I would appreciate your opinion about a case in which pituitary surgery has been indicated. A patient in his early 70s was diagnosed with a prolactinoma ten years ago. He was prescribed a tablet of Dostinex 0.5 mg per week, which was then reduced to 0.5 mg per two weeks. The prolactin levels went down, but tumor size was slowly increasing. He was evaluated this month, but his prolactin levels are still low, and the optic chiasma compression affects the visual fields. I would like to know if we can assume that his adenoma is drug-resistant even though the maximum dosage reported in the literature is 3.5 mg of Cabergoline per week. As his prolactin levels are low, will the tumor shrink on increasing the dose? The patient took a tablet of Sotalol and had a history of Wolf-Parkinson-White syndrome.
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Pituitary surgery is rarely required in prolactinomas and is generally reserved for patients intolerant or resistant to Dopamine agonist therapy, Cabergoline. Surgery is indicated only if visual field defects, headaches, and hypopituitarism are present. In addition, the tumor is resistant to the drug, so there will not be any benefit in increasing the drug dose.
Thank you doctor for the reply,
I would like to know if Cortisol is required before surgery, as they usually inject Hydrocortisone right before surgery, and dosage might depend on initial levels.
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It depends on the decision of your endocrine surgery team. Unfortunately, I am unaware of the patient's Adrenocorticotropic hormone (ACTH) and other pituitary hormone levels, so I might not be in a better position to judge the cortisol requirements at this point.
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