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Diagnosis and Treatment > Medication

You are looking at 1 - 2 of 2 items for :

  • Cabergoline x
  • Corticosteroids x
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Benedetta Zampetti Endocrinology Unit, Niguarda Hospital, Milan, Italy

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Giorgia Simonetti Neurooncology Unit, Fondazione IRCCS Neurological Institute Carlo Besta, Milan, Italy

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Roberto Attanasio Endocrinology Service, Galeazzi Institute IRCCS, Milan, Italy

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Antonio Silvani Neurooncology Unit, Fondazione IRCCS Neurological Institute Carlo Besta, Milan, Italy

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Renato Cozzi Endocrinology Unit, Niguarda Hospital, Milan, Italy

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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.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, Cortisol, IGF1, Prolactin, Testosterone, Thyroxine (T4), Condition/ Syndrome, Hyperprolactinaemia, Macroprolactinoma, Panhypopituitarism, Patient Demographics, Age, Adolescent/young adult, Gender, Male, Ethnicity, White, Country of Treatment, Italy, Diagnosis and Treatment, Signs and Symptoms, Hemianopia, Hyperprolactinaemia, Vision - acuity reduction, Investigation, Cortisol (9am), FT4, Histopathology, IGF1, Immunohistochemistry, Immunostaining, MRI, Prolactin, Testosterone, Intervention, Chemotherapy, Radiotherapy, Resection of tumour, Transsphenoidal surgery, Medication, Cabergoline, Corticosteroids, Dopamine agonists, Temozolomide, Testosterone, Thyroxine (T4), Publication Details, Case Report Type, Novel treatment
DOI:
https://doi.org/10.1530/EDM-18-0092
Volume/Issue:
Volume 2018: Issue 1
Open access
Aimee R Hayes Departments of Endocrinology and Neurosurgery, St George Hospital and University of New South Wales, Kogarah, Sydney, New South Wales 2217, Australia

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Anthony J O'Sullivan Departments of Endocrinology and Neurosurgery, St George Hospital and University of New South Wales, Kogarah, Sydney, New South Wales 2217, Australia

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Mark A Davies Departments of Endocrinology and Neurosurgery, St George Hospital and University of New South Wales, Kogarah, Sydney, New South Wales 2217, Australia

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Summary

Pituitary apoplexy is a rare event in pregnancy. A 41-year-old woman with a known pituitary microadenoma presented with visual disturbance and headache during the second trimester of pregnancy. Magnetic resonance imaging (MRI) demonstrated pituitary apoplexy with chiasmal compression. After treatment with corticosteroid therapy, she underwent transsphenoidal excision of the pituitary adenoma. Visual abnormalities were completely restored and pituitary function preserved. There was no evidence of impact on the foetus. The literature on the subject is reviewed with emphasis on the management of the apoplectic patient with mild and stable neuro-ophthalmological signs.

Learning points

  • There are no clear guidelines on the management of pituitary apoplexy in pregnancy. A multidisciplinary approach can minimise morbidity and mortality.

  • Pituitary apoplexy has an unpredictable clinical course and determining which clinical situations warrant early surgery needs to take into consideration the presence and severity of neurological signs and their stability.

  • The management of conscious apoplectic patients with absent or mild and stable neuro-ophthalmological signs is controversial.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, Prolactin, Condition/ Syndrome, Pituitary adenoma, Pituitary apoplexy, Pituitary haemorrhage, Pregnancy, Prolactinoma, Patient Demographics, Age, Pregnant adult, Gender, Female, Ethnicity, White, Country of Treatment, Australia, Diagnosis and Treatment, Signs and Symptoms, Headache, Infertility, Visual field defect, Investigation, Cortisol, IGF1, Immunohistochemistry, MRI, Prolactin, Intervention, Transsphenoidal surgery, Medication, Cabergoline, Corticosteroids, Dopamine agonists, Related Disciplines, Obstetrics, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-14-0043
Volume/Issue:
Volume 2014: Issue 1
Open access