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Exp Clin Endocrinol Diabetes 2002; 110(7): 364-369
DOI: 10.1055/s-2002-34995
Case Report

© Johann Ambrosius Barth

Autonomic Failure Mimicing Dopamine Agonist Induced Vertigo in a Patient With Macroprolactinoma

L. Seiler1 , S. Braune2 , K. Borm1 , C. Magerkurth2 , J. Talazko3 , T. Peters4 , M. Reincke1
  • 1 Department of Internal Medicine II, University of Freiburg, Germany
  • 2 Department of Neurology, University of Freiburg, Germany
  • 3 Department of Radiology, University of Freiburg, Germany
  • 4 Department of Internal Medicine, Claraspital, Basel, Switzerland
Further Information

Publication History

received 19 November 01 first decision 23 March 02

accepted 27 March 02

Publication Date:
24 October 2002 (online)

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Summary

A 68-year-old man presented with general fatigue, increasing adynamia, weakness, vertigo and recurrent syncope. Six weeks earlier the diagnosis of a macroprolactinoma had been established based on a greatly elevated prolactin concentration (161 170 μU/l) and MR-evidence of a 3.5 cm measuring pituitary mass. The patient had been started on cabergoline (1.5 mg weekly). Orthostatic hypotension due to the dopamine agonist was considered very likely and carbergoline therapy was stopped. However, there was no relief of the symptoms and further syncopes followed. Testing of blood pressure and heart rate regulation, selective testing of postganglionic cardiac neurons with [123J] metaiodobenzylguanidine scintigraphy provided evidence of grossly impaired neurogenic cardiovascular regulation due to failure of postganglionic efferent sympathetic activity. This is characteristic for pure autonomic failure. The patient was treated symptomatically with high fluid intake, compression stockings, fludrohydrocortisone (0.1 mg o.d.s.), piroxicam (20 mg o.d.s.) and etilephrin (10 mg q.d.s.), which enabled him to cope with daily activities without syncope. This case shows that vertigo in a patient with macroprolactinoma is not always related to drug therapy but may be related to other causes.

Key words:

Orthostatic hypotension - autonomic failure - prolactinoma

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Dr. Lysann Seiler

Department of Internal Medicine II

Hugstetter Strasse 55

79106 Freiburg

Germany

Phone: + 49-761-2703401

Fax: + 49-761-2703413

Email: seiler@medizin.ukl.uni-freiburg.de

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