Macroprolactinomas: therapy compliance (case report)
A. Florescu, A. Loghin, I. Grozavu, D. Haba, L. Apostu & C. Galesanu
Prolactinomas represent 60% of primary pituitary tumors, galactorrrhoea and menstrual disturbances beeing the most frequent clinical features in women. The mass effect of macroadenomas is expressed by headache, visual field defects and hypopituitarism. The aims of therapy are reduction of tumour size, prevention of tumour expansion and restoration of gonadal function. Dopamine agonists normalize prolactin secretion and reduce tumour size in 40% of patients with macroadenoma.
We are presenting a case of an 49 year old female, who came to us first in 1995, presenting headache, galactorrrhoea and secondary amenorrhea. Her prolactine level was very high with the rest of the pituitary hormones in normal range. We performed an MRI, which showed the presence of a macroadenoma. After the patient refuses surgery, we started dopamine agonists therapy, with reevaluation every 6 months, until 2004, when the patient discontinues therapy (at that moment the prolactin levels were still high, and the adenoma offered signs of protrusion in the sphenoidal sinus). The patient came to us in november 2011 with a prolactine level of 7742 μUI/ml (102496) and a MRI image of empty sella and a tumoral mass which evolves in the sphenoidal sinus. Again, the patient refuses surgery, so we started once more dopamine agonists therapy.
Discussions: In routine practice, hyperprolactinaemia recurs early in most macroprolactinomas (93%) and microprolactinomas (64%) following dopamine agonists discontinuation. For most macroprolactinomas, cesssation of dopamine agonists cannot be recommended even after 7 years of therapy.
Conclusions: The patient refused surgery, although it was an early diagnosis and all the treatment options were discussed. Dopamine agonists therapy was initiated and after 9 years of intermitent therapy she stopped the treatment and we had no contact afterwards. For this type of patients in particulary, the 1 year followup is very important.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.