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DOI: 10.1055/s-0044-1786740
The Effect of Preoperative Cabergoline on Prolactinoma Fibrosis: A Case Series
Abstract
Introduction Prolactinomas are a common intracranial neoplasm and constitute most pituitary tumors. Although patients can present with variable hormone dysregulation and symptom severity, the use of dopamine agonists remains a first-line treatment. While bromocriptine has been found to increase tumor fibrosis, the effect of cabergoline on collagen deposition has been disputed. The aim of this article is to understand the influence of cabergoline on tumor fibrosis prior to resection.
Case Presentations Four male patients who underwent prolactinoma resection were included in this report. The average age was 39.8 years (range: 26–52 years). Pre-treatment prolactin levels ranged from 957.8 to 16,487.4 ng/mL. Three patients received cabergoline for at least 1 month prior to surgery (treatment range: 1–6 months). One patient had surgery without prior cabergoline use. Pathology reports confirmed each tumor to be of lactotroph origin. For each sample, Masson's trichrome staining was performed and the percentage of sample fibrosis was quantified using an artificial intelligence imaging software. Among those who received preoperative cabergoline, the extent of tumor fibrosis was in the range of 50 to 70%. In contrast, specimen fibrosis was approximately 15% without cabergoline use.
Conclusion This report demonstrates that a short duration of preoperative cabergoline can cause significant prolactinoma fibrosis. Understanding the effect of cabergoline on tumor consistency prior to surgery is essential as increased fibrosis can lead to more difficult tumor removal, reduce the extent of resection, and increase surgical complications. Considering these effects, further studies regarding the use of surgery prior to cabergoline for prolactinoma management are warranted.
Keywords
cabergoline - pituitary neuroendocrine tumors - prolactinoma - neurosurgery - neuroendocrinologyPublikationsverlauf
Eingereicht: 19. Januar 2024
Angenommen: 08. März 2024
Artikel online veröffentlicht:
15. Mai 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Petersenn S, Fleseriu M, Casanueva FF. et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society International Consensus Statement. Nat Rev Endocrinol 2023; 19 (12) 722-740
- 2 Chanson P, Maiter D. The epidemiology, diagnosis and treatment of prolactinomas: the old and the new. Best Pract Res Clin Endocrinol Metab 2019; 33 (02) 101290
- 3 Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA 2017; 317 (05) 516-524
- 4 Majumdar A, Mangal NS. Hyperprolactinemia. J Hum Reprod Sci 2013; 6 (03) 168-175
- 5 Moraes AB, Silva CM, Vieira Neto L, Gadelha MR. Giant prolactinomas: the therapeutic approach. Clin Endocrinol (Oxf) 2013; 79 (04) 447-456
- 6 Alsubaie S, Almalki MH. Cabergoline treatment in invasive giant prolactinoma. Clin Med Insights Case Rep 2014; 7: 49-51
- 7 Verhelst J, Abs R, Maiter D. et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 1999; 84 (07) 2518-2522
- 8 Su J, Simonsen U, Carlsen J, Mellemkjaer S. Pulmonary artery occlusion and mediastinal fibrosis in a patient on dopamine agonist treatment for hyperprolactinemia. Front Pharmacol 2017; 8: 492
- 9 Menucci M, Quiñones-Hinojosa A, Burger P, Salvatori R. Effect of dopaminergic drug treatment on surgical findings in prolactinomas. Pituitary 2011; 14 (01) 68-74
- 10 Herzog A, Minne H, Ziegler R. Retroperitoneal fibrosis in a patient with macroprolactinoma treated with bromocriptine. BMJ 1989; 298 (6683): 1315
- 11 Esiri MM, Bevan JS, Burke CW, Adams CB. Effect of bromocriptine treatment on the fibrous tissue content of prolactin-secreting and nonfunctioning macroadenomas of the pituitary gland. J Clin Endocrinol Metab 1986; 63 (02) 383-388
- 12 Mohan N, Chia YY, Goh GH, Ting E, Teo K, Yeo TT. Cabergoline-induced fibrosis of prolactinomas: a neurosurgical perspective. BMJ Case Rep 2017; 2017: bcr2017220971
- 13 Sughrue ME, Chang EF, Tyrell JB, Kunwar S, Wilson CB, Blevins Jr LS. Pre-operative dopamine agonist therapy improves post-operative tumor control following prolactinoma resection. Pituitary 2009; 12 (03) 158-164
- 14 Boling CC, Karnezis TT, Baker AB. et al. Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery. Int Forum Allergy Rhinol 2016; 6 (01) 101-107
- 15 Barnett GC, West CM, Dunning AM. et al. Normal tissue reactions to radiotherapy: towards tailoring treatment dose by genotype. Nat Rev Cancer 2009; 9 (02) 134-142
- 16 Kim EH, Kim J, Ku CR, Lee EJ, Kim SH. Surgical treatment of prolactinomas: potential role as a first-line treatment modality. Yonsei Med J 2023; 64 (08) 489-496
- 17 Maiter D. Management of dopamine agonist-resistant prolactinoma. Neuroendocrinology 2019; 109 (01) 42-50
- 18 Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. Cabergoline Comparative Study Group. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. N Engl J Med 1994; 331 (14) 904-909
- 19 Andereggen L, Frey J, Andres RH. et al. First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center. J Endocrinol Invest 2021; 44 (12) 2621-2633