Restoration of fertility in a woman with giant prolactinoma in response to cabergoline treatment

Abstract

Summary A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6–7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. Learning points: Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.

Cabergoline: an effective treatment for conception in prolactinoma

“…13 However, long-term use of Cabergoline may cause heart and lung issues and so regular monitoring is desired by the treating physicians. 14 Cabergoline, an ergoline derivative, selectively inhibits prolactin secretion from the anterior pituitary for a long time. After binding to the D2 dopamine receptor, it inhibits adenylyl cyclase that decreases cAMP and mediates apoptosis resulting in autophagic cell death, thus resulting in a decrease in serum prolactin levels.…”

Restoration of fertility in a woman with giant prolactinoma in response to cabergoline treatment (case report)

“…According to the European and Russian recommendations in diagnosing and treatment of hyperprolactinaemia, it is advised to discontinue dopamine agonists (DAs) at the start of pregnancy. It is recommended to resume DA therapy in case any clinical signs of tumour enlargement are present during the pregnancy (14,15). Over 900 cases of patients' exposure to CAB during pregnancy have been reported, although in most of the described cases women discontinued CAB treatment at 3-4 weeks of gestation (12,16).…”