title: Efficacy of the combined cabergoline and octreotide treatment in a case of a dopamine-agonist resistant macroprolactinoma.
abstract: Prolactinomas in males can be voluminous macroadenomas invading the surrounding structures. Medical therapy with dopamine agonists (the treatment of choice for these tumours) may be ineffective in the case of pharmacological resistance. In such cases, even surgical and/or radiation therapy cannot be curative due to the invasive potential of the adenoma. Hence, the appropriate therapeutic approach for these tumours is still a relevant clinical problem for endocrinologists. We report the history of an adolescent male who was diagnosed with a large invasive macroprolactinoma in 2002. He had severe bitemporal hemianopsia and hypopituitarism; prolactin levels at diagnosis were higher than 8,000 ng/ml. Medical therapy with cabergoline was initiated and resulted in decreased prolactin levels but not complete normalisation (maximal tolerated dose 3 mg/day). However, due to the worsening of the visual defect, the patient was operated in July 2004 through the trans-nasal approach and 2 years later through both the transcranial and the transphenoidal approaches. After the second surgery, a significant reduction of tumour mass was obtained. Immunohistochemistry for somatostatin receptors (sstr) subtypes showed a positive staining with the anti-sstr5 antibody. A scintigraphy with 111In-pentetreotide (Octreoscan) revealed a very intense tracer uptake in the sellar region. The administration of long-acting octreotide was initiated. After 12 months of therapy, prolactin levels normalised for the first time. Pituitary MRI did not reveal any tumor progression during a 2-year follow-up. This is a case of an invasive dopamine-resistant macroprolactinoma that was successfully controlled by extensive surgery and combined treatment with cabergoline and octreotide. The expression and functionality of sstr should be investigated in these tumours since a combined therapy with cabergoline and octreotide may be a good therapeutic course of action for select cases.
authors.affiliation: Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fusco
authors.forename: Francesca
authors.initials: F
authors.lastname: Lugli
authors.forename: Eugenia
authors.initials: E
authors.lastname: Sacco
authors.forename: Laura
authors.initials: L
authors.lastname: Tilaro
authors.forename: Antonio
authors.initials: A
authors.lastname: Bianchi
authors.forename: Flavia
authors.initials: F
authors.lastname: Angelini
authors.forename: Anna
authors.initials: A
authors.lastname: Tofani
authors.forename: Angela
authors.initials: A
authors.lastname: Barini
authors.forename: Libero
authors.initials: L
authors.lastname: Lauriola
authors.forename: Giulio
authors.initials: G
authors.lastname: Maira
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pontecorvi
authors.forename: Laura
authors.initials: L
authors.lastname: de Marinis
mesh_terms: D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D004873:Ergolines / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D015282:Octreotide / Q000008:administration & dosage*; D010911:Pituitary Neoplasms / Q000188:drug therapy*; D015175:Prolactinoma / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D018491:Dopamine Agonists; D004873:Ergolines; D000077465:Cabergoline; D015282:Octreotide