Excellent response to pasireotide therapy in an aggressive and dopamine resistant prolactinoma.
Prolactinomas are the most commonly encountered pituitary adenomas in the clinical setting. While most can be controlled by dopamine agonists, a subset of prolactinomas are dopamine resistant and very aggressive. In such tumors, the treatment of choice is neurosurgery and radiotherapy, with or without temozolomide. Here, we report a patient with an highly aggressive, dopamine resistant prolactinoma, who only achieved biochemical and tumor control during pasireotide long acting release (PAS LAR) therapy a second generation somatostatin receptor ligand (SRL) Interestingly, cystic degeneration, tumor cell necrosis, or both was observed after PAS LAR administration suggesting an antitumor effect. This case shows that PAS LAR therapy holds clinical potential in selective aggressive, dopamine resistant prolactinomas that express somatostatin (SST) receptor subtype 5 and appears to be a potential new treatment option before starting temozolomide. In addition, PAS LAR therapy may induce cystic degeneration, tumor cell necrosis, or both in prolactinomas.
European journal of endocrinology