Cabergoline Therapy Research Articles

Efficacy of standard methods in the treatment of prolactin-secreting pituitary carcinoma

Pituitary carcinoma (metastatic neuroendocrine tumor of the pituitary gland) is the pituitary tumor with confirmed craniospinal and/or systemic metastases. These tumors are extremely rare accounting for only 0.1% to 0.5% of all pituitary tumours and are characterized by high mortality. In the presented case, pituitary carcinoma with intracranial metastasis was diagnosed in a young patient 25 years after manifestation of an aggressive recurrent prolactin-secreting pituitary tumor. Standard therapy (removal of metastasis, radiation therapy, cabergoline therapy) resulted in a long-term remission of the disease.

6555 Cabergoline-induced psychiatric symptoms in a patient with a pituitary macroadenoma

Abstract Disclosure: G.S. Patel: None. J. Prater: None. Cabergoline is a long-acting dopamine agonist that is used for the treatment of hyperprolactinemia, especially in pituitary macroadenomas. It reduces the levels of prolactin (PRL) but is also effective in reducing the tumor size and allows patients to avoid undergoing surgical resection of the mass. It commonly causes side effects such as abdominal pain, bloating, dizziness, and headaches. It rarely can cause new onset psychological side effects or an exacerbation of pre-existing mood and behavioral disorders. We present the case of a male on cabergoline therapy who had new-onset psychiatric symptoms that persisted even after treatment was discontinued. The patient is a 40-year-old male who was found to have a pituitary macroadenoma measuring 2.2 x 1.8 x 1.6 cm on brain MRI after a one-year history of headaches, dizziness, and hearing loss. His vital signs and physical examination were unremarkable. Laboratory investigations revealed a PRL of 1,072 ng/mL. He was started on cabergoline 0.25 mg twice a week which reduced levels of PRL to 465.3 ng/dL. Throughout the next year, his PRL levels remained persistently elevated to >100 ng/dL and the cabergoline dose was steadily increased to 1 mg three times per week. About a year into treatment he began experiencing significant emotional lability, a tendency to cry, and bursts of temper which required the addition of multiple psychiatric medications. After two years of continued psychiatric symptoms, there was an attempt to both reduce cabergoline doses and switch to escalating doses of bromocriptine, both of which resulted in a reduction of psychiatric symptoms but also significant increases in PRL levels. The patient’s mood symptoms returned shortly after switching back to cabergoline, especially with increased doses. He eventually underwent trans-sphenoidal resection for his treatment-resistant pituitary macroadenoma. He was taken off cabergoline before surgery with a significant reduction in his mood symptoms but continues to require psychiatric medications for lasting emotional lability. Although rare, psychiatric side effects of cabergoline have been documented and must be addressed if a patient develops them while receiving treatment. Our patient had a severe presentation of mood symptoms from cabergoline therapy that required multiple psychiatric medications in escalating doses to control. It not only affected his quality of life but also resulted in long-term consequences. It is recommended that patients with similar presentations should be continued on cabergoline with the addition of clozapine as it has less of an effect on PRL levels. Other treatment options also include aripiprazole and quetiapine. However, when patients have treatment resistant macroprolactinomas and are unable to tolerate cabergoline, one would have to consider surgical treatment options for the treatment of hyperprolactinemia from pituitary macroadenomas. Presentation: 6/1/2024

