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Spontaneous reduction of prolactinoma post cabergoline withdrawal.

Venkatesh SK, Kothari D, Manchanda S, Taneja A, Kulshreshtha B - Indian J Endocrinol Metab (2012)

Bottom Line: Uncommonly, there may be little or no shrinkage in pituitary tumor.In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely.Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

ABSTRACT
Prolactinomas are common pituitary tumors usually highly responsive to dopamine agonists. Around 70-90% of the prolactinomas exhibit decrease in tumor size, though variably with these agents. Uncommonly, there may be little or no shrinkage in pituitary tumor. In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely. We report here a case showing only modest reduction in prolactinoma with cabergoline given for a period of one and a half years. Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

No MeSH data available.


Related in: MedlinePlus

MRI sella at 1 year interval shows no significant change
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Figure 3: MRI sella at 1 year interval shows no significant change

Mentions: A 48-year-old male presented to the endocrinology department of this hospital with complaints of episodic headache for the past 10 years, with increasing severity for 2 years. There were no complaints suggestive of visual field defects. The patient also complained of decreased libido and erectile dysfunction. His shaving frequency had decreased to once per week. He had been a diabetic for four years and had been well controlled on metformin. Examination including genitalia and virilization was essentially normal, galactorrhea was absent. MRI sella revealed a large pituitary lesion (13×10 mm) in the right half of pituitary gland [Figure 1]. Prolactin levels were 557.67 ng/ml (3-20ng/ ml). LH, FSH and testosterone levels were 0.81, 0.38 and 1.56 ng/ml respectively. Thyroid profile and serum cortisol levels were normal. A diagnosis of prolactinoma was made and the patient was started on cabergoline 0.5 mg thrice a week. The prolactin levels gradually came down to normal over a period of 3-4 months (51, 19, and 14ng/ml over consecutive month). Improvement in sexual functions was also reported by the patient. Prolactin levels remained normal with cabergoline. MRI done 4 months later showed around 15% reduction in tumor size (11×10 mm) [Figure 2]. However, MRI done one year later showed no significant change in mass (10×9 mm) [Figure 3]. He also complained of daily headaches requiring analgesics. Cabergoline was stopped and the patient was referred to neurosurgery for further intervention. After 3 months, a repeat MRI was done, which surprisingly showed a significant (40%) reduction in size of pituitary tumor (6×5 mm) [Figure 4]. Patient reported improvement in headache with frequency now reduced to once a week. There was modest elevation of prolactin levels from 11.7 to 34.2 ng/ml. Decrease in libido was managed with testosterone injections.


Spontaneous reduction of prolactinoma post cabergoline withdrawal.

Venkatesh SK, Kothari D, Manchanda S, Taneja A, Kulshreshtha B - Indian J Endocrinol Metab (2012)

MRI sella at 1 year interval shows no significant change
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475917&req=5

Figure 3: MRI sella at 1 year interval shows no significant change
Mentions: A 48-year-old male presented to the endocrinology department of this hospital with complaints of episodic headache for the past 10 years, with increasing severity for 2 years. There were no complaints suggestive of visual field defects. The patient also complained of decreased libido and erectile dysfunction. His shaving frequency had decreased to once per week. He had been a diabetic for four years and had been well controlled on metformin. Examination including genitalia and virilization was essentially normal, galactorrhea was absent. MRI sella revealed a large pituitary lesion (13×10 mm) in the right half of pituitary gland [Figure 1]. Prolactin levels were 557.67 ng/ml (3-20ng/ ml). LH, FSH and testosterone levels were 0.81, 0.38 and 1.56 ng/ml respectively. Thyroid profile and serum cortisol levels were normal. A diagnosis of prolactinoma was made and the patient was started on cabergoline 0.5 mg thrice a week. The prolactin levels gradually came down to normal over a period of 3-4 months (51, 19, and 14ng/ml over consecutive month). Improvement in sexual functions was also reported by the patient. Prolactin levels remained normal with cabergoline. MRI done 4 months later showed around 15% reduction in tumor size (11×10 mm) [Figure 2]. However, MRI done one year later showed no significant change in mass (10×9 mm) [Figure 3]. He also complained of daily headaches requiring analgesics. Cabergoline was stopped and the patient was referred to neurosurgery for further intervention. After 3 months, a repeat MRI was done, which surprisingly showed a significant (40%) reduction in size of pituitary tumor (6×5 mm) [Figure 4]. Patient reported improvement in headache with frequency now reduced to once a week. There was modest elevation of prolactin levels from 11.7 to 34.2 ng/ml. Decrease in libido was managed with testosterone injections.

Bottom Line: Uncommonly, there may be little or no shrinkage in pituitary tumor.In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely.Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

ABSTRACT
Prolactinomas are common pituitary tumors usually highly responsive to dopamine agonists. Around 70-90% of the prolactinomas exhibit decrease in tumor size, though variably with these agents. Uncommonly, there may be little or no shrinkage in pituitary tumor. In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely. We report here a case showing only modest reduction in prolactinoma with cabergoline given for a period of one and a half years. Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

No MeSH data available.


Related in: MedlinePlus