A 32-year-old woman presented with primary amenorrhea, prolactin (PRL) level of 154150 mIU/l (40530 mIU/l) diagnosed with an endo-supra-infra-laterosellar giant pituitary adenoma measuring maximum 6.2 cm. The patient was prescribed a treatment with cabergoline (CAB) at an initial dose of 0.5 mg per week. The treatment decreased the tumour size and brought to normal the level of PRL. After 7 months of CAB treatment menarche was achieved, after 12 months the patient became pregnant. The pregnancy ended up with a missed miscarriage at 67 weeks; an artificial abortion was conducted. Pituitary MRI scan did not show any negative changes. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25 weeks of gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. There was no breastfeeding; the CAB therapy was resumed after the delivery. During the treatment, prolactin level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the 3rd time. The pregnancy ended up with a delivery of a healthy girl via C-section. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. After the delivery the patient continued taking CAB. The further MRI scans did not show any tumour enlargement. Therefore, CAB therapy was effective to normalize PRL level, reduce the tumour size, induce menarche and pregnancies which lead to the birth of healthy children in a woman with primary amenorrhea and a giant prolactinoma invading the skull base bones.
18 - 21 May 2019
European Society of Endocrinology