Bromokriptin direnci olan makroprolaktinomalı bir hastada kabergolin tedavisi ile oluşan gebelik : olgu sunumu
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Bromokriptin ve kabergolin prolaktinoma tedavisinde kullanılan en yaygın dopamin agonistleridir. Dopamin agonistlerine direnç %10-15 civarında görülmektedir. Kliniğimize amenore ve baş ağrısı şikayeti ile başvuran 19 yaşında kadın hastaya yapılan tetkikler sonucu makroprolaktinoma tanısı konuldu. Başlangıç tedavisine kabergolin ile yanıt alınan hastanın takibinde gebelik istemi olması nedeniyle ilacı kesilip bromokriptin tedavisine geçildi. Bromokriptin 15 mg/gün yaklaşık 1 yıl kullanan hastada tedaviye cevapsızlık görüldüğü için bromokriptin direnci düşünülerek kabergolin tedavisine tekrar geçildi. Kabergolin tedavisi altında gebelik oluşan bu vakada, bromokriptin direncinin makroprolaktinoma takip ve tedavisini güçleştirebileceği ve direnç gelişen hastalarda alternatif ilaçlara geçilerek başarının sağlanabileceği vurgulanmak istenmiştir.
Bromocriptine and cabergoline are the most preferred dopamine agonists in the therapy of prolactinomas. Primary resistance to dopamine agonists is usually seen in 10-15 % of the patients. Here, we described a case of a 19 year-old woman who was presented with amenorrhea and headache and then was diagnosed with macroprolactinoma. She was initially treated with cabergoline with a perfect response. We had switched cabergoline to bromocriptine because of the desire for pregnancy. After one year of 15 mg/day of bromocriptine treatment, the patient reported irregular menses with elevated prolactin levels. There with we changed bromocriptine to cabergoline because the cabergoline response was perfect at the beginning. We would like to emphasize that the resistance to bromocriptine therapy is not uncommon and may complicate the follow up of the patients with prolactinomas and in case of resistance, it is important to keep in mind to switch agents.
Bromocriptine and cabergoline are the most preferred dopamine agonists in the therapy of prolactinomas. Primary resistance to dopamine agonists is usually seen in 10-15 % of the patients. Here, we described a case of a 19 year-old woman who was presented with amenorrhea and headache and then was diagnosed with macroprolactinoma. She was initially treated with cabergoline with a perfect response. We had switched cabergoline to bromocriptine because of the desire for pregnancy. After one year of 15 mg/day of bromocriptine treatment, the patient reported irregular menses with elevated prolactin levels. There with we changed bromocriptine to cabergoline because the cabergoline response was perfect at the beginning. We would like to emphasize that the resistance to bromocriptine therapy is not uncommon and may complicate the follow up of the patients with prolactinomas and in case of resistance, it is important to keep in mind to switch agents.
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