6534 Schwannoma-Induced Hyperprolactinemia: A Rare Presentation Unveiled

Abstract Disclosure: G. Naronowicz: None. F.F. Foo: None. J. Cheng: None. R. Ong: None. S.W. Holland: None. K. Chalasani: None. Background: This case describes a rare presentation of a schwannoma manifesting with hyperprolactinemia. Case Description: A 37 year-old female with a past medical history including prolactinoma presented to our endocrine office to establish care. Prior to presentation, this patient had been diagnosed with a prolactinoma in 2015 via MRI. She was started on Cabergoline 0.5mg twice a week for treatment and continued this medication without any bothersome side effects. However, she began experiencing progressive dizziness, tinnitus, bilateral galactorrhea, and vision changes, prompting her to seek further intervention. The patient presented to our endocrine office in October 2017 for her initial visit. Due to ongoing symptoms, an MRI was done which revealed an adenoma vs hyperplasia of the pituitary gland. During this time her prolactin level was within normal limits, thus she continued her Cabergoline regimen. Soon thereafter, the patient was seen again in April 2018 with evidence of stable prolactin levels on Cabergoline treatment, although a repeat MRI showed a concern for a 1.2 cm mass in the left cerebellopontine angle extending to the right auditory canal. The patient underwent a follow-up consultation with a neurosurgeon; However given the unavailability of surgery at that time owing to insurance-related matters, a subsequent MRI was performed in August 2019 which revealed a vestibular schwannoma with no pituitary mass, and she ultimately underwent resection of this mass in February 2020. Throughout this period, the patient presented with a rise in prolactin levels (23.7 to 41.9 ng/mL). However, due to an asymptomatic state and the absence of concerning pituitary mass, the decision to be observed off Cabergoline therapy appeared to be the appropriate clinical course of action. Following the surgery, she was seen again in June 2020 with normalization of her prolactin levels without ongoing cabergoline treatment. We continue to follow this patient to present day for annual appointments and she continues to have normal prolactin levels. Conclusion: This report underlines the importance of a thorough and multidisciplinary approach in the assessment of elevated prolactin levels in light of a schwannoma. This also highlights the significance of continued surveillance and the value of repeat imaging. Exploring alternative diagnoses, such as Schwannoma, broadens the scope of etiologies, thus allowing a comprehensive approach for accurate diagnosis. Presentation: 6/1/2024

12612 Chiasmal Herniation - A Rare Complication Of Prolactinoma Treatment

Abstract Disclosure: A. Syeda: None. V. Kantorovich: None. Introduction: Primary treatment of symptomatic prolactinomas is medical therapy with dopamine agonists (DA). Herniation of optic chiasm is a rare complication of tumor shrinkage induced by DA therapy which causes secondary deterioration in visual fields. Case:A 26-year-old man presented to our hospital after a syncopal episode. He had headaches and blurry vision in the left eye for the past 4 months. He was diagnosed with a 4 cm x 3.6 cm x 2.6 cm pituitary macroprolactinoma compressing the optic chiasm, his prolactin (PRL) was 4700 ng/mL (N: 4.0-15.2 ng/mL) and testosterone was suppressed to 10 ng/dL (N: 249-836 ng/dL). Other hormonal workup was unremarkable. Ophthalmologic evaluation was consistent with left optic nerve pallor and neural rim thinning suggestive of a guarded prognosis. Immediate neurosurgical intervention was deemed unnecessary. Cabergoline 0.25 mg twice a week was initiated. Subsequently, the PRL levels improved but remained elevated to 414.2 ng/mL and cabergoline dose was increased to 0.5 mg twice a week. MRI Brain after 10 months revealed significant tumor reduction to 2.1 cm x 2.1cm x 1.2 cm. He was inconsistent with his endocrinology follow up appointments and was also non-adherent to cabergoline intermittently. After 14 months of starting DA therapy, he presented with worsening blurriness in his left eye. A repeat brain MRI showed stable appearance of the large pituitary macroadenoma with inferior bowing of the optic chiasm. Significant distortion, tented appearance, and attenuation of the left prechiasmatic optic nerve was also noted. He was evaluated by neuro ophthalmology and a diagnosis of secondary visual deterioration due to optic chiasmal herniation was made. Cabergoline therapy was promptly discontinued. Two weeks post-cabergoline cessation, he underwent trans-sphenoidal resection reporting vision improvement pre-surgery. Post-operative MRI depicted changes with no residual tumor and improved optic chiasm position. Discussion:Various theories explain chiasmal herniation with dopamine agonist (DA) treatment for prolactinomas. Pre-existing chiasm-tumor tethering may exacerbate downward pull during tumor reduction caused by DA therapy. Some case series have suggested that not all patients with chiasmal herniation have visual field defects and that despite improvement in visual fields with decrease in DA dosage, there are no appreciable radiographic changes/reversal of chiasmal herniation. One of the explanations for this lack of correlation is that visual impairment is rather a consequence of vascular compression. This case underscores the need for regular perimetry in macroprolactinoma patients on medical treatment. Adjusting dopamine agonist dosage to allow controlled tumor regrowth, monitored closely with frequent visual field and prolactin assessments, is crucial for relieving optic chiasm tension. Presentation: 6/3/2024

