Clinical case of partially resistant prolactinoma

Yulia Ukhanova; Irena Ilovayskaya

doi:10.1530/endoabs.90.EP882

In real practice, pituitary adenomas may have non-specific clinical manifestations. Patients are consulted by doctors of various specialties, but not endocrinologists. In confirmation of this we would like to present a Clinical case Male patient D. experienced severe headache at the age 39 y.o., was consulted by the neurologist. MRI demonstrated a pituitary macroadenoma 35x36x36 mm in size (22680 mm3) with supra-para-infrasellar growth. The neurosurgeon recommended surgical treatment. However, the patient referred to an endocrinologist. During the survey the patient noted that his weight has increased over the past 7 years by 20 kg, and his libido decreased. A hormonal examination showed very high levels of total and monomeric prolactin without any signs of hypopituitarism (see tab. 1). Cabergoline was prescribed in initial dose 0,5 mg/week. According to prolactin levels, the dose was up titrated to maximal 4.5 mg/week. The patient’s condition improved during the first year of treatment: headache disappeared completely, body weight decreased by 8 kg, erectile function was restored. But normalization of the prolactin level was not achieved. Considering clinical improvement, decreasing prolactin levels and tumor volume, as well as the patient’s desire, it was decided to continue drug therapy, the prolactin level and the adenoma volume gradually decreased. After 6 years of treatment (at the age of 45), prolactin level normalized for the first time. Total weight loss was 25 kg from the entire period of treatment. Tumor volume decreased by 82.5% compared with the parameter before treatment. The patient is currently taking cabergoline at the same dose of 4.5 mg (9 tabs)/week. Due to high dose of cabergoline, the patient undergoes echocardiography annually to exclude pathological changes in the valvular apparatus of the heart - no changes were noted.

Table 1
Parameter		Reference range
Total prolactin	104700 mlU/l	39–422
Monomeric prolactin	98500 mlU/l	22–340
IGF-1	284 ng/ml	111-284
TSH	0,923 mlU/l	0,4-4
Т4 free	11,3 pmol/l	9-22
LG	1,24 mlU/l	1,14-8,75
FSG	1,23 mlU/l	0,95-11,95
Total testosterone	6,0 nmol/l	5,76-30,43
SGBH	16,7 nmol/l	13-71
Cortisol, 8.00	197 nmol/l	101–536
24-hour urinary free cortisol	406 nmol/l/day	138-524

Conclusions: 1. This Clinical case demonstrates long term follow up male patient with partially resistant macroprolactinoma

2. Long-term use of maximum doses of cabergoline for 6 years was safe

3. The multidisciplinary approach to the treatment of patients with pituitary adenomas is necessary.

Endocrine Abstracts

EP882