Macroprolactinoma with secondary resistance to dopamine agonists: a case report and review of the literature.
Bromocriptine
Cabergoline
Case report
Dopamine agonists
Macroprolactinoma
Pergolide
Prolactin-secreting adenoma
Quinagolide
Secondary resistance
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
17 Mar 2023
17 Mar 2023
Historique:
received:
22
11
2022
accepted:
14
02
2023
entrez:
17
3
2023
pubmed:
18
3
2023
medline:
21
3
2023
Statut:
epublish
Résumé
Resistance to dopamine agonists is not uncommonly seen in prolactinomas. However, development of resistance to dopamine agonists after an initial period of robust treatment response is rare, and only 39 cases have been reported in the past four decades. We describe a Chinese man with this rare condition and explored the postulated mechanisms that may explain this phenomenon. We compiled similar cases that were previously reported and compared their etiology, progress, and response to treatment. On the basis of these cases, we derived a list of differential diagnoses to consider in patients with secondary resistance to dopamine agonists. A 63-year-old Chinese man presented with blurred vision and was subsequently diagnosed with a macroprolactinoma. He had initial response to cabergoline but developed secondary resistance to it after 5 years. The prolactinoma continued to grow, and his serum prolactin remained markedly elevated despite adherence to escalating dosages of cabergoline up to 6 mg/week. The patient finally underwent transsphenoidal surgery and was found to have a sparsely granulated lactotroph tumor with Ki-67 index of 5%. Postoperatively, there was improvement in his serum prolactin level, although he still required treatment with cabergoline at 6 mg/week. Surgery can facilitate disease control in patients with prolactinomas that develop secondary resistance to dopamine agonists. Malignant prolactinoma is an important differential diagnosis in this group of patients, especially when serum prolactin remains markedly elevated despite resolution or stability of the primary pituitary lesion, suggesting a metastatic source of prolactin secretion.
Sections du résumé
BACKGROUND
BACKGROUND
Resistance to dopamine agonists is not uncommonly seen in prolactinomas. However, development of resistance to dopamine agonists after an initial period of robust treatment response is rare, and only 39 cases have been reported in the past four decades. We describe a Chinese man with this rare condition and explored the postulated mechanisms that may explain this phenomenon. We compiled similar cases that were previously reported and compared their etiology, progress, and response to treatment. On the basis of these cases, we derived a list of differential diagnoses to consider in patients with secondary resistance to dopamine agonists.
CASE PRESENTATION
METHODS
A 63-year-old Chinese man presented with blurred vision and was subsequently diagnosed with a macroprolactinoma. He had initial response to cabergoline but developed secondary resistance to it after 5 years. The prolactinoma continued to grow, and his serum prolactin remained markedly elevated despite adherence to escalating dosages of cabergoline up to 6 mg/week. The patient finally underwent transsphenoidal surgery and was found to have a sparsely granulated lactotroph tumor with Ki-67 index of 5%. Postoperatively, there was improvement in his serum prolactin level, although he still required treatment with cabergoline at 6 mg/week.
CONCLUSIONS
CONCLUSIONS
Surgery can facilitate disease control in patients with prolactinomas that develop secondary resistance to dopamine agonists. Malignant prolactinoma is an important differential diagnosis in this group of patients, especially when serum prolactin remains markedly elevated despite resolution or stability of the primary pituitary lesion, suggesting a metastatic source of prolactin secretion.
Identifiants
pubmed: 36927797
doi: 10.1186/s13256-023-03820-5
pii: 10.1186/s13256-023-03820-5
pmc: PMC10021939
doi:
Substances chimiques
Dopamine Agonists
0
Cabergoline
LL60K9J05T
Ergolines
0
Prolactin
9002-62-4
Types de publication
Review
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
96Informations de copyright
© 2023. The Author(s).
