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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(02): e66-e73
DOI: 10.1055/s-0044-1786740
Case Report

The Effect of Preoperative Cabergoline on Prolactinoma Fibrosis: A Case Series

Isabella L. Pecorari 
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Eros Qama
3   Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Department of Pathology, Montefiore Medical Center, Bronx, New York, United States
,
Nadeem Akbar
5   Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
6   Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Patrick Colley
5   Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
6   Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Christina H. Fang
5   Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
6   Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Vijay Agarwal
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
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Abstract

Introduction Prolactinomas are a common intracranial neoplasm and constitute most pituitary tumors. Although patients can present with variable hormone dysregulation and symptom severity, the use of dopamine agonists remains a first-line treatment. While bromocriptine has been found to increase tumor fibrosis, the effect of cabergoline on collagen deposition has been disputed. The aim of this article is to understand the influence of cabergoline on tumor fibrosis prior to resection.

Case Presentations Four male patients who underwent prolactinoma resection were included in this report. The average age was 39.8 years (range: 26–52 years). Pre-treatment prolactin levels ranged from 957.8 to 16,487.4 ng/mL. Three patients received cabergoline for at least 1 month prior to surgery (treatment range: 1–6 months). One patient had surgery without prior cabergoline use. Pathology reports confirmed each tumor to be of lactotroph origin. For each sample, Masson's trichrome staining was performed and the percentage of sample fibrosis was quantified using an artificial intelligence imaging software. Among those who received preoperative cabergoline, the extent of tumor fibrosis was in the range of 50 to 70%. In contrast, specimen fibrosis was approximately 15% without cabergoline use.

Conclusion This report demonstrates that a short duration of preoperative cabergoline can cause significant prolactinoma fibrosis. Understanding the effect of cabergoline on tumor consistency prior to surgery is essential as increased fibrosis can lead to more difficult tumor removal, reduce the extent of resection, and increase surgical complications. Considering these effects, further studies regarding the use of surgery prior to cabergoline for prolactinoma management are warranted.

Keywords

cabergoline - pituitary neuroendocrine tumors - prolactinoma - neurosurgery - neuroendocrinology


Publication History

Received: 19 January 2024

Accepted: 08 March 2024

Article published online:
15 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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