Macroprolactinoma and empty sella: Swinging pendulum and lessons for dopamine agonists therapy

Abstract

Abstract Prolactinomas account for nearly 40% of all pituitary tumors with a remarkable response to dopamine agonist (DA) therapy, rendering surgical intervention unnecessary in most cases. Clinical guidelines recommend discontinuing DA therapy two years after achieving normalized prolactin levels and without tumor visibility on MRI. We report a middle-aged man with a macroprolactinoma who presented with apoplexy and panhypopituitarism. The patient responded remarkably to cabergoline with normalization of prolactin and complete tumor disappearance with radiological empty sella within 18 months, and subsequently, he discontinued cabergoline. The patient presented lately (after 10 years) with a recurrence of macroprolactinoma, for which he was reinitiated on cabergoline therapy. Patients with an empty sella remain susceptible to tumor recurrence, as pituitary adenomas may arise from residual pituitary tissue or microscopic tumor remnants may persist, which is not discernible radiologically. This case is a poignant reminder of the importance of diligent and long-term clinical and biochemical monitoring in patients with prolactinomas.