title: Concomitant Cushing's Disease and Marked Hyperprolactinemia: Response to a Dopamine Receptor Agonist.
abstract: A 38-year-old woman was admitted to our hospital because of amenorrhea, multiple bone fractures, and a Cushingoid appearance. Endocrinological investigations revealed that she had co-existing Cushing's disease and prolactinoma, with a serum level of prolactin (PRL) at 1,480 ng/mL, corticotropin (ACTH) at 81.3 pg/mL, and cortisol at 16.6 μg/dL. Due to the lack of indication for transsphenoidal surgery, cabergoline monotherapy was initiated. A 6-month course of treatment resulted in only subtle amelioration of hypercortisolism, while hyperprolactinemia was dramatically improved. In 5 cases of bihormonal (ACTH/PRL) pituitary macroadenoma reported in the English literature, 2 were initially treated with dopaminergic agonists with substantial effectiveness for both PRL and ACTH. We herein report an extremely rare case of bihormonal macroadenoma in which only PRL was responsive to treatment.
authors.affiliation: Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shiraishi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Shirakawa
authors.forename: Reiichi
authors.initials: R
authors.lastname: Ishikura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okazaki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kurajoh
authors.forename: Takuhito
authors.initials: T
authors.lastname: Shoji
authors.forename: Yuji
authors.initials: Y
authors.lastname: Moriwaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Namba
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006966:Hyperprolactinemia / Q000150:complications; D047748:Pituitary ACTH Hypersecretion / Q000150:complications; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy*; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000150:complications / Q000188:drug therapy*
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D000077465:Cabergoline; D006854:Hydrocortisone