Références
N Engl J Med. 1982 Jan 21;306(3):145-55
pubmed: 6798440
J Clin Endocrinol Metab. 2001 Nov;86(11):5256-61
pubmed: 11701688
Proc Natl Acad Sci U S A. 1993 Sep 1;90(17):7961-5
pubmed: 8367448
J Clin Endocrinol Metab. 2006 Dec;91(12):4769-75
pubmed: 16968795
Mol Endocrinol. 1996 Mar;10(3):272-85
pubmed: 8833656
Zh Vopr Neirokhir Im N N Burdenko. 2010 Oct-Dec;(4):48-51; discussion 51-2
pubmed: 21374937
J Neurooncol. 2014 May;117(3):421-8
pubmed: 24146188
Horm Res. 2004;61(3):111-6
pubmed: 14671387
Physiol Rev. 2000 Oct;80(4):1523-631
pubmed: 11015620
J Neurol Neurosurg Psychiatry. 1992 Dec;55(12):1205-6
pubmed: 1479402
J Clin Endocrinol Metab. 2011 Feb;96(2):273-88
pubmed: 21296991
Horm Res. 1992;38(1-2):84-9
pubmed: 1306523
Br Med J (Clin Res Ed). 1983 Aug 13;287(6390):451-2
pubmed: 6411170
Cancer. 1997 Feb 15;79(4):804-12
pubmed: 9024719
Bol Asoc Med P R. ;108(10066):29-34
pubmed: 29193914
Clin Endocrinol (Oxf). 1993 May;38(5):539-46
pubmed: 8101148
Intern Med. 2001 Sep;40(9):857-61
pubmed: 11579944
Eur J Endocrinol. 2007 Apr;156 Suppl 1:S13-S21
pubmed: 17413183
J Clin Endocrinol Metab. 2000 Jan;85(1):398-401
pubmed: 10634416
J Clin Endocrinol Metab. 2012 Mar;97(3):967-77
pubmed: 22259062
Neurosurgery. 1989 Mar;24(3):417-23
pubmed: 2927618
Baillieres Best Pract Res Clin Endocrinol Metab. 1999 Oct;13(3):451-60
pubmed: 10909435
J Endocrinol. 2015 Aug;226(2):T101-22
pubmed: 26101377
Eur J Endocrinol. 2012 Mar;166(3):383-90
pubmed: 22127489
Neuroendocrinology. 1994 Sep;60(3):314-22
pubmed: 7969790
Cancer. 1985 Feb 1;55(3):598-604
pubmed: 3965110
Clin Endocrinol (Oxf). 2000 Jul;53(1):53-60
pubmed: 10931080
N Engl J Med. 1994 Oct 6;331(14):904-9
pubmed: 7915824
Brain Res Bull. 2019 Jul;149:21-31
pubmed: 30946881
Endocr J. 1995 Jun;42(3):413-20
pubmed: 7670571
J Neurosurg. 1981 Oct;55(4):615-9
pubmed: 7277008
J Clin Endocrinol Metab. 2008 Dec;93(12):4721-7
pubmed: 18812485
Eur J Endocrinol. 2006 Oct;155(4):523-34
pubmed: 16990651
Mol Endocrinol. 2013 Jun;27(6):953-65
pubmed: 23608643
Eur J Endocrinol. 2009 May;160(5):747-52
pubmed: 19223454
Eur J Endocrinol. 2012 Nov;167(5):651-62
pubmed: 22918301
Clin Endocrinol (Oxf). 2007 Jan;66(1):149-50
pubmed: 17201816
Endocrinology. 1991 Aug;129(2):1101-3
pubmed: 1830267
Pituitary. 2011 Dec;14(4):362-6
pubmed: 19191028
Eur J Endocrinol. 2007 Feb;156(2):143-53
pubmed: 17287403
Pharmacology. 2002 Dec;66(4):173-81
pubmed: 12393939
Endocr Pathol. 2009 Spring;20(1):35-40
pubmed: 19172414
J Clin Endocrinol Metab. 2002 Oct;87(10):4447-51
pubmed: 12364416
Neuroendocrinology. 2015;101(1):66-81
pubmed: 25592453
J Neurooncol. 2010 Aug;99(1):25-32
pubmed: 20063113
J Clin Endocrinol Metab. 1989 Sep;69(3):500-9
pubmed: 2760167
Endocrinol Diabetes Metab Case Rep. 2016;2016:
pubmed: 27855233
Endocr Rev. 1992 May;13(2):220-40
pubmed: 1352243
J Endocrinol Invest. 1983 Feb;6(1):47-50
pubmed: 6841916
J Clin Endocrinol Metab. 1999 Jul;84(7):2518-22
pubmed: 10404830
Pituitary. 2010 Dec;13(4):380-2
pubmed: 20652638
Clin Endocrinol (Oxf). 2010 Mar;72(3):377-82
pubmed: 19650784
Horm Res. 1998;49(5):250-3
pubmed: 9568811