Cabergoline
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Development of resistance in an elderly patient with invasive prolactinoma: case report A man developed resistance to cabergoline during treatment for invasive giant prolactinoma; he subsequently died. The man was diagnosed with invasive giant prolactinoma at age 70 years, and commenced treatment with cabergoline 1 mg/week, increased to 3.5 mg/week in his first year of treatment. Thirty-six months after starting cabergoline, his symptoms had improved, and his serum prolactin level was 25 ng/mL. After 44 months of treatment, his serum prolactin level had increased to 3912 ng/mL, and cabergoline was increased to 4.5 mg/week. Five months later, his tumour had increased in size, and his serum prolactin level was 16 000 ng/mL; cabergoline was increased to 5 mg/week. Episodic amnesia and right-eye vision loss developed, and his serum insulin-like growth factor-1 (IGF-1) level was 974 ng/mL. The man underwent partial tumour resection. Pathology revealed a pituitary adenoma with moderate anisokaryosis. Densely granulated prolactin positive cells were observed on immunohistochemistry, as well as growth hormone (GH) positive cells in scattered groups; Ki-67 was elevated. On post-operative day 4, his serum prolactin level has decreased to 10 000 ng/mL, but remained persistently high thereafter, despite cabergoline 3.5 mg/week. Octreotide was started, but his serum prolactin level had increased to 16 800 ng/mL within 6 months, and both IGF-1 and GH levels were elevated. Repeat MRI scan demonstrated progression of his tumour, with further compression of adjacent structures. Fourteen months after surgery, he died. Analysis of his tumour sample revealed strong immunoreactivity for VEGF, FGF-2 and CD31, indicating high vascularisation of his adenoma. Author comment: "A particular characteristic of this patient was late resistance to cabergoline . . . VEGF overexpression may be linked to dopamine resistant tumors." Mallea-Gil MS, et al. Invasive giant prolactinoma with loss of therapeutic response to cabergoline: Expression of angiogenic markers. Endocrine Pathology 20: 35-40, No. 1, Mar 2009. Available from: URL: http://dx.doi.org/10.1007/ 803018611 s12022-009-9057-3 - Argentina
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Reactions 5 Jun 2010 No. 1304
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