Temozolomide in treatment resistant prolactinomas

We report a case of a 23-year-old gentleman, diagnosed with macroprolactinoma at age 14. He presented with bitemporal hemianopia and no other symptoms of prolactinoma. He underwent two trans-sphenoidal surgeries and subsequently developed panhypopituitarism requiring replacement therapy. Despite compliance and up titrated doses of cabergoline (maximum total dose of 12mg/week), resistant prolactin (PRL) levels up to 22614mU/L were noted. Trial of temozolomide combined with cabergoline showed prolactin levels that drastically declined over 16 weeks and remained stable at 52 weeks with significant radiological remission.