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First demonstration of the effectiveness of peptide receptor radionuclide therapy (PRRT) with 111In-DTPA-octreotide in a giant PRL-secreting pituitary adenoma resistant to conventional treatment


In prolactin-secreting giant adenomas, cabergoline treatment is the first line approach. Surgery and/or radiotherapy are indicated when the tumour is resistant to medical treatment and continues growing, causing visual field impairment. Data concerning other therapeutic approach are scanty. Although PRL-secreting tumours may express somatostatin receptors type 2, 3 and 5, somatostatin analogs treatment is generally ineffective and peptide receptor radionuclide therapy (PRRT) has never been reported. A 58 year-old woman complaining of severe neurological symptoms caused by a giant prolactinoma, relapsing after surgery and not-responding to dopamine-agonists and octreotide LAR treatment, underwent four cycles of PRRT with 111-Indium-DTPA-octreotide with remarkable tumour shrinkage and a significant improvement in clinical conditions. No side effects were reported. This is the first report on the effectiveness and safety of PRRT with radio-labelled somatostatin analogs in a patient with aggressive giant prolactinoma resistant to conventional treatment.

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  1. Colao A, Di Sarno A, Pivonello R, Di Somma C, Lombardi G (2002) Dopamine receptor agonists for treating prolactinomas. Expert Opin Investig Drugs 11:787–800

    PubMed  Article  CAS  Google Scholar 

  2. Colao A (2009) Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Metab 23:575–596

    PubMed  Article  CAS  Google Scholar 

  3. Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27(5):485–534

    PubMed  Article  CAS  Google Scholar 

  4. Acosta-Gómez MJ, Muros MA, Llamas-Elvira JM, Ramírez A, Ortega S, Sabatel G, Ramos C, de la Riva-Aguilar A (2005) The role of somatostatin receptor scintigraphy in patients with pituitary adenoma or post-surgical recurrent tumours. Br J Radiol 78(926):110–115

    PubMed  Article  Google Scholar 

  5. Jaquet P, Ouafik L, Saveanu A, Gunz G, Fina F, Dufour H, Culler MD, Moreau JP, Enjalbert A (1999) Quantitative and functional expression of somatostatin receptor subtypes in human prolactinomas. J Clin Endocrinol Metab 84(9):3268–3276

    PubMed  Article  CAS  Google Scholar 

  6. Corsello SM, Ubertini G, Altomare M, Lovicu RM, Migneco MG, Rota CA, Colosimo C (2003) Giant Prolactinomas in men: efficacy of cabergoline treatment. Clin Endocrinol 58:662–670

    Article  CAS  Google Scholar 

  7. Shimon I, Benbassat C, Hadani M (2007) Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men. Eur J Endocrinol 156(2):225–231

    PubMed  Article  CAS  Google Scholar 

  8. Acharya SV, Gopal RA, Menon PS, Bandgar TR, Shah NS (2010) Giant prolactinoma and effectiveness of medical management. Endocr Pract 16(1):42–46

    PubMed  Article  Google Scholar 

  9. Cannavò S, Bartolone L, Blandino A, Spinella S, Galatioto S, Trimarchi F (1999) Shrinkage of a PRL-secreting pituitary macroadenoma resistant to cabergoline. J Endocrinol Invest 22(4):306–309

    PubMed  Google Scholar 

  10. Byrne S, Karapetis C, Vrodos N (2009) A novel use of temozolomide in a patient with malignant prolactinoma. J Clin Neurosci 16(12):1694–1696

    PubMed  Article  Google Scholar 

  11. Lau Q, Scheithauer B, Kovacs K, Horvath E, Syro LV, Lloyd R (2010) MGMT immunoexpression in aggressive pituitary adenoma and carcinoma. Pituitary 13(4):367–379

    PubMed  Article  Google Scholar 

  12. Greenman Y, Melmed S (1994) Expression of three somatostatin receptor subtypes in pituitary adenomas: evidence for preferential SSTR5 expression in the mammosomatotroph lineage. J Clin Endocrinol Metab 79:724–729

    PubMed  Article  CAS  Google Scholar 

  13. Thodou E, Kontogeorgos G, Theodossiou D, Pateraki M (2006) Mapping of somatostatin receptor types in GH or/and PRL producing pituitary adenomas. J Clin Pathol 59:274–279

    PubMed  Article  CAS  Google Scholar 

  14. Ur E, Mather SJ, Bomanji J, Ellison D, Britton KE, Grossman AB, Wass JA, Besser JM (1992) Pituitary imaging using a labelled somatostatin analogue in acromegaly. Clin Endocrinol (Oxf) 36(2):147–150

