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Reminder of important clinical lesson
CASE REPORT
Cabergoline-induced fibrosis of prolactinomas: a neurosurgical perspective
  1. Niraj Mohan1,
  2. Yi Yan Chia1,
  3. Giap Hean Goh2,
  4. Eric Ting3,
  5. Kejia Teo4,
  6. Tseng Tsai Yeo4
  1. 1Yong Loo Lin School of Medicine, National University of SIngapore
  2. 2Department of Pathology, National University Hospital (NUH), Singapore
  3. 3Department of Diagnostic Imaging, National University Hospital (NUH), Singapore
  4. 4Division of Neurosurgery, National University Hospital (NUH), Singapore
  1. Correspondence to Dr Niraj Mohan, nirajmohan{at}u.nus.edu

Summary

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.

  • Pituitary disorders
  • Neuroendocrinology
  • Neuroimaging
  • Neurosurgery

https://doi.org/10.1136/bcr-2017-220971

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    Footnotes

    • Contributors NM and CYY were actively involved in the literature review and conceptualisation of this case report, as well as the writing and editing of the entire manuscript. NM and CYY were also involved in coordinating the team, taking charge of the administrative aspects of this case report. GGH has provided the team with the pathology images and has written up the pathology section of the manuscript. He also contributed to the overall editing of the manuscript. ET has provided the team with the radiology images and has written up the radiology section of the manuscript. He also contributed to the overall editing of the manuscript. KT has written up the surgical treatment section of the manuscript as he was the neurosurgeon in charge of the patient’s neurosurgery and care. He also contributed to the conceptualisation and overall editing of the manuscript. TTY contributed to the conceptualisation and overall editing of the manuscript. He also provided invaluable advice and insight into the technicalities of the neurosurgical aspect of this case report.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.