Abstract
Primary resistance to dopamine agonists occurs in 10–15% of prolactinomas but secondary resistance following initial biochemical and anti-proliferative response is very rare and has only been hitherto described in four previous cases, two with bromocriptine and two with cabergoline. We describe a case of a 57-year-old woman who presented with a large macroprolactinoma with suprasellar extension. She was initially treated with bromocriptine therapy with a resolution of symptoms, marked reduction in prolactin concentration and complete tumour shrinkage; a response which was subsequently maintained on cabergoline. After 8 years of dopamine agonist therapy, her prolactin concentration began to rise and there was symptomatic recurrence of her tumour despite escalating doses of cabergoline up to 6 mg weekly. Non-compliance was outruled by observed inpatient drug administration. The patient underwent surgical debulking followed by radiotherapy with good response. This case adds to the previous two cases of secondary resistance to cabergoline therapy in prolactinomas a marked initial response. While the mechanism of secondary resistance remains unknown and not possible to predict, close observation of prolactinoma patients on treatment is necessary.
References
Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27:485–534. doi:10.1210/er.2005-9998
Webster J (1996) A comparative review of the tolerability profiles of dopamine agonists in the treatment of hyperprolactinaemia and inhibition of lactation. Drug Saf 14:228–238. doi:10.2165/00002018-199614040-00003
Molitch ME (2005) Pharmacologic resistance in prolactinoma patients. Pituitary 8:43–52. doi:10.1007/s11102-005-5085-2
Brue T, Pelligrini I, Priou A et al (1992) Prolactinomas and resistance to dopamine agonists. Horm Res 38:84–89. doi:10.1159/000182496
Kovacs K, Stefaneanu L, Hovarth E (1995) Prolactin producing pituitary tumour: resistance to dopamine agonist therapy. J Neurosurg 82:886–890
Kars M, Roelfsema F, Romijin A, Pereira AM (2006) Malignant prolactinoma: case report and review of the literature. Eur J Endocrinol 155:523–534. doi:10.1530/eje.1.02268
Dallabonzana D, Spelta B, Oppizzi G et al (1983) Reenlargement of macroprolactinomas during bromocriptine treatment: report of two cases. J Endocrinol Invest 6:47–50
Breidahl H, Topliss D, Pike JW (1983) Failure of bromocriptine to maintain reduction in size of a macroprolactinoma. Br Med J (Clin Res Ed) 287:451–452
Delgrange E, Crabbe J, Donickier J (1998) Late development if resistance to bromocriptine in a patient with macroprolactinoma. Horm Res 49:250–253. doi:10.1159/000023180
McCall D, Hunter SJ, Cooke RS, Herron B et al (2007) Unusual late development of dopamine agonist resistance in two women with hyperprolactinaemia associate with transition from micro to macroadenoma. Clin Endocrinol (Oxf) 66:149–150
Caccavelli L, Feron F, Morange I et al (1994) Decreased expression of the two D2 dopamine receptor isoforms in bromocriptine-resistant prolactinomas. Neuroendocrinology 60(3):314–322. doi:10.1159/000126764
Missale C, Losa M, Sigala S et al (1996) nerve growth factor controls proliferation and progression of human prolactinoma cell lines through autocrine mechanism. Mol Endocrinol 10(3):272–285. doi:10.1210/me.10.3.272
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Behan, L.A., Draman, M.S., Moran, C. et al. Secondary resistance to cabergoline therapy in a macroprolactinoma: a case report and literature review. Pituitary 14, 362–366 (2011). https://doi.org/10.1007/s11102-009-0168-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-009-0168-0