6823 A Puzzling Case: Complete Regression of Pituitary Macroadenoma

Abstract Disclosure: N.T. Mazengia: None. D.R. Vangipuram: None. S.K. Majumdar: None. Introduction: The natural course of nonfunctioning pituitary macroadenomas remains poorly understood, largely because the majority are surgically treated [1]. There are a few case reports describing the spontaneous regression of nonfunctioning pituitary macroadenomas. Here we describe a case of pituitary macroadenoma which completely regressed following childbirth and two months of cabergoline therapy. Case Presentation: A 25-year-old female presented with bilateral nipple discharge and persistently elevated prolactin levels ranging from 31µg/liter to 45.9 µg/liter (NV <25 µg/L). She did not have any signs and symptoms of hypo or hypersecretion of the pituitary hormones. All her pituitary hormone levels were within normal range. Initial MRI revealed a pituitary mass measuring 9x13x9mm (AP, TR, CC). Given her lack of symptoms, the decision was made to follow up without any intervention. A repeat MRI after one year showed the size of the mass to be 11x13x11mm. Two years after her initial diagnosis, the patient had a spontaneous pregnancy, during which she remained asymptomatic with normal pituitary hormone levels. She had Cesarean delivery at term with no complication. She was lost to follow-up for about two years after childbirth then presented with breast discomfort and galactorrhea at which time, she was started on cabergoline. A subsequent MRI done two months after the start of cabergoline showed asymmetric fullness of the pituitary gland on the right with no discrete measurable lesion. Conclusion: We currently lack a comprehensive explanation for the regression observed in our patient. Silent ischemia may have played a role, particularly considering the natural increase in pituitary gland size during pregnancy. We are not sure if the regression can be solely attributed to the two months of cabergoline treatment. In asymptomatic patients diagnosed with nonfunctioning pituitary macroadenoma, tumor regression can potentially occur through either a "wait and watch" strategy or medical management using dopamine agonists, specifically cabergoline. However, the use of cabergoline as a primary treatment for asymptomatic nonfunctioning pituitary adenoma warrants further investigation. This is especially crucial given that, in most cases, nonfunctioning pituitary macroadenomas tend to increase in size during follow-up without any intervention.

Depression and Anxiety Disorders in Patients with Reported Prolactinoma Using Cabergoline Therapy: A Comparative Analysis with Controls

Depression and Anxiety Disorders in Patients with Reported Prolactinoma Using Cabergoline Therapy: A Comparative Analysis with Controls

Impact of medical therapy for hormone-secreting Pituitary tumors on bone.

