The Effect of Preoperative Cabergoline on Prolactinoma Fibrosis: A Case Series

Isabella L. Pecorari; Eros Qama; Nadeem Akbar; Patrick Colley; Christina H. Fang; Vijay Agarwal

doi:10.1055/s-0044-1786740

Journal of Neurological Surgery Reports, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(02): e66-e73
DOI: 10.1055/s-0044-1786740

Case Report

The Effect of Preoperative Cabergoline on Prolactinoma Fibrosis: A Case Series

Isabella L. Pecorari

¹Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States

²Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States

,

Eros Qama

³Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States

⁴Department of Pathology, Montefiore Medical Center, Bronx, New York, United States

,

Nadeem Akbar

⁵Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States

⁶Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States

,

Patrick Colley

⁵Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States

⁶Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States

,

Christina H. Fang

⁵Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States

⁶Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States

,

Vijay Agarwal

¹Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States

²Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States

› Author Affiliations

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 - neuroendocrinology

Full Text

References

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