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Endocrine Abstracts (2022) 86 P247 | DOI: 10.1530/endoabs.86.P247

SFEBES2022 Poster Presentations Neuroendocrinology and Pituitary (72 abstracts)

Surgical management of prolactinomas in patients with dopamine agonist-associated impulse control disorders or who are deemed at ‘high risk’

Arthur T. C. Yu 1 , Florian Wernig 2 , Karim Meeran 2 , Niamh Martin 2 , Nigel Mendoza 2 , Ramesh Nair 2 , Brynmor Jones 2 , Anastasia Gontsarova 2 & Preeshila Behary 2

1Imperial College London, London, United Kingdom; 2Imperial College Healthcare NHS Trust, London, United Kingdom

Introduction: Prolactinomas are the commonest type of secretory pituitary tumours. In current practice, dopamine agonists (DA) remain the mainstay treatment. However, treating physicians are increasingly aware of DA-associated impulse control disorders (ICD) in their patients. We describe 4 individuals with prolactinomas, who either developed ICD on DA or deemed at ‘high risk’, successfully managed surgically with preservation of pituitary function. All decisions for surgery were made within our Pituitary MDT (Multi-disciplinary Team).

Cases: A 56-year-old gentleman with a macroprolactinoma (prolactin 3,464 mU/l), presented with low libido. He developed symptoms of hypersexuality on cabergoline which resulted in a relationship breakdown. He therefore underwent a transsphenoidal resection (TSS), with normalisation of prolactin to 153 mU/l. A 38-year-old lady with a macroprolactinoma (prolactin 5,000 mU/l) was referred after experiencing symptoms of ICD on cabergoline (overspending, mood swings). She underwent TSS, which led to a drop in prolactin to 447 mU/l and she was able to conceive post-surgery. A 28-year-old gentleman with a macroprolactinoma (prolactin 24,399 mU/l) presented with low libido. Notably, he has a history of major depressive episodes with suicidal intent requiring hospitalisation. TSS was offered as first-line treatment due to the risk of a mental health relapse with DA. Post-operatively, his prolactin levels normalised to 243 mU/l. A 33-year-old gentleman with a microprolactinoma (prolactin 4,544 mU/l) was referred with low libido. He struggled with emotional instability and anger management for which he required psychotherapy. TSS was suggested as first-line treatment, and he recently underwent surgery.

Conclusion: Surgical management of prolactinomas can be considered in patients with DA-induced ICD or as first-line treatment in ‘high-risk’ individuals. The pituitary MDT has a crucial role in identifying patients with a discrete surgical target, who are likely to benefit from surgery, without compromising pituitary function.

Volume 86

Society for Endocrinology BES 2022

Harrogate, United Kingdom
14 Nov 2022 - 16 Nov 2022

Society for Endocrinology 

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