Summary
Background. Prolactinoma is the most common secretory pituitary tumor, accounting for about 40% of total pituitary adenomas. It can cause a wide variety of symptoms due to prolactin hypersecretion or due to mass effect of the tumor. Most prolactinomas are success fully man - aged with first-line treatment – dopamine agonists, which effectively decrease excessive prolactin secretion as well as the size of the tumor. However, a subset of individuals does not respond to medical therapy. This resistance is defined by failure to achieve normal blood prolactin levels and reduce tumor size by 30% or more (in the case of macroprolactinoma) under maximally tolerated dopamine agonists doses. The estimated prevalence of resistant prolactinomas is approximately 20–30% for bromocriptine and 10% for cabergoline.
Objective. To present the case of partially treatment-resistant prolactinoma and to review prevalence, characteristics and current treatment alternatives of dopamine resistant-prolactinomas.
Material and methods. We performed literature search in PubMed, UpToDate, Cochrane Library and Medscape medical data bases. We described case of partially treatment-resistant prolactinoma and presented review of scientific data.
Conclusions. Management of drugresis tant macroprolactinomas remains challenging and includes several op tions: shift treat ment to cabergoline, cabergoline dose escalation to the maximally tolerated dose, surgical debulking, radio therapy for aggressive prolactinomas and temo zolomide for malignant prolactinomas. Each treatment method has certain in dications; preferred treatment method is chosen individually.
