abstracts

Prolactinomas are the most common hormone-secreting pituitary tumors. They have good response for conservative treatment. In the time of diagnosis large pituitary tumors unrarely can cause hypopituitarism. We have two cases of partially or totally recovery of hypopituitarism in consequence of effective dopamine agonists use. The 24-years man with large prolactinoma (prolactin 52 times higher) and laboratory markers of panhypopituitarism had total recovery in 1 year of cabergoline treatment. The dramatic shrinkage of prolactinoma was observed and the last one was the secondary hypothyroidism which disappeared. The second case is 52 years old man with macroadenoma and ten times higher prolactin. He also has hypogonadism, secondary hypothyroidism and moderate hypocorticoidism (according to laboratory tests). Cabergoline, thyroxine and cortisone were administered. In 1 year despite of tumor shrinkage and prolactin normalisation, testosteron level was still undetected which was qualified as unreversible secondary hypogonadism and testosterone injection were administered. At the same time serum cortisol was at normal-low level and therapy was continued. In one more year the serum cortisol was even more high and the patient reported that he avoided to take cortisone with no consequence as for well-being. He also informed that after several testosterone injection in routine regimen the testosterone level was abnormally high so he discontinued the therapy. After laboratory tests gonadal function was found partially restored with testosterone level slightly lower than lower limit of normal, the level of cortisol was medium-high, but thyroid function remained impaired. Therefore, in case of large prolactin-secreting tumor which leads to hypopituitarism, there is still a chance of at least partially restoring of pituitary function when there is any positive size-dinamic. Our patients didn’t have heavy symptoms of hypopituitarism (exept hypogonadism) and was instructed about frequence and expectance from laboratory testing. The thyroid function was the hardest to restore.