Bone health is often impaired in patients with hormone-secreting pituitary tumors. Since medical therapy is central to their care, understanding how its use impacts on this is highly important. This review summarizes a systemmatic review of the literature on the effects of medical therapies for hormone-secreting pituitary tumors on bone. In acromegaly, medical therapy lowers bone turnover marker (BTM) levels, consistent with correction of the high bone turnover of active disease, and overall, areal bone mineral density (aBMD) does not change or increases. Somatostatin-receptor ligand (SRL) and pegvisomant-treated acromegaly patients have persistently reduced volumetric BMD and microarchitectural abnormalities of the peripheral skeleton, deficits that are similar to those in surgically-treated patients. Fracture risk remains elevated in medically-treated acromegaly patients but in conjunction with biochemical control the risk is lessened. Treatment of prolactin-secreting tumors with dopamine agonists is associated with improvements in aBMD, but this does not always fully normalize despite effective medical treatment of the prolactinoma. In one cross-sectional study, prolactinoma patients had lower total volumetric BMD and impaired microarchitecture suggesting that bone microstructure does not fully normalize despite dopamine agonist therapy. Cross-sectional studies show a high rate of VF in patients with prolactin-secreting tumors that is lowered on cabergoline therapy, but still the fracture rate of men and postmenopausal women is higher than that of controls in some studies. Studies on the effects of modern-day medical therapy for Cushing's disease on bone are lacking. More research is needed on the effectsof medical therapies for hormone secreting pituitary tumors on bone health.

Apoplexy of microprolactinoma after cabergoline therapy: rare situation but big emergency

Apoplexy of microprolactinoma after cabergoline therapy: rare situation but big emergency

Cabergoline, metformin and Clomiphene citrate therapy in infertile female with mild endometriosis: A Randomized Clinical Trial

Cabergoline, metformin and Clomiphene citrate therapy in infertile female with mild endometriosis: A Randomized Clinical Trial

Cabergoline therapy against hyperadrenocorticism in a dog

A 9-year-old male Labrador dog was presented to Small Animal Medicine Unit of Veterinary Clinical Complex, Veterinary College and Research Institute, Orathanadu with a history of chronic skin infection for the past 6 months. Clinical examination revealed alopecia, skin thinning, calcinosis cutis and comedone with pendulous abdomen. Laboratory examination revealed increased ALP and hyperglycemia. Hepatomegaly and bilateral adrenal gland hyperplasia were noticed on ultrasonography. Based on clinical and ultrasonographic findings it was diagnosed as hyperadrenocorticism. The dog was treated with Cabergoline @ 0.07 mg/kg P.O every 3 days for 3 months. The clinical signs were gradually subsided and animal recovered uneventfully with 3 months of treatment. Cabergoline found to be an alternative treatment of choice for the management of hyperadrenocorticism in dogs.

Apoplexy of Microprolactinoma after Cabergoline Therapy: Rare Situation but Big Emergency

Pituitary apoplexy (PA) is a rare clinical situation caused by pituitary infarction with or without haemorrhage. Although it is usually spontaneous, dopaminergic agonists (DA) are known to be predisposing factors, particularly Bromocriptine, more rarely Cabergoline. We report the case of a 31-years-old patient with a microprolactinoma who developed acute visual acuity loss due to pituitary apoplexy 5 months after taking Cabergoline. The evolution was marked by a considerable improvement of the visual state. Pituitary apoplexy is a rare situation. Often reported with Bromocriptine, PA can also occur with Cabergoline. Due to the high mortality and morbidity of apoplexy, it should be borne in mind that close monitoring is necessary when treatment with DA is prescribed and the patient should be informed of this risk. Although DA precipitate risk, treatment can be continued for hormonal and anti-tumour remission.

