Combined cabergoline and recombinant human growth hormone treatment of an adolescent with a macroprolactinoma causing GH deficiency.
The rare macroprolactinomas seen in childhood frequently cause delayed puberty and GH deficiency. We report the combined use of cabergoline and recombinant human GH (rhGH) therapy in a male adolescent with macroprolactinoma and GH deficiency. Computed tomography and magnetic resonance imaging of the hypothalamic-pituitary region showed a macroadenoma with extrasellar extension. Neither bromocriptine nor dihydroergocryptine therapy was successful in decreasing serum PRL levels. On cabergoline treatment normal serum PRL levels were achieved within 3 months along with a marked shrinkage of the adenoma but growth rate did not increase nor did puberty start. The addition of exogenous rhGH therapy improved the growth rate, but complete pubertal development was obtained only after the administration of exogenous gonadotropins. During the combined treatment no expansion of the macroadenoma was observed. In conclusion, the combined therapy with cabergoline and rhGH seems to be safe and highly effective. Nevertheless, it warrants careful monitoring and on-going evaluation.
Cesario
F
F
Divisione di Endocrinologia Ospedale S. Croce, Cuneo, Italy.
Borretta
G
G
Meineri
I
I
Muratori
M
M
Pizzocaro
A
A
Beck-Peccoz
P
P
D000293:Adolescent; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004088:Dihydroergotoxine / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008596:Menotropins / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
D006063:Chorionic Gonadotropin; D018491:Dopamine Agonists; D004873:Ergolines; D004088:Dihydroergotoxine; D019382:Human Growth Hormone; D001971:Bromocriptine; D008596:Menotropins; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D000077465:Cabergoline