Ahmed S R, Shalet S M
Clin Endocrinol (Oxf). 1986 Apr;24(4):421-6. doi: 10.1111/j.1365-2265.1986.tb01647.x.
A 19-year-old woman presented with headaches, temporal lobe epilepsy and primary amenorrhoea. There was a family history of multiple endocrine adenomatosis. Investigation revealed normal visual fields and acuity, hyperprolactinaemia (48 000 mU/l) and a very large pituitary tumour with extrasellar spread. Treatment with bromocriptine reduced the tumour size and the prolactin level to 2440 mU/l. Six months after the start of therapy, resistance to bromocriptine developed and the prolactin concentration progressively rose to pretreatment levels, despite increasing the dose of bromocriptine to 40 mg/d. At this stage treatment with a second dopamine agonist, pergolide, was effective in reducing the prolactin concentration to normal within four months. Serial CT scans at 1, 6 and 12 months on dopamine agonist therapy showed a progressive decrease in tumour size, which seemed to be maintained even during the period of rising prolactin concentrations due to bromocriptine resistance. This case illustrates that during dopamine agonist therapy a discrepancy may exist in the clinical response as judged by reduction in tumour size and decrease in the circulating prolactin level. Furthermore, in patients with prolactinomas, pergolide may induce a response when resistance to bromocriptine develops.
一名19岁女性出现头痛、颞叶癫痫和原发性闭经。有多重内分泌腺瘤病家族史。检查发现视野和视力正常，高泌乳素血症（48000 mU/l）以及一个非常大的垂体瘤并向鞍外扩散。用溴隐亭治疗后肿瘤大小缩小，泌乳素水平降至2440 mU/l。治疗开始6个月后，出现对溴隐亭的耐药，尽管将溴隐亭剂量增至40 mg/d，泌乳素浓度仍逐渐升至治疗前水平。在此阶段，换用第二种多巴胺激动剂培高利特治疗，4个月内有效将泌乳素浓度降至正常。在多巴胺激动剂治疗的1、6和12个月时进行的系列CT扫描显示肿瘤大小逐渐减小，即使在因对溴隐亭耐药导致泌乳素浓度上升期间，肿瘤大小似乎仍保持减小趋势。该病例表明，在多巴胺激动剂治疗期间，根据肿瘤大小缩小和循环泌乳素水平降低判断的临床反应可能存在差异。此外，在泌乳素瘤患者中，当出现对溴隐亭的耐药时，培高利特可能会诱导产生反应。