THU100 Case Of A Large Suprasellar-clival Mass: Prolactinoma Vs Paraganglioma

Abstract Disclosure: L.N. Madera Marin: None. Y. Rivera-Nieves: None. M.A. Ortiz-Rivera: None. A. Rosado-Burgos: None. L. El Musa Penna: None. W. Medina-Torres: None. L. Sepulveda-Garcia: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. M. Alvarado: None. N. Canales: None. Introduction Prolactin secreting adenomas comprise 30-40% of all pituitary adenomas. Generally, serum prolactin levels correlate with tumor size. Giant prolactinomas measure >4 cm, most have mass related clinical effects. Even large masses respond to cabergoline. Some may require surgical intervention. We present a case of a large pituitary mass associated with elevated prolactin levels, but with an interesting histopathologic analysis. Patient Description 30 y/o male patient with new onset decreased peripheral vision. Retinologist evaluation showed no abnormalities. Laboratories done by PCP found with altered thyroid function tests, but no treatment offered at the time. Two months later, the patient complained of worsening peripheral vision and was found with a left dilated pupil. A head CT scan was performed that showed a large brain mass. Admitted for urgent neurosurgery evaluation and high dose dexamethasone was initiated. ROS was remarkable for weight gain over the past year, and decreased morning erections, although denied decreased libido or erectile dysfunction. MRI showed an infiltrative skull base tumor extending from the clivus to the parasellar area encasing the left cavernous segment of the internal carotid artery with expansion of the sella obliterating the pituitary gland, and extension into the left optic canal. Pre-operative laboratories: Prolactin >877 ng/ml (2-17ng/ml), Cortisol 1.80 mcg/dL (4-22 mcg/dL), TSH 1.45 uIU/ml (0.4-4.0 uIU/ml), Sodium 142mMol/L (135-145mMol/L). Patient underwent left pterional craniotomy. Initial intra-operative pathology: “Positive for Neoplasia”. Post-operative laboratories: Prolactin >877 ng/ml, TSH 0.229 uIU/ml, FSH <0.30 mIU/ml (1.2-7.8 mIU/ml), and LH 0.16 mIU/ml (1.5-9.3 mIU/ml). Case Outcomes/Discussion Central hypothyroidism and hypogonadism confirmed, secondary hypocortisolism could not be assessed due to emergent corticosteroid infusion upon admission. A presumptive diagnosis of a giant prolactinoma was made for which cabergoline therapy was initiated. Final pathologic diagnosis revealed a paraganglioma. Urine fractionated metanephrines and catecholamines were normal. Immunostaining for prolactin requested. Paragangliomas arise from neuroendocrine cells, from either sympathetic or parasympathetic ganglia and can be solitary or multiple. Skull base and neck paragangliomas are usually benign while ∼20% of abdominal paragangliomas (sympathetic) are malignant. Anterior skull base paragangliomas are predominantly located in the sella and are rare but have been described in the literature. Very rare cases of pheochromocytomas or paragangliomas associated to pituitary adenomas have been reported. It has been named as the three P association, thought to be related to succinate dehydrogenase B and D mutations. Moreover, there are no cases in the literature of paragangliomas secreting prolactin. Presentation: Thursday, June 15, 2023

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

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.

Cabergoline and Low-Dose Steroid Therapy İn Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis(IGM) is a rare, chronic granulomatous inflammatory disease of the breast. It is mostly seen in young women with a history of breastfeeding. It typically presents as a painful lump in the breast, erythema, focal abscess formation, skin ulceration, or fistula. The etiology and pathogenesis of IGM could not yet be well understood. It is thought to be caused by a localized autoimmune response against fat and protein-rich secretions leaking from the lobules due to previous hyperprolactinemia. There is no definite treatment protocol defined for IGM. Pharmacological agents and surgical interventions are used alone or in combination in the treatment. In this study, we aimed to examine the results of patients who were treated with cabergoline and low-dose steroids for IGM in our center.
 Methods: In this study, the files of patients who were treated with cabergoline and steroids for idiopathic granulomatous mastitis in our clinic were reviewed retrospectively. 36 patients were included in the study. The patients were invited to the outpatient clinic for the final examination. Demographic characteristics of the patients, symptoms at presentation, examination findings, laboratory tests, radiological imaging, tru-cut biopsy results, microbiological culture results, treatment doses and durations, remission times, surgery requirements, and recurrence were recorded.
 Results: All 36 patients included in the study were women of childbearing age. The most common presenting complaint was a palpable painful mass. Abscesses were present in 12 patients. Ulcers were observed in 9 patients and fistulas were observed in 4 patients. The most common involvement was in the lower outer quadrant. S.aureus was detected in the culture of 1 patient. Complete recovery was observed in 20 of 36 patients as a result of the treatment. The mean duration of remission was 2.85±2.54 months. The treatment of 29 (74.3%) patients was completed medically. Surgical excision was performed in 7 patients with a residual lump. No recurrence was observed during the follow-up period of 27.88 ± 8.21 months.
 Conclusion: The treatment of IGM is still controversial. The fact that cabergoline and low-dose steroid therapy provides remission in a short time, minimizes the need for surgery, and does not relapse in medium-term follow-up shows that it is a successful option in IGM treatment.

