Experience with Dopamine Agonists in the Treatment of Prolactinomas

Abstract

The article is devoted to the conservative treatment of hyperprolactinemia of tumor origin. Cabergoline is considered as an effective treatment not only for microadenomas but also for large pituitary tumors which is illustrated by the clinical case of the patient P. The most important effects of cabergoline demonstrated in this clinical case are reduction in the size of the adenoma from macro to micro, reverse development of chiasmal syndrome with restoration of visual functions, achievement and maintenance of the target level of prolactin. Besides the article focused on the possible development of primary and secondary resistance to dopamine analogues. One of such difficult clinical scenario is illustrated by clinical case of patient M., who was treated with different dopamine analogues with the development of secondary dopamine resistance. Along with described in literature possible mechanisms for its development in our patient we also suggest the role of prolonged inadequate therapy with dopamine agonists, when the dose of the drug was not properly adjusted, despite not reaching the target prolactin level. The literature considers several ways of optimization of treatment in resistant patients but despite of this fact it remains one of unresolved problems in the management of patients with hyperprolactinemia.

Current and Perspective Approaches to the Treatment of Prolactinomas

“…So, the ambiguity of the identified risk factors for the development of resistance to DAs is confirmed by the data of other authors and our own observations [ 20 ]. Based on a retrospective assessment of the treatment outcomes in patients with prolactinomas, Araujo-Castro M. et al argue that large tumor size, but not male gender, is a risk factor for DAs resistance [ 21 ].…”

“…Our own experience indicates a pronounced therapeutic efficacy in the treatment of macroprolactinoma complicated by compression syndrome in men with average therapeutic doses of cabergoline. At the same time, we observed a young woman with microprolactinoma and the initial absence of any response to the use of DAs, despite an increase in the dose of the drug [ 20 ]. Szmygin H. et al also observed a 26-year-old woman with microadenoma, whose treatment was complicated by both primary resistance to all drugs of the DAs group, and their poor tolerance [ 12 ].…”