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Efficacy of the combined cabergoline and octreotide treatment in a case of a dopamine-agonist resistant macroprolactinoma

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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.

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Authors and Affiliations

  1. Section of Endocrinology, Department of Internal Medicine, Università Cattolica del Sacro Cuore, Via Cassia 901, 00168, Rome, Italy

    Alessandra Fusco, Francesca Lugli, Eugenia Sacco, Laura Tilaro, Antonio Bianchi, Alfredo Pontecorvi & Laura de Marinis

  2. Laboratory of Vascular Biology and Genetics, Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy

    Flavia Angelini

  3. Nuclear Medicine, Sant’Andrea Hospital, Rome, Italy

    Anna Tofani

  4. Department of Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy

    Angela Barini

  5. Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy

    Libero Lauriola

  6. Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Giulio Maira

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  1. Alessandra Fusco
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  2. Francesca Lugli
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Correspondence to Laura de Marinis.

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Fusco, A., Lugli, F., Sacco, E. et al. Efficacy of the combined cabergoline and octreotide treatment in a case of a dopamine-agonist resistant macroprolactinoma. Pituitary 14, 351–357 (2011). https://doi.org/10.1007/s11102-008-0162-y

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