Giant cabergoline-resistant prolactinoma in a man who presented with a psychotic episode during treatment: a case report

Journal of Medical Case Reports

José Luiz Mendonça¹  Maria de Fátima Magalhães Gonzaga²  Luiz Augusto Casulari²  Iruena Moraes Kessler³  Lucas Faria de Castro⁴ 

[1] Clinic of Radiology Vila Rica;Endocrinology Service of the Brasilia University Hospital;Institute of Cardiology of the Federal District, University Foundation of Cardiology;Medical Clinic Service of the Brasilia University Hospital;

关键词: Prolactinoma;    Cabergoline;    Resistance;    Quetiapine;    Mirtazapine;   

DOI  :  10.1186/s13256-019-2071-2

来源: DOAJ

【 摘 要 】

Abstract Background Prolactinomas are tumors of the pituitary gland that usually respond very well to treatment with cabergoline. Resistance to cabergoline is very rare, but when it occurs, it is a difficult problem to resolve if the tumor is inoperable. Case presentation A 62-year-old white man was treated for a giant macroprolactinoma detected during investigation of a subacute subdural hematoma of the left frontal lobe. The patient was treated with cabergoline for 17 years with a dose ranging from 1.0 mg to 3.5 mg per week. We were not able to normalize his prolactin level, which initially was 14,992 ng/ml and ultimately 1754 ng/ml. The tumor significantly shrank during the follow-up period but persisted. The patient had cardiac valvulopathies that did not worsen. He had an ischemic stroke and developed a psychotic condition that was successfully treated by lowering the cabergoline and administering quetiapine and mirtazapine together. This regimen led to a small increase in the patient’s prolactin that returned to previous levels and remained as such until the last medical evaluation. The tumor continued to shrink and had a cystic degeneration in the last evaluation. Conclusions Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in our patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors.

【 授权许可】

Unknown