A Case Report of Delusions in a Patient Receiving Cabergoline Therapy for Prolactinoma: Pathophysiology and Proposed Treatment With Aripiprazole.

Cabergoline is a dopamine 2 receptor agonist used as first-line treatment of pituitary prolactinomas. Here, we describe the case of a 32-year-old woman with a pituitary prolactinoma who was treated with cabergoline for 1 year, during which time she developed delusions. We also discuss the use of aripiprazole to mitigate the psychotic symptoms, while maintaining the efficacy of cabergoline treatment.

De Novo Psychiatric Disorders in a Woman With Giant Prolactinoma Treated With Cabergoline

Dopamine agonists are the first-line treatment of prolactinomas. The risk of developing de novo psychiatric symptoms during dopamine agonist therapy is low. Herein, we report the case of a 42-year-old woman with a giant prolactinoma who developed a psychiatric disorder after 1 day of cabergoline therapy initiation. She presented with amenorrhea, galactorrhea, headaches, and disturbed vision. Biological investigations revealed hyperprolactinemia (2975 ng/ml) with gonadotropin deficiency. Pituitary MRI showed a giant pituitary adenoma. The patient was treated with cabergoline at the dose of 1 mg twice weekly. One day after the treatment initiation, she developed acute delirium with temporospatial disorientation and compulsive medication use. These symptoms disappeared 1 week after the reduction of the dose of cabergoline. Patients with hyperprolactinemia receiving an initial high dose of cabergoline may develop changes in mood and behavior regardless of prior psychiatric history.

Effect of High-Dose Cabergoline Therapy for Hyperprolactinemic Infertility among Bangladeshi Women

Background: Cabergoline is effective in the treatment of hyperprolactinemic hypogonadism. It is a highly effective and long-acting inhibitor of prolactin secretion. The rate of cabergoline-induced pregnancy in women with prolactinoma, is unknown. Objective: The aim of present study is to evaluate the efficacy and safety of high-dose cabergoline therapy for hyperprolactinemic infertility among Bangladeshi women. Method: This descriptive cross- sectional study was conducted among 50 patients from January, 2020 to January, 2022 in at The Medinova Diagnostic Centre, Sylhet, Bangladesh. Results: In our study, maximum (14) patients belong to the age group of 19 to 23 years, and minimum number of patients (4) was between 39 to 43 years. Maximum (52%) patients had the primary infertility and 48% had secondary infertility. The mean values of thyroid stimulating hormone (TSH), Follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin PRL is 3.93±6.58, 10.96±13.58, 9.83±6.8, and 12.46±14.39 respectively and these were significant. 12% patients had PCO and 88% patients were normal in our study. 78% semens were normal, 4% semen showed Azzospermia, 14% semens showed Oligo Astheno Spine and 4% semens showed Astheno spine. Conclusion: In infertile women with prolactinoma, cabergoline can achieve a high pregnancy rate with uneventful outcomes. The findings demonstrated that cabergoline can be used safely to improve menstrual cycles in hyperprolactinemia.

