[Macroprolactinemia associated with pituitary macroadenoma: treatment with quinagolide].
According to current concept, macroprolactin is biologically inactive and, therefore, its accumulation in serum has little, if any, pathological significance. Authors present the history of a 80-year-old man who proved to have, among other associated disorders, an intra- and parasellar pituitary tumor measuring 21x12x12 mm in size which was revealed by pituitary MRI. His hormonal evaluation indicated a marked hyperprolactinemia mainly due to macroprolactinemia (total prolactin, 514 ng/ml; reference range, 1.6-10.7 ng/ml; macroprolactin 436 ng/ml, monomer prolactin 78.2 ng/ml). Tests for function of the pituitary-thyroid axis showed a mild subclinical primary hypothyroidism. The function of the pituitary-adrenal axis was normal, and other hormonal tests revealed low-normal serum gonadotropins and decreased testosterone level, whereas serum insulin-like growth factor I was normal. Although the majority of current guidelines state that dopamine-agonist treatment which is successfully used in prolactin-producing pituitary tumors and in other hyperprolactinemic disorders is unnecessary in patients with macroprolactinemia, the authors introduced a dopamine-agonist, quinagolide. During prolonged treatment, plasma prolactin returned close to the upper limit of normal (12.3 ng/ml) and 9 months after the beginning of treatment pituitary MRI showed a remarkable shrinkage of the pituitary tumor. Authors propose that in this patient the pituitary tumor secreted macroprolactin, and they recommend a treatment trial with dopamine-agonist in pituitary macroadenomas associated with macroprolactinemia.
Lakatos
Gergely
G
Semmelweis Egyetem Altalános Orvostudományi Kar Budapest.
Szücs
Nikolette
N
Kender
Zoltán
Z
Czirják
Sándor
S
Rácz
Károly
K
D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D011388:Prolactin / Q000097:blood* / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome
D000634:Aminoquinolines; D018491:Dopamine Agonists; C046650:quinagolide; D011388:Prolactin