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An 18-year Odyssey: navigating the complex path of prolactinoma management: a case report
Firdhous Alimathunisa Abdul Kather1, Ariel Barkan2, Shafaq Khairi2
1Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA. afirdhou@med.umich.edu.
Background:
Prolactinomas are the most common type of pituitary adenomas, typically managed with dopamine agonists. However, some cases are refractory to standard therapies, posing significant clinical challenges. This case highlights the complexities of managing an aggressive macroprolactinoma resistant to conventional treatments and explores the use of immunotherapy as a novel intervention.
Case Presentation:
A 54-year-old male with a history of hypertension and type 2 diabetes mellitus presented with erectile dysfunction and low libido, leading to a diagnosis of prolactinoma. Over an 18-year period, he underwent multiple interventions, including cabergoline therapy, four transsphenoidal surgeries, radiation therapy, and various pharmacotherapies. Despite these, he had refractory disease with markedly elevated prolactin levels and tumor growth. In the final stages of the disease, pembrolizumab immunotherapy was attempted. Unfortunately, the patient's condition continued to deteriorate, ultimately leading to hospice care and death at the age of 71.
Conclusions:
This case underscores the challenges associated with managing refractory prolactinomas and highlights the need for innovative therapeutic strategies, including immunotherapy. Further research is essential to establish the role of emerging treatments in improving outcomes for patients with aggressive pituitary adenomas.
Insights
Refractory prolactinomas present significant challenges. This case explored immunotherapy in an aggressive macroprolactinoma, but the patient ultimately did not improve, highlighting the need for new treatments.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Prolactinomas, the most common pituitary adenomas, are usually treated with dopamine agonists.
- Some prolactinomas are refractory to standard therapies, creating complex clinical scenarios.
- Aggressive macroprolactinomas resistant to conventional treatments require novel therapeutic approaches.
Purpose of the Study:
- To highlight the challenges in managing refractory prolactinomas.
- To explore the potential of immunotherapy in aggressive, treatment-resistant prolactinomas.
- To underscore the need for innovative strategies in pituitary adenoma treatment.
Main Methods:
- A case presentation of a 54-year-old male with a refractory macroprolactinoma.
- Review of 18 years of treatment, including cabergoline, multiple surgeries, and radiation.
- Administration of pembrolizumab immunotherapy in advanced stages of the disease.
Main Results:
- The patient had persistently high prolactin levels and tumor growth despite extensive treatments.
- Pembrolizumab immunotherapy was administered as a last resort.
- The patient's condition continued to deteriorate, leading to hospice care and death.
Conclusions:
- Refractory prolactinomas pose significant management difficulties.
- Immunotherapy, such as pembrolizumab, may not be effective in all aggressive pituitary adenomas.
- Further research is crucial to develop effective treatments for aggressive pituitary adenomas.
