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Open access

Benedetta Zampetti, Giorgia Simonetti, Roberto Attanasio, Antonio Silvani and Renato Cozzi

Summary

We describe the 20-year course of a 63-year-old male with a macroprolactinoma that acquired resistance to treatment and aggressive behavior after a 4-year successful treatment with cabergoline. He was submitted to multiple surgical resections by a skilled surgeon, fractionated radiotherapy and was eventually treated with temozolomide. After a first 6-month standard cycle, a relapse occurred and he was treated again successfully.

Learning points:

  • Prolactinomas are the most frequent type of pituitary adenoma.
  • They usually have a benign course.
  • In most cases dopamine-agonist drugs, mainly cabergoline, are first-line (and usually only) treatment.
  • Occasionally prolactinomas can have or acquire resistance to treatment and/or aggressive behavior.
  • Temozolomide (TMZ), an oral alkylating drug, can be effective in such aggressive tumors.
  • Multimodal treatment (surgery, radiation, cabergoline and TMZ) is warranted in aggressive pituitary tumors.
  • We describe here successful rechallenge with TMZ after relapse occurring 18 months after a first TMZ cycle.