Cabergoline

Abstract

Lack of efficacy: case reportA 37-year-old woman exhibited a lack of efficacy during treatment with cabergoline for hyperprolactinaemia. The woman presented for infertility investigation as she was not able to conceive even after 14 months of unprotected intercourse. Her menstrual periods were irregular. Initial routine investigations showed a mildly elevated prolactin level. Her antral follicle count was 17 and 19, so she was started on letrozole for ovulation induction. She had received two cycles of letrozole and achieved ovulation. Subsequently, she experienced galactorrhoea and an elevated prolactin level was discovered. A pelvic ultrasound showed a sub-serosal leiomyoma. Thereafter, in view of hyperprolactinaemia, she started receiving cabergoline 0.5 mg/week [route not stated]. Subsequently, the dosage was increased to 1 mg/week; however, despite increasing in dose, her serum prolactin continued to rise, indicating lack of efficacy. Later, based on the finding leiomyosarcoma was suspected.The woman underwent hysteroscopy, endometrial biopsy, laparoscopy, midline laparotomy and myomectomy. Histopathology confirmed the diagnosis of benign uterine leiomyoma. Two days after surgery, her serum prolactin level decreased significantly. Hence, cabergoline was stopped. One month after surgery, her serum prolactin level normalised.