PMON78 Improvement in Resistant Hypogonadism with use of Clomiphene in Prolactinomas Treated with Dopamine Agonist: A Case Study and Review of Literature

Abstract Introduction Prolactinomas account less than half of all pituitary adenomas and cause persistent hypogonadism and infertility despite treatment with dopamine agonists such as cabergoline or bromocriptine and improvement of prolactin levels (Gillam 2006). Conventional therapy for persistent hypogonadism in males is testosterone supplementation but this can cause fluctuations in serum testosterone levels and inhibition of spermatogenesis and infertility. Clomiphene citrate has been used to treat infertility and hypogonadism in males and females for over 50 years. Below we present a patient with persistent hypogonadism and review of available literature while on cabergoline with improving prolactin levels being treated with clomiphene Case Report A 21-year-old Caucasian male presented to our clinic after being diagnosed with macroadenoma measuring 1.6 x1.7×1.8 cm without stalk compression. Further pituitary functional work up was normal except for elevated prolactin levels of 232 ng/mL and total testosterone level of 107 ng/dL and free testosterone level of 4.1 ng/dL. Patient was started on cabergoline and titrated according to prolactin levels. Despite being on high dose cabergoline, 3.5 mg weekly, and improvement of prolactin levels (Prolactin level 53 ng/mL), he continued to have persistent hypogonadism (Total Testosterone 188 ng/dL and Free Testosterone 8.5 ng/dL) along with hypogonadal symptoms. Patient expressed his desire to preserve his future fertility and was uncertain he could use gel or self-inject replacement therapy therefore clomiphene citrate 25 mg tablet daily was started. Repeat testosterone levels six weeks later normalized (Testosterone 532 ng/dL and Free Testosterone 19 ng/dL) and symptoms improved. Treatment was continued with subsequent testosterone levels remained stable along with improved prolactin levels over the last year. Discussion/Conclusion A prospective study of hypogonadism in 14 males treated for prolactinomas with dopamine agonist showed 71% of patients responded to clomiphene treatment with improved testosterone levels and symptoms (Ribeiro 2009). A second study done by Vilar et al in 2018 of similar hypogonadal males on dopamine agonist treatment for prolactinomas showed 72% improvement in symptoms and testosterone levels over 12 weeks of clomiphene treatment. Our case, along with reviewed literature, showed that clomiphene is an effective alternative treatment option for resistant or persistent hypogonadism in male patients with prolactinomas being treated with dopamine agonists. References Gillam, M. P., Molitch, M. E., Lombardi, G., & Colao, A. (2006). Advances in the treatment of prolactinomas. Endocrine Reviews. https://doi.org/10.1210/er.2005-9998Ribeiro, R. S., & Abucham, J. (2009). Recovery of persistent hypogonadism by clomiphene in males with prolactinomas under dopamine agonist treatment. European Journal of Endocrinology, 161(1), 163–169. https://doi.org/10.1530/EJE-09-0084Vilar, L., Lyra, R., The, A. C., Trovao, E., Gadelha, P., Albuquerque, L. (2018). The role of clomiphene citrate in the resolution of hypogonadism in male patients with prolactinomas under cabergoline therapy. 20th European Congress of Endocrinology. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP430 Unusual Complication after a controlled ovarian stimulation presenting as ascites

