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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 385-390
DOI: 10.4103/ajns.AJNS_16_20
Case Report

Decrease of proliferative potential and vascular density of giant prolactinoma in patients treated with cabergoline

Ludmila Astaf'eva
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow
,
Ludmila Shishkina
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow
,
Pavel Kalinin
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow
,
Boris Kadashev
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow
,
Galina Melnichenko
1   National Medical Research Centre of Endocrinology, Moscow
,
Dariia Tserkovnay
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow
,
Oleg Sharipov
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow
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Introduction: Currently, cabergoline therapy is the main treatment for prolactinomas. The use of the drug in most cases leads to regression of the tumor, normalization of prolactin (PRL) levels, and restoration of gonadotropic function. The mechanism of its action in tumor cells “in vivo” tracked in dynamics in the same human tumor is of considerable interest. Materials and Methods: A 30-year-old male was admitted to N.N. Burdenko National Medical Research Center of Neurosurgery. An magnetic resonance imaging (MRI) revealed a giant pituitary adenoma. The level of PRL was more than 5000 mU/l (30-360) (serum dilution was not used to determine PRL). Transcranial microsurgical removal of the tumor was performed. He was treated by cabergoline after surgery. Endoscopic transsphenoidal approach was repeated with subtotal removal of the rest of the tumor. Morphological and immunohistochemical studies of the tumor were done. Results: A morphological study revealed PRL-positive tumor with a Ki-67 LI of 8% with a distinctive expression of D2R, CD31, and CD34 markers. Control MRI in 3 months after surgery revealed remnants of a tumor of endoinfrasellar localization, the tumor remainders were found in endoinfrasellar localization. The tumor retained pronounced immunopositivity to PRL and D2R and a decrease in the Ki-67 to 2% and in the expression of CD31 and CD34. Subsequent therapy with cabergoline resulted in persistent normoprolactinemia, restoration of androgenic function, and absence of tumor recurrence during the 10-year follow-up period. Conclusions: Cabergoline is an effective treatment for prolactinoma, which leads to tumor regression. One of its mechanisms is the reduction of the proliferative index and tumor angiogenesis.

Key-words:

Aggressive pituitary adenoma - cabergoline - giant prolactinoma - Ki-67 - male prolactinoma - proliferative potential

Financial support and sponsorship

Nil.




Publication History

Received: 15 January 2020

Accepted: 11 March 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. 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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