Treatment of aggressive prolactinoma with temozolomide

Rationale: Aggressive pituitary adenomas and pituitary carcinomas are rare and demand multiple treatment strategies. Temozolomide, an orally active alkylating chemotherapeutic agent, has recently been recommended as a salvage medication for refractory pituitary adenomas or carcinomas. Patient concerns: A 17-year-old male presenting with aggressive prolactinoma that continued to progress despite surgery, gamma knife, and dopamine agonists. Diagnoses: The diagnosis of refractory aggressive prolactinoma was made on the basis of clinical findings and the lack of efficacy of conventional treatment. Interventions: The patient received the most frequently recommended regimen of temozolomide treatment for 22 cycles. Outcomes:Temozolomide resulted in a remarkable shrinkage of tumor mass and inhibition of prolactin secretion and this patient’s clinical condition improved progressively. Lessons: Temozolomide can be used as a salvage treatment to refractory pituitary tumors and o(6)-methylguanine-DNA methyltransferase (MGMT) status is a significant predictor to the effectiveness of temozolomide based on the existing literature. Abbreviations: ACTH = adrenocorticotrophic hormone, FSH = follicle-stimulating hormone, GH = growth hormone, MGMT = O (6)-methylguanine-DNA methyltransferase, MRI = magnetic resonance imaging, PRL = prolactin, TSH = thyroid-stimulating hormone, VEGF = vascular endothelial growth factor.