An Unusual Complication of Cabergoline Treatment of Macroprolactinomas

Dopamine agonist (DA) treatment is the first choice treatment of prolactinomas. Optic chiasm prolapse with secondary visual deterioration is an unusual and rare complication of DA treatment. A 40-year-old man with giant prolactinoma was successfully treated by cabergoline. After 14 months, he presented with a visual impairment with no ophthalmologic anomalies that could explain this worsening. The pituitary magnetic resonance imaging (MRI) revealed an important shrinkage of prolactinoma with a prolapse and a central atrophy of optic chiasm secondary to the adenoma shrinkage. This case highlights the need of regular assessment of visual field all along cabergoline treatment of macroprolactinomas despite initial improvement or even normalization of visual field, to promptly identify an optic chiasm prolapse and avoid the optic chiasm atrophy. J Endocrinol Metab. 2021;11(2):52-55 doi: https://doi.org/10.14740/jem730