Remarkable effects of cabergoline in a patient with huge prolactinoma resistant to high-dose bromocriptine: case report.
BACKGROUND
Cabergoline (CAB) has been proposed as the first-line treatment in the management of prolactin (PRL)-secreting tumors (prolactinoma [PRLoma]), including those resistant to standard dopamine agonist (DAA) therapy. The authors report remarkable effects of CAB in a case of huge PRLoma that had been resistant to a long-term, high-dose treatment with bromocriptine (BRC).


METHODS
A 28-year-old man was originally presented with oculomotor paresis when he was 9 years old. After 2 partial resections, he was treated with a maximum 60-mg/d dose of BRC for 18 years. Nonetheless, the tumor grew up to more than 8 cm in diameter, serum PRL increased over 60000 ng/mL, and his visual acuity deteriorated. Cabergoline normalized serum PRL level, shrank the tumor mass remarkably, and caused marked improvement of visual acuity.


CONCLUSIONS
Prolactin normalization and significant tumor shrinkage could be achieved with CAB even in extremely BRC-resistant PRLomas. Surgical resection should be reserved only for patients who are resistant to cabergoline or who require urgent decompression in such emergency as massive intratumoral hemorrhage.
Kawabata
Yasuhiro
Y
Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka 430-8525, Japan. ykawabata-kyt@umin.ac.jp
Ueno
Yasushi
Y
Horikawa
Fumihiko
F
Miyake
Hidenori
H
Miki
Nobuhiro
N
Ono
Masami
M
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D004873:Ergolines / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015175:Prolactinoma / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; D000077465:Cabergoline