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Massive reduction of tumour load and normalisation of hyperprolactinaemia after high dose cabergoline in metastasised prolactinoma causing thoracic syringomyelia
  1. S H M van Uum1,
  2. N van Alfen2,
  3. P Wesseling3,
  4. E van Lindert4,
  5. G F F M Pieters1,
  6. P Nooijen3,
  7. A R M M Hermus1
  1. 1Department of Endocrinology, University Medical Center Nijmegen, Nijmegen, the Netherlands
  2. 2Department of Neurology, University Medical Center Nijmegen, Nijmegen, the Netherlands
  3. 3Department of Pathology, University Medical Center Nijmegen, Nijmegen, the Netherlands
  4. 4Department of Neurosurgery, University Medical Center Nijmegen, Nijmegen, the Netherlands
  1. Correspondence to:
 S H M van Uum MD PhD
 Assistant Professor, Endocrinology and Metabolism, St Joseph’s Health Centre, Room G401, 268 Grosvenor St, London, Ontario, Canada, N6A 4V2;


In 1970 a 20 year old woman presented with a pituitary chromophobe adenoma for which she underwent transfrontal pituitary surgery. In 1978 she had to be reoperated on because of local tumour recurrence, resulting in hypopituitarism. Bromocriptine (5 mg/day) was given for 15 years, but the plasma prolactin levels remained elevated. In 2000 the patient presented with signs and symptoms suggestive of a spinal cord lesion at the mid-thoracic level. A magnetic resonance imaging (MRI) scan showed an extensive leptomeningeal mass extending from the brainstem to L5, with a thoracic syringomyelia at the T7–T8 level. The plasma prolactin level was very high (5114 μg/l). A biopsy showed the presence of a metastasised prolactinoma.

On administration of high dose cabergoline, 0.5 mg twice a day orally, the plasma prolactin levels decreased within one month and then normalised within 26 months. Tumour load reduced considerably but unfortunately, her signs and symptoms did not improve. This case illustrates that a high dose dopamine agonist might be an important therapeutic option in patients with a metastasised prolactinoma.

  • CSF, cerebrospinal fluid
  • MRI, magnetic resonance imaging
  • MRC, Medical Research Council
  • prolactinoma
  • cabergoline
  • dopamine agonists
  • syringomyelia

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  • Competing interests: none declared