Management of resistant prolactinoma in infertile lady with successful maternal and perinatal outcome

Niroopama Pushpagiri, Gayathri Manam


Mrs. X of 28 years presented to the gynaecology department with primary infertility for 4 years, secondary amenorrhea for 6 months and galactorrhea for 3 months. She was investigated and diagnosed to have macroprolactinoma. Medical treatment with cabergoline was started. Patient became symptomatically free in 6 months with gradual reduction in serum prolactin levels as well as tumour size. After 2 years of therapy, failure of normalisation of prolactin levels and failure of significant tumour reduction observed and diagnosed it as resistant prolactinoma. Considering her infertility and future complications associated with resistant macroadenoma, she was treated with stereotactic radiosurgery using cyber knife radiation. Tumour regression in MRI with significant decrease in serum prolactin levels were observed in the post radiation period and monthly follow up done. She conceived spontaneously after 2 months of radiotherapy. She has been followed up with visual field testing during antenatal period. Her antenatal, intranatal period was uneventful with successful maternal and perinatal outcome.



Resistant prolactinoma, Stereotactic radiotherapy, Cyber knife radiation

Full Text:



Colao A. Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Meta. 2009:23:575-96.

Vance ML, Thorner MO. Prolactinomas, Endocrinol Metab Clin North Am. 1987;16:731-53.

Liu JK, Couldwell WT. Contemporary management of prolactinomas. Neurosurg Focus. 2004:16(4):E2.

Colao A, Annunziato L, Lombardi G. Treatment of prolactinomas. Ann Med. 1998;30:452-59.

Colao A, di Sarno A. Pivonello R, et al. Dopamine receptor agonists for treating prolactinomas. Exp Opin Investig Drugs. 200211:787-800.

Colao A, Di Sarno A, Sarnacchiaro F, et al. Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. J Clin Endocrinol Metab. 1997:82:876-83.

Couldwell WT, Weiss MH. Medical and surgical management of microprolactinoma. Pituitary. 2004;7:31-2.

Ono M, Miki N, Kawamata T, Makino R, Amano K, Seki T. et al. Prospective study of high-dose cabergoline treatment of prolactinomas in 150 patients. J Clin Endocrinol Metab. 2008;93(12):4721-7.

Gilliam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactiomas, Endocr Rev. 2006;27:485-534.

Losa M, Mortini P, Barzaghi R, Gioia L, Giovanelli M 2002. Surgical treatment of Prolactin - secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab. 2002;87:3180-6.

Serri O, Rasio E, Beauregard H, Hardy J, Somma M 1983. Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma. N Engl J Med. 1983;309:280-3.

Maiter D, Delgrange E et al. Therapy of endocrine disease: the challenges in managing giant prolactinomas. Eur J Endocrinol. 2014;170(6):R213-27.

Kajiwara K, Saito K, Yoshikawa K, Ideguchi M, Nomura S, Fujii M, Suzuki M. et al, Stereotactic radiosurgery / radiotherapy for pituitary adenomas: a review of recent literature. Neurol Med Chir (Tokyo). 2010;50(9):749-55.

Molitch ME 2006 Pituitary disorders during pregnancy. Endocrinol Metab Clin North Am. 2006;35:99-116.

Almalki MH, Alzahrani S, Alshahrani F, Alsherbeni S, Almoharib O, Aljohani N, Almagamsi A. Managing Prolactinomas during Pregnancy. Front Endocrinol (Lausanne). 2015;26;6:85.