Concomitant Cushing's Disease and Marked Hyperprolactinemia: Response to a Dopamine Receptor Agonist

Jun Shiraishi; Hidenori Koyama; Manabu Shirakawa; Reiichi Ishikura; Hirokazu Okazaki; Masafumi Kurajoh; Takuhito Shoji; Yuji Moriwaki; Tetsuya Yamamoto; Mitsuyoshi Namba

doi:10.2169/internalmedicine.55.5301

CASE REPORTS

Concomitant Cushing's Disease and Marked Hyperprolactinemia: Response to a Dopamine Receptor Agonist

Jun Shiraishi, Hidenori Koyama, Manabu Shirakawa, Reiichi Ishikura, Hirokazu Okazaki, Masafumi Kurajoh, Takuhito Shoji, Yuji Moriwaki, Tetsuya Yamamoto, Mitsuyoshi Namba

Author information

Jun Shiraishi
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Hidenori Koyama
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Manabu Shirakawa
Department of Neurosurgery, Hyogo College of Medicine, Japan
Reiichi Ishikura
Department of Radiology, Hyogo College of Medicine, Japan
Hirokazu Okazaki
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Masafumi Kurajoh
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Takuhito Shoji
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Yuji Moriwaki
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Tetsuya Yamamoto
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan
Mitsuyoshi Namba
Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Japan

Keywords: bihormonal pituitary adenoma, ACTH, prolactin, Cushing's disease, hyperprolactinemia, dopaminergic agonist

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 8 Pages 935-941

DOI https://doi.org/10.2169/internalmedicine.55.5301

Details

Abstract

A 38-year-old woman was admitted to our hospital because of amenorrhea, multiple bone fractures, and a Cushingoid appearance. Endocrinological investigations revealed that she had co-existing Cushing's disease and prolactinoma, with a serum level of prolactin (PRL) at 1,480 ng/mL, corticotropin (ACTH) at 81.3 pg/mL, and cortisol at 16.6 μg/dL. Due to the lack of indication for transsphenoidal surgery, cabergoline monotherapy was initiated. A 6-month course of treatment resulted in only subtle amelioration of hypercortisolism, while hyperprolactinemia was dramatically improved. In 5 cases of bihormonal (ACTH/PRL) pituitary macroadenoma reported in the English literature, 2 were initially treated with dopaminergic agonists with substantial effectiveness for both PRL and ACTH. We herein report an extremely rare case of bihormonal macroadenoma in which only PRL was responsive to treatment.

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