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Prolactin-secreting pituitary carcinomas with intra- and extracranial metastasis: case report and review

Published on Saturday, 08 February 2025

Abstract

According to the modern WHO classification, pituitary carcinomas (or metastatic neuroendocrine pituitary tumors) are pituitary tumors with confirmed craniospinal and/or distant metastases. The main goal of histological analysis of pituitary carcinomas is to confirm pituitary origin of metastases. Treatment usually includes surgery and radiotherapy, dopamine agonists in maximum possible doses in case of prolactin-secreting pituitary carcinomas and chemotherapy with preferable temozolomide.

Objective: To present the results of diagnosis and treatment of two patients with prolactin-secreting pituitary carcinomas.

Material and methods: The authors describe 2 patients with prolactin-secreting pituitary carcinomas arising from drug-resistant aggressive prolactinomas with histologically confirmed metastases. In both cases, combined treatment included surgery, radio- and chemotherapy (cabergoline and temozolomide).

Results: A 47-year-old patient underwent surgery, radio- and dopamine agonist therapy with subsequent regression of tumor growth in the follow-up period. However, progressive increase in prolactin concentration necessitated PET/CT with detection of multiple metastases in bones and lymph nodes. Temozolomide therapy led to temporary shrinkage of metastatic foci with subsequent progression. The second case was characterized by multiple brain and spinal cord metastases in a 47-year-old woman. Resection of intracranial metastasis and temozolomide therapy stabilized the disease and normalized serum prolactin throughout 2-year follow-up with subsequent progression.

Conclusion: Pituitary carcinoma is a rare tumor with unfavorable prognosis. Treatment is currently not standardized and determined by available world experience regarding various chemotherapeutic drugs. Temozolomide is the most effective drug. However, short-term remission is usually followed by subsequent disease progression in most cases.

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About this publication.

The Di Bella's Method: Use of Bromocriptine and/or Cabergoline w./w.o. Temozolomide (together with others chemical compounds) in Brain/Head&Neck Cancers:

- A retrospective observational study on cases of anaplastic brain tumors treated with the Di Bella Method: A rationale and effectiveness;

- Recurrent Glioblastoma Multiforme (grade IV – WHO 2007): a case of complete objective response achieved by means of the concomitant administration of Somatostatin and Octreotide – Retinoids – Vitamin E – Vitamin D3 – Vitamin C – Melatonin – D2 R agonists (Di Bella Method – DBM) associated with Temozolomide;

- The Di Bella Method DBM improved survival objective response and performance status in a retrospective observational clinical study on 23 tumours of the head and neck;

- The Di Bella Method (A Fixed Part - Bromocriptine and/or Cabergoline);

- Prolactin inhibitors in oncology - In vitro, review and in vivo publications;

- The Di Bella Method (A Fixed Part - Cyclophosphamide 50mg tablets and/or Hydroxyurea 500mg tablets, one or two per day);

- The Di Bella Method (A Fixed Part - Dihydrotachysterol, Alfacalcidol, synthetic Vitamin D3);

- Vitamin D (analogues and/or derivatives) and cancer - In vitro, review and in vivo publications;

- The Di Bella Method (A Fixed Part - Calcium, 2 grams per day, orally);

- The Di Bella Method (A Fixed Part - Somatostatin, Octreotide, Sandostatin LAR, analogues and/or derivatives);

- Somatostatin in oncology, the overlooked evidences - In vitro, review and in vivo publications;

- Publication, 2018 Jul: Over-Expression of GH/GHR in Breast Cancer and Oncosuppressor Role of Somatostatin as a Physiological Inhibitor (from Di Bella's Foundation);