COMBINED CABERGOLINE AND RECOMBINANT HUMAN GROWTH-HORMONE TREATMENT OF AN ADOLESCENT WITH A MACROPROLACTINOMA CAUSING GH DEFICIENCY

The rare macroprolactinomas seen in childhood frequently cause delayed puberty and GH deficiency. We report the combined use of cabergoline and recombinant human GH (rhGH) therapy in a male adolescent with macr oprolactinoma and GH deficiency. Computed tomography and magnetic reso nance imaging of the hypothalamic-pituitary region showed a macroadeno ma with extrasellar extension. Neither bromocriptine nor dihydroergocr yptine therapy was successful in decreasing serum PRL levels. On caber goline treatment normal serum PRL levels were achieved within 3 months along with a marked shrinkage of the adenoma but growth rate did not increase nor did puberty start, The addition of exogenous rhGH therapy improved the growth rate, but complete pubertal development was obtai ned only after the administration of exogenous gonadotropins. During t he combined treatment no expansion of the macroadenoma was observed. T n conclusion, the combined therapy with cabergoline and rhGH seems to be safe and highly effective. Nevertheless, it warrants careful monito ring and on-going evaluation.