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Brain and optic chiasmal herniation following cabergoline treatment for a giant prolactinoma: wait or intervene?

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Abstract

OBJECTIVE

Dopamine agonists (DA) are the treatment of choice in patients with macroprolactinomas. Brain and optic chiasm herniation are unusual complications following treatment with DA.

REPORT

We present a case of a giant prolactinoma complicated by visual deterioration following cabergoline treatment. A 42-year-old man was admitted with seizures, right visual loss and visual defect in the upper left temporal quadrant. Magnetic resonance imaging (MRI) identified a giant adenoma, which proved to be a prolactinoma, compressing the optic chiasm and extending into the suprasellar region. Treatment with cabergoline was initiated resulting in improvement in visual fields, tumor shrinkage and prolactin level decrease. Five months later and despite tumor reduction, a deterioration of his visual fields was observed. The second MRI revealed brain and optic chiasmal herniation into the pituitary sella. Cabergoline dose was reduced and surgical resection of the adenoma along with untethering of the optic nerve was performed leading to improvement of the visual defects.

CONCLUSIONS

This report describes a rare case of brain and optic chiasmal herniation attributed to DA therapy for a macroprolactinoma. It is important for clinicians to examine visual fields and promptly identify any visual deterioration in patients with macroprolactinomas receiving DA treatment.

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Authors and Affiliations

  1. Department of Endocrinology and Diabetes Center, Athens General Hospital “G. Gennimatas”, 154 Mesogion Avenue, 11527, Athens, Greece

    Labrini Papanastasiou, Stelios Fountoulakis, Theodora Pappa, Dimosthenis Malliopoulos, Athina Markou & George Piaditis

  2. Department of Radiology, General Hospital of Athens “G. Genimatas”, Athens, Greece

    Konstantinos Liberopoulos

Authors
  1. Labrini Papanastasiou
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  2. Stelios Fountoulakis
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  3. Theodora Pappa
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  4. Konstantinos Liberopoulos
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  5. Dimosthenis Malliopoulos
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  6. Athina Markou
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  7. George Piaditis
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Correspondence to Labrini Papanastasiou.

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Papanastasiou, L., Fountoulakis, S., Pappa, T. et al. Brain and optic chiasmal herniation following cabergoline treatment for a giant prolactinoma: wait or intervene?. Hormones 13, 290–295 (2014). https://doi.org/10.1007/BF03401344

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  • DOI: https://doi.org/10.1007/BF03401344

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