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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
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
Multiple pituitary adenomapolyclonalresistant prolactinoma

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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.