Cabergoline-induced fibrosis of prolactinomas: a neurosurgical perspective

Abstract

Presently, the standard of care for prolactinomas, a type of pituitary adenoma, is dopaminergic agents such as bromocriptine and cabergoline. However, dopaminergic agents may induce fibrosis of cardiac valves leading to valvular insufficiency, necessitating surgical treatment of prolactinoma. Fibrosis of prolactinoma can be induced by prolonged medical treatment with bromocriptine, and this usually occurs after years of treatment. In comparison to bromocriptine, there have been no reports of cabergoline-induced fibrosis of prolactinoma. There is a potential for greater emphasis to be placed on assessing the tumour consistency from preoperative MRI scans, or even preoperative contrast-enhanced 3D Fast Imaging Employing Steady-state Acquisition imaging to allow better planning of the surgery. We report a rare case of fibrosis of prolactinoma after cabergoline treatment resulting in its subsequent difficult surgical removal. This patient had early MRI changes of fibrosis of prolactinoma after a short period of 6 months of cabergoline treatment.

Giant prolactinoma case with side effects due to cabergoline

“…Most patients will not achieve hormonal remission postoperatively [6,9], will remain with a signi icant adenoma residue, and will require continuous medical treatment. Surgical resection may also be hampered by intratumoral ibrosis, which may develop following long-term dopamine agonist management [16,17]. Moreover, surgery in patients with gigantic tumors can be associated with complications such as diabetes insipidus, mental deterioration, CSF leak, meningitis, worsening vision, and even perioperative mortality [18].…”

A scoping review to understand the indications, effectiveness, and limitations of cabergoline in radiological and biochemical remission of prolactinomas

“…Table 1 lists the studies (n = 19) that were excluded along with the reason for exclusion [ Table 1 ]. [ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 ] Finally, eight (n = 8) studies were included in this scoping review. [ 34 35 36 37 38 39 40 41 ] Characteristics of all the studies[ 34 35 36 37 38 39 40 41 ] are shown in Table 2 .…”

“…[ 79 ] Fibrosis in the prolactinoma has been described after long-term therapy with bromocriptine and rarely with cabergoline therapy. [ 27 80 ] Mohan et al . [ 27 ] reported a case of prolactinoma, which developed fibrosis in the tumor after 6 months of cabergoline therapy.…”

“…[ 27 80 ] Mohan et al . [ 27 ] reported a case of prolactinoma, which developed fibrosis in the tumor after 6 months of cabergoline therapy. Additionally, the patient also developed moderately severe tricuspid valve regurgitation after 9 months of therapy with cabergoline.…”

Commentary: “Prolactinomas: Prognostic Factors of Early Remission After Transsphenoidal Surgery”

“…While cabergoline has a better drug tolerance profile and allows for easier administration thanks to its longer half-life (19)(20)(21), it is the preferred drug when it comes to medical treatment of prolactinomas (22). It has been reported that prolactinomas exposed to bromocriptine may develop tumor fibrosis (18,(23)(24)(25)(26)(27)(28)(29), yet rarely after cabergoline (18,30). Menucci et al reported that patients exposed to bromocriptine are more likely to have tumor fibrosis than patients that are untreated or treated with cabergoline alone (18).…”