Poster Abstract Abstract

(Adults - Pituitary/Neuroendocrinology), #220530616907

ROLE OF TEMOZOLAMIDE IN MACROPROLACTINOMA COMPLICATED BY DOPAMINE AGONIST INTOLERANCES AND REFRACTORY TO SURGERY: A CASE REPORT

Dr Tan Ying Jie, Hospital Sultanah Bahiyah; Dr Shartiyah Ismail, Hospital Sultanah Bahiyah; Dr Nor Shaffinaz Azmi Merican, Hospital Sultanah Bahiyah; Dr Noor Rafhathi Adyani Abdullah, Hospital Sultanah Bahiyah

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Introduction

Prolactinomas comprise approximately 40% of all pituitary adenomas, the majority of which treated with dopamine agonists(DAs). Patients who fail conventional treatment may be considered for surgery or radiotherapy.

Methods

We described a patient who was treated with temozolamide, an alkylating agent following multiple DAs intolerances and unsuccessful surgery.

Results

A 43 years-old female with secondary amenorrhea, primary infertility and galactorrhea was diagnosed to have macroprolactinoma with prolactin level 8143mIu/l (59-619mIU/L). MRI pituitary revealed parasellar and carvenous sinus soft tissue lesion measuring 1.2cm( AP) x 1.1cm( W)x 0.8cm(CC). Cabergoline was initiated and unfortunately, she developed severe headache and vomiting that necessitated hospitalisation. Similar problems occurred when cabergoline was switched to bromociptine. She could not comply with her medication due to the side effects. The prolactin level gradually increased to 11636mIU/L. Endoscopic transphenoidal surgery was performed as a salvage treatment. Postoperatively, the prolactin level remained as high as 19722 mIU/L, complicated by secondary hypothyroidism and hypocortisolism. Temozolamide 150mg/m2 for 5 days every 28 days was initiated with monthly surveillance of parameters. She exhibited good tolerability. Following 12th cycle of temozolamide, the prolactin was 3956 mIU/ L, a rapid 80% reduction from the peak in 1 year.

Conclusion

Temozolamide is an effective alternative in treating prolactinoma after unsuccessful conventional modalities . Future research is needed to establish the role of temozolamide in the treatment algorithm.

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