Endocrine Abstracts

A 44 year old man was referred in 2012 to his local endocrine service for headaches and visual deterioration with bi-temporal hemianopia. His prolactin was found at 107,240 mU/l(85-325) and pituitary MRI demonstrated a 3.1x1.5x3.3 cm adenoma, compressing the optic chiasm. He was commenced on cabergoline 0.5 mg twice per week and hydrocortisone 20 mg and 10 mg empirically and was referred to us. On review in our Pituitary clinic, he reported considerable improvement in his headaches and vision. Formal assessment of his visual fields had shown no deficits. Blood tests showed prolactin 18174 mU/l(85-325), 11: a.m. testosterone 2.3 nmol/l(7.0-27.0), SHBG 17.4 nmol/l(19.0-95.0) , FSH 3.1 IU/l(1.5-12.4), LH 2.2 IU/ L (1.7-8.6), IGF-1:17 nmol/l(13-37) and free T4 15.5 pmol/l(9-19). He had normal cortisol response on the short Synacthen test and he was advised to stop hydrocortisone. Baseline echocardiogram showed a good biventricular systolic function and normal valves. During the subsequent follow-up, his prolactin continued to decline slowly with also significant shrinkage of the tumour. In 2014, the dose of cabergoline was increased to 0.5 mg three times per week due to a slight increase in the prolactin levels. This led to a further gradual reduction of the prolactin, as well as normalisation of his testosterone levels. In 2018, follow-up echocardiogram showed normal function and structure of the heart, with no evidence of valve disease. On last assessment in January 2023, he was still on cabergoline 0.5 mg three times a week with no reported side effects. The repeat prolactin is awaiting and his pituitary scan MRI demonstrated an empty sella.