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Resistant prolactinoma: Is it monoclonal or polyclonal?
K V S Hari Kumar1, Pitambar Prusty
1Department of Endocrinology, Command Hospital, Lucknow, Uttar Pradesh, India.
Indian Journal of Endocrinology and Metabolism
|November 20, 2013
Summary
This case study highlights a rare instance of multiple pituitary microadenomas progressing to a macroprolactinoma. It suggests a potential polyclonal origin for these resistant prolactinomas.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Prolactinomas, typically solitary benign neoplasms, can occasionally present resistance to dopamine agonists.
- Multiple pituitary adenomas are rare, occurring in less than 1% of cases, and rarely lead to resistant prolactinoma.
Observation:
- A patient with hyperprolactinemia presented with multiple pituitary microadenomas.
- Initial treatment with dopamine agonists normalized prolactin levels, allowing for a successful pregnancy and subsequent drug withdrawal.
Findings:
- Post-delivery evaluation revealed a progression to a macroprolactinoma.
- Dopamine agonist therapy achieved biochemical cure, though tumor size remained unchanged, indicating resistance or altered tumor behavior.
Implications:
- This case suggests a potential evolution from multiple microadenomas to a macroprolactinoma, possibly indicating a polyclonal origin.
- Understanding such progressions is crucial for managing complex cases of resistant prolactinoma and hyperprolactinemia.
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