Endocrine Abstracts

This is a case presentation of macroprolactinoma, the most common type of functional tumour among pituitary adenomas. The typical presentation of pituitary macroadenomas (PA) is either due to mass effect, hormonal excess or deficit. It is vital to evaluate the pituitary axis and visual field assessment to know the extent of the local compression effect. The imaging fine-cut computer tomography or MRI helps to see the tumour burden. It is generally recommended to begin treatment with dopamine agonists for prolactinomas. All other pituitary adenomas are typically treated with trans-sphenoidal surgery, with medical therapy reserved for those who are not cured by surgery. About 5-18% of prolactinoma patients show resistance to dopamine agonists. In this case, pituitary macroadenoma (prolactinoma) recurred after eight years of complete response to CBG. There is a discussion of Dopamine agonist resistance and other management options for pituitary macroadenoma in cases of DA resistance. The patient developed central hypothyroidism and hypoadrenalism due to the mass effect of PA. A multidisciplinary team approached the patient.

Conclusion: The most common functional pituitary tumours are pituitary adenomas. The most effective treatment for these tumours is dopamine agonists. It’s worthwhile to note that resistance to dopamine agonists can be primary or secondary. Secondary resistance can occur after one year of the initial response. It is advisable to conduct further biochemical and radiological tests to determine the response of the tumour to DA. For managing pituitary macroadenomas, surgery is the most effective treatment. Radiotherapy or Chemotherapy may be considered when surgery is not feasible. New therapeutic options such as Tyrosine kinase inhibitors (lapatinib) and Octreotide therapies can be considered for treating PA.