Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report

Abstract

BackgroundDopamine agonists are the standard first-line medical therapy for prolactinoma. We report a rare case of giant prolactinoma with a first epileptic seizure due to rapid reduction of the tumor as a complication of dopamine agonist therapy.Case presentationA 27-year-old Japanese man presented to our institution with a history of visual disturbance for 1 year and general fatigue for 3 months. Magnetic resonance imaging showed a tumor that arose from the pituitary and extended to the bilateral anterior skull base, the clivus, and the cavernous sinus, with compression of the optic chiasm and the bilateral frontal and temporal lobes. On the basis of the patient’s serum concentration of prolactin, we diagnosed a prolactinoma and started dopamine agonist therapy with cabergoline. The patient had a general seizure immediately after starting dopamine agonist therapy and required general anesthetic treatment following the rapid reduction of the tumor. We speculated that the rapid reduction of the tumor resulted in the retraction of the surrounding brain structure, and the epileptic seizure was then induced by dopamine agonist therapy.ConclusionsWe report a rare case of giant prolactinoma with a first epileptic seizure immediately after the initiation of dopamine agonist therapy. Clinicians need to be aware that the rapid reduction of a giant prolactinoma by dopamine agonist therapy may cause an epileptic seizure.

Giant Clinically Non-Functioning Pituitary Adenoma Presenting as New Onset Generalized Tonic‒Clonic Seizures: A Case Report

“…However, it is important to note that seizures are increasingly common in patients with prolactinomas, specifically those treated with dopamine agonists such as cabergoline and bromocriptine, as discussed in depth through multiple case studies and case series. 9 , 13 , 14 This is speculated to be due to the intratumoural hemorrhage that occurs during the medical treatment of prolactinomas, hence acting as an instigator for seizure development, as supported by MRI evidence of hemosiderin deposition in the medial temporal lobes of those patients. 6 …”