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A macroprolactinoma becoming resistant to cabergoline and developing atypical pathology
Pituitary adenomas are a common intracranial neoplasm, usually demonstrating a benign phenotype. They can be classified according to pathological, radiological or clinical behaviour as typical, atypical or carcinomas, invasive or noninvasive, and aggressive or nonaggressive. Prolactinomas account fo...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Bioscientifica Ltd
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093397/ https://www.ncbi.nlm.nih.gov/pubmed/27855233 http://dx.doi.org/10.1530/EDM-16-0038 |
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author | Sbardella, Emilia Farah, George Fathelrahman, Ahmed Cudlip, Simon Ansorge, Olaf Karavitaki, Niki Grossman, Ashley B |
author_facet | Sbardella, Emilia Farah, George Fathelrahman, Ahmed Cudlip, Simon Ansorge, Olaf Karavitaki, Niki Grossman, Ashley B |
author_sort | Sbardella, Emilia |
collection | PubMed |
description | Pituitary adenomas are a common intracranial neoplasm, usually demonstrating a benign phenotype. They can be classified according to pathological, radiological or clinical behaviour as typical, atypical or carcinomas, invasive or noninvasive, and aggressive or nonaggressive. Prolactinomas account for 40–60% of all pituitary adenomas, with dopamine agonists representing the first-line treatment and surgery/radiotherapy reserved for drug intolerance/resistance or in neuro-ophthalmological emergencies. We present the case of a 62-year-old man with an apparently indolent prolactin-secreting macroadenoma managed with partial resection and initially showing a biochemical response to cabergoline. Five years later, the tumour became resistant to cabergoline, despite a substantial increase in dosage, showing rapid growth and causing worsening of vision. The patient then underwent two further transsphenoidal operations and continued on high-dose cabergoline; despite these interventions, the tumour continued enlarging and prolactin increased to 107 269 U/L. Histology of the third surgical specimen demonstrated features of aggressive behaviour (atypical adenoma with a high cell proliferation index) not present in the tumour removed at the first operation. Subsequently, he was referred for radiotherapy aiming to control tumour growth. LEARNING POINTS: The development of secondary resistance to dopamine agonists (DAs) is a serious sign as it may be associated with de-differentiation of the prolactinoma and thus of aggressive or malignant transformation. Significant de-differentiation of the adenoma documented on consecutive histologies suggests a possible transition to malignancy. A combination of histological ‘alarm’ features associated with persistent growth and escape from DAs treatment in recurrent adenomas should alert clinicians and demands close follow-up. A multidisciplinary approach by pathologists, endocrinologists and neurosurgeons is essential. |
format | Online Article Text |
id | pubmed-5093397 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-50933972016-11-04 A macroprolactinoma becoming resistant to cabergoline and developing atypical pathology Sbardella, Emilia Farah, George Fathelrahman, Ahmed Cudlip, Simon Ansorge, Olaf Karavitaki, Niki Grossman, Ashley B Endocrinol Diabetes Metab Case Rep Unusual Effects of Medical Treatment Pituitary adenomas are a common intracranial neoplasm, usually demonstrating a benign phenotype. They can be classified according to pathological, radiological or clinical behaviour as typical, atypical or carcinomas, invasive or noninvasive, and aggressive or nonaggressive. Prolactinomas account for 40–60% of all pituitary adenomas, with dopamine agonists representing the first-line treatment and surgery/radiotherapy reserved for drug intolerance/resistance or in neuro-ophthalmological emergencies. We present the case of a 62-year-old man with an apparently indolent prolactin-secreting macroadenoma managed with partial resection and initially showing a biochemical response to cabergoline. Five years later, the tumour became resistant to cabergoline, despite a substantial increase in dosage, showing rapid growth and causing worsening of vision. The patient then underwent two further transsphenoidal operations and continued on high-dose cabergoline; despite these interventions, the tumour continued enlarging and prolactin increased to 107 269 U/L. Histology of the third surgical specimen demonstrated features of aggressive behaviour (atypical adenoma with a high cell proliferation index) not present in the tumour removed at the first operation. Subsequently, he was referred for radiotherapy aiming to control tumour growth. LEARNING POINTS: The development of secondary resistance to dopamine agonists (DAs) is a serious sign as it may be associated with de-differentiation of the prolactinoma and thus of aggressive or malignant transformation. Significant de-differentiation of the adenoma documented on consecutive histologies suggests a possible transition to malignancy. A combination of histological ‘alarm’ features associated with persistent growth and escape from DAs treatment in recurrent adenomas should alert clinicians and demands close follow-up. A multidisciplinary approach by pathologists, endocrinologists and neurosurgeons is essential. Bioscientifica Ltd 2016-10-18 2016 /pmc/articles/PMC5093397/ /pubmed/27855233 http://dx.doi.org/10.1530/EDM-16-0038 Text en This is an Open Access article distributed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB) . |
spellingShingle | Unusual Effects of Medical Treatment Sbardella, Emilia Farah, George Fathelrahman, Ahmed Cudlip, Simon Ansorge, Olaf Karavitaki, Niki Grossman, Ashley B A macroprolactinoma becoming resistant to cabergoline and developing atypical pathology |
title | A macroprolactinoma becoming resistant to cabergoline and developing
atypical pathology |
title_full | A macroprolactinoma becoming resistant to cabergoline and developing
atypical pathology |
title_fullStr | A macroprolactinoma becoming resistant to cabergoline and developing
atypical pathology |
title_full_unstemmed | A macroprolactinoma becoming resistant to cabergoline and developing
atypical pathology |
title_short | A macroprolactinoma becoming resistant to cabergoline and developing
atypical pathology |
title_sort | macroprolactinoma becoming resistant to cabergoline and developing
atypical pathology |
topic | Unusual Effects of Medical Treatment |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093397/ https://www.ncbi.nlm.nih.gov/pubmed/27855233 http://dx.doi.org/10.1530/EDM-16-0038 |
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