Endocrine Abstracts

JOINT909

Introduction: Particular clinical difficulties are presented by patients with mixed hyperproduction, as well as situations with secondary hyperprolactinemia due to compression of the pituitary stalk. Thus, the aim was to study the results of using of dopamine receptor agonists in patients with macroadenomas and hyperprolactinemia.

Material and Methods: An observational study was performed on clinical cases of three patients referred for management and treatment at the Republican Endocrinology Centre. The observation period was from the beginning of 2022 to the present.

Results: Patient 1. A 38-year-old man consulted a doctor due to a constant, terrible headache. During the interview, he noted a change in appearance over the past 4 years. The headache has increased worse since March 2022, nasal congestion appeared. In the sellar region, a tumor with uneven clear contours with overall dimensions of 67*53*85mm, a heterogeneous structure with the presence of calcifications and small cystic components, measuring up to 7 mm, is determined. Serum tests: TSH 1,27 mIU/nL, Free T4 14,21pmol/l, Prolactin 10000mIU/l, Cortisol 214.5nmol/l, IGF-1: 956.6 ng/ml, HbA1 – 6,24%. Ophthalmologist’s report: long-standing papilledema; OD - absolute scotoma in the posterior pole next to the optic disc, OS - widening of the blind spot. In a year treatment prolactin 369.7mIU/l, GH 0.556ng/ml, IGF-1 251.7, then prolactin 282mIU/L. Dynamics Pt MRI: 67*53*85mm (May2022) vs. 35*18*40mm (October2022) vs. 27*15*25 mm (March2023). Patient2. A 23-year-old man with any symptoms and changes in health. In February 2021 he consulted a doctor with the results of a hormonal analysis: TSH 1,98 mIU/nL, fT4: 15,3 pmol/l, prolactin: 6 395mkIU/l, MonoProlactin: 5650mIU/l87%, FSH 33,43 mIU/l, total testosterone – 1,97pmol/l, cortisol: 419nmol/l, HbA1C 5.3%. PT MRI: a pituitary adenoma was detected in the left half measuring 7.5x10x9.5 mm without displacement of the pituitary stalk. Cabergoline 0.5mg twice a week was prescribed. Patient3. A 38-year-old woman consulted a doctor about dizziness and lack of menstrual cycle. Hormonal status parameters: TSH 3,09mIU/nL, FreeT4: 14.72pmol/l, Prolactin: 123100 mkIU/ml, MonoProlactin: 97736mkIU/ml–79.4%, FSH 5.54 mIU/l, Estradiol: 57.71pmol/l, Cortisol: 389.8nmol/l, IGF-1: 135.5ng/ml. PTMRI: a pituitary adenoma 22x20x19mm with clear contours of a solid structure, suprasellar growth, compression of the chiasm. Normalization of prolactin occurred after several months of treatment, but to resume the menstrual cycle it was necessary to increase the dose of cabergoline.

Conclusion: The use of cabergoline is an effective and safe treatment for pituitary macroadenomas in the first step.