Pituitary Apoplexy during Cabergoline Therapy for Prolactinoma: A Rare but Serious Clinical Complication

Abstract

Pituitary apoplexy is an uncommon yet potentially life threatening endocrine and neurosurgical emergency characterized by hemorrhage or infarction within the pituitary gland, most frequently occurring in a pre-existing pituitary adenoma. Although prolactinomas are commonly managed conservatively with dopamine agonists, pituitary apoplexy has occasionally been reported during treatment with these medications. Cabergoline associated pituitary apoplexy remains particularly rare. We report the case of an 18-year-old male with macroprolactinoma who developed acute pituitary apoplexy during treatment with cabergoline. The patient initially presented with progressive visual impairment and was diagnosed with a pituitary macroadenoma associated with markedly elevated serum prolactin levels exceeding 2000 ng/mL. Medical therapy with cabergoline was initiated and gradually escalated over six months with serial hormonal monitoring. Although serum prolactin levels significantly decreased, the patient subsequently developed acute bifrontal headache and worsening visual disturbance one week after dose escalation. Computed tomography of the head demonstrated a hyperdense sellar and suprasellar lesion consistent with hemorrhagic transformation. Emergency endoscopic transnasal transsphenoidal decompression was performed. Intraoperatively, the tumor demonstrated hemorrhagic and necrotic components. Near-total tumor resection was achieved, and postoperative recovery was favorable with significant improvement in visual function. Histopathological examination confirmed pituitary adenoma. This case underscores the rare occurrence of pituitary apoplexy during cabergoline therapy and highlights the importance of close clinical and radiological surveillance in patients receiving dopamine agonists for macroprolactinomas. Early recognition and prompt surgical intervention may result in favorable neurological and visual outcomes.