Abstract Assisted Reproductive Technologies have become an integral element of care for women suffering from infertility. These comprise all interventions that include in vitro handling of both human oocytes and sperm, or of embryos for the purposes of reproduction. Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction technologies (ART). Hereby we are describing the case of a patient who developed severe OHSS presenting prominent ascites who benefitted from early onset cabergoline therapy and paracentesis. Case of 28 y/o female with past medical history of hypothyroidism and hyperprolactinemia admitted after presenting worsening abdominal pain and distention, nausea, vomiting and decreased urine output 3 days after receiving treatment before a planned follicular extraction. She initially was started on intramuscular follistim and Menopur, exogenous gonadotropins, preceded by intramuscular progesterone in preparation for said extraction. On physical examination, there was a pronounced abdominal ascites with positive fluid wave accompanied by abdominal discomfort at palpation, tachycardia of 103bpm, oliguria (less than 0.5cc/kg/hr) but no palpable masses or visceromegaly. Evaluation showed leukocytosis of 23. 0K/uL, hematocrit level of 43.5 g/dl (N: 36-48% in females), hypotonic hyponatremia with sodium level: 134 (136-145mmol/L), serum osmolality of 268 mOsm/L (N: 269-295mOsm/L), estradiol level of 3,057 pg/ml and progesterone level of 253.3 ng/ml; hormones both well above normal range compatible with response to ovarian stimulation therapy received. Afterwards, the patient underwent an abdominal ultrasound reporting small to moderate amount of ascites and findings highly suggestive of OHHS. Endovaginal Ultrasound was done which showed a prominent endometrium measuring 6.5×5. 0x 3.2 cm with bilateral large ovaries containing numerous complex cysts. Patient was started with intravenous hydration with normal saline to maintain adequate intravascular volume and cabergoline 0.25mg intravaginally daily, a dopamine agonist associated with a significant reduction in the incidence of symptoms and signs of moderate to severe OHSS. Her symptoms improved initially, but three days later she complained of worsening abdominal distention, to which abdominal ultrasound was repeated to localize a pocket for abdominal paracentesis. Paracentesis was performed: 1.8 liters of yellow fluid were aspirated and ascites resolved. Although the most severe form of OHSS is rare as in our patient, the incidence observed over time is less than 1% reported in literature. This case is an example of women with low risk factors who develop severe OHSS who had a good response to dopamine agonist therapy. As strategies to reduce the incidence of OHSS and its severity, clinical trials are needed to study the efficacy as well as safety of different doses and durations of cabergoline administration for both prophylactic and therapeutic purposes. Presentation: No date and time listed

Cabergoline treatment promotes myocardial recovery in peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare heart disease, occurring in previously heart-healthy women during the last month of pregnancy or the first months after delivery due to left ventricular (LV) systolic dysfunction. A common pathomechanistic pathway of PPCM includes increased oxidative stress and the subsequent generation of a cleaved prolactin fragment (16kDa PRL), which promotes the onset of heart failure (HF) in a microRNA (miR)-146a-dependent manner. Inhibition of prolactin secretion with the dopamine D2 receptor (D2R) agonist bromocriptine combined with standard HF therapy supports cardiac recovery. This study examined whether treatment with the more selective D2R agonist cabergoline prevents HF development in an experimental PPCM mouse model and might be used as an alternative treatment regime for PPCM. Postpartum (PP) female PPCM-prone mice with a cardiomyocyte restricted STAT3-deficiency (αMHC-Cretg/+ ; Stat3fl/fl ; CKO) were treated over two consecutive nursing periods with cabergoline (CKO Cab, 0.5mg/kg/day) and were compared with bromocriptine treated CKO (CKO Br) and postpartum-matched WT and CKO mice. Cabergoline treatment in CKO PP mice preserved cardiac function [fractional shortening (FS): CKO Cab: 34.5±9.4% vs. CKO: 22.1±9%, P<0.05] and prevented the development of cardiac hypertrophy, fibrosis, and inflammation as effective as bromocriptine therapy (FS: CKO Br: 33.4±5.6%). The myocardial up-regulation of the PPCM biomarkers plasminogen inhibitor activator 1 (PAI-1) and miR-146a were prevented by both cabergoline and bromocriptine therapy. A small cohort of three PPCM patients from the German PPCM Registry was treated with cabergoline (1mg per week for 2weeks, followed by 0.5mg per week for another 6weeks) due to a temporary unavailability of bromocriptine. All PPCM patients initially presented with a severely reduced LV ejection fraction (LVEF: 26±2%). However, at 6months of follow-up, LV function (LVEF: 56±2%) fully recovered in all three PPCM patients, and no adverse events were detected. In the experimental PPCM mouse model, the selective D2R agonist cabergoline prevents the onset of postpartum HF similar to bromocriptine. In PPCM patients, cabergoline treatment was safe and effective as all patients fully recovered. Cabergoline might serve as a promising alternative to bromocriptine. However, these findings are based on experimental data and a small case series and thus have to be interpreted with caution and should be validated in a larger clinical trial.