Endocrine Abstracts

Experience in complex therapy of selective and non-selective dopamine agonists in women with resistant prolactinomas for recovering of ovulation function.

Introduction: Prolactinomas are the most common pituitary adenomas and dopamine agonists (DA) still remain the first choice of treatment. Nevertheless, it does not always exert an adequate effect and endocrinologists face the challenge of resistant prolactinomas more frequently. This problem is very important for women who desire to become pregnant. In view of this fact, the search for a new ways for overcoming medical resistance becomes one of pressing issues in endocrinology. We present two clinical cases of women with DA-resistant prolactinomas, which successfully conceived after addition of bromocriptine to stable long-term high-dose cabergoline treatment.

Clinical case #1: A 26-year old woman presented with menstrual disturbances since 15 years old, secondary amenorrhea, galactorrhea for 3 past years. Clinical examination revealed hyperprolactinemia (PRL 10 000 IU/l, no macroprolactinemia), endosellar macroprolactinoma (10 × 11 × 12 mm) without visual disturbances, hypoplastic uterus. Administration of carbegoline with maximum dose 3,0 mg per week didn’t result in significant clinical or laboratory improvement. The further increment of cabergoline dose was not possible due to patient’s socioeconomic problems. However, the recovery of menstrual function and decrease in prolactin level to 1800 IU/l was observed after complex therapy of selective and nonselective DA (cabergoline 3.0 mg/week and bromocriptine 8 mg/day). And after 3 months of the therapy the patient naturally conceived. No pregnancy, delivery or fetus-associated complications were noted. She had a term delivery of a girl, weight – 3000 g, length – 50 cm.

Clinical case #2: A 27-year old woman presented amenorrhea, prolactin level was 13 146 IU/l, by MRI microprolactinoma 8*8 mm was detected. The therapy with cabergoline was started in dose 0.5 mg per week with escalation to maximum dose 4.5 mg per week. Despite treatment menstrual disturbance were persisting and prolactin level decreased to 2010 IU/l. Ultrasound examination revealed normal follicular count without signs of ovulation. The patient was recommended to add to the therapy bromocriptine in dose 2.5 mg per day. In two months, the patient got pregnant without recovering of menstrual function. Nowadays clinical examination on 26 gestational week did not present any fetal problems.

Conclusion: These clinical observationsdemonstrate an overcoming medical resistance to DA and achievement of natural pregnancy in patients with resistant prolactinoma using combination of selective and non-selective DA.