    Article  CAS  Google Scholar 

  15. Boni G, Ferdeghini M, Bellina CR, Matteucci F, Castro Lopez E, Parenti G, Canapicchi R, Bianchi R (1995) [111In-DTPA-D-Phe]-octreotide scintigraphy in functioning and non-functioning pituitary adenomas. Q J Nucl Med 39:90–93

    PubMed  CAS  Google Scholar 

  16. de Herder WW, Kwekkeboom DJ, Reijs AEM (1996) Receptor scintigraphy with somatostatin analogues and dopamine antagonists of pituitary tumours. In: Von Werder K, Fahlbusch R (eds) Pituitary adenomas. From basic research to diagnosis and therapy. Elsevier, Amsterdam, pp 93–104

    Google Scholar 

  17. Rieger A, Rainov NG, Elfrich C, Klaua M, Meyer H, Lautenschlager C, Burkert W, Mende T (1997) Somatostatin receptor scintigraphy in patients with pituitary adenoma. Neurosurg Rev 20(1):7–12

    PubMed  Article  CAS  Google Scholar 

  18. Kwekkeboom DJ, de Herder WW, Krenning EP (1999) Receptor imaging in the diagnosis and treatment of pituitary tumors. J Endocrinol Invest 22(1):80–88

    PubMed  CAS  Google Scholar 

  19. Colao A, Lastoria S, Ferone D, Varrella P, Marzullo P, Pivonello R, Cerbone G, Acampa W, Salvatore M, Lombardi G (1999) The pituitary uptake of (111)In-DTPA-D-Phe1-octreotide in the normal pituitary and in pituitary adenomas. J Endocrinol Invest 22(3):176–183

    PubMed  CAS  Google Scholar 

  20. Moulik PK, Varma TRK, Vora JP, Vinjamuri S (2002) The role of somatosatin receptor scintigraphy in the management of pituitary tumours. Nucl Med Commun 23:117–120

    PubMed  Article  CAS  Google Scholar 

  21. Plockinger U, Bader M, Hopfenmuller W, Saeger W, Quabbe HJ (1997) Results of somatostatin receptor scintigraphy do not predict pituitary tumor volume- and hormone-response to octreotide therapy and do not correlate with tumor histology. Eur J Endocrinol 136(4):369–376

    PubMed  Article  CAS  Google Scholar 

  22. Ferone D, Pivonello R, Lastoria S, Faggiano A, Ferone D, Lombardi G, Fenzi G (2001) In vivo and in vitro effects of octreotide, quinagolide and cabergoline in four hyperprolactinaemic acromegalics: correlation with somatostatin and dopamine D2 receptor scintigraphy. Clin Endocrinol (Oxf) 54(4):469–477

    Article  CAS  Google Scholar 

  23. Fusco A, Gunz G, Jacquet P, Dufour H, Germanetti AL, Culler MD, Barlier A, Saveanu A (2008) Somatostatinergic ligands in dopamine-sensitive and resistant prolactinomas. Eur J Endocrinol 158:599–603

    Article  Google Scholar 

  24. Hofland LJ, Feelders RA, de Herder WW, Lamberts SW (2010) Pituitary tumours: the sst/D2 receptors as molecular targets. Mol Cell Endocrinol 326:89–98

    PubMed  Article  CAS  Google Scholar 

  25. Meyer P, Bohnen NI, Barkan AL, Shapiro B (1999) Somatostatinrezeptorszintigraphie bei einem Patienten mit invasivem Makroprolaktinom. Somatostatin receptor scintigraphy of a patient with a giant invasive prolactinoma. Nuklearmedizin 38(2):66–67

    PubMed  CAS  Google Scholar 

  26. Fusco A, Lugli F, Sacco E, Tilaro L, Bianchi A, Angelini F, Tofani A, Barini A, Lauriola L, Maira G, Pontecorvi A, de Marinis L (2009) Efficacy of the combined cabergoline and octreotide treatment in a case of a dopamine-agonist resistant macroprolactinoma. Pituitary [Epub ahead of print]

  27. de Herder WW, Ferone D, Kwekkeboom D, Lamberts SWJ (2000) Scintigraphy of pituitary tumors. In: de Herder WW (ed) Functional and morphological imaging of the endocrine system, Endocrine Updates Series. Kluwer, Boston, pp 47–58

    Chapter  Google Scholar 

  28. de Herder WW, Lamberts SWJ (2005) Somatostatin analogs as radiodiagnostic tools. Rev Endocr Metab Disord 6:23–27

    PubMed  Article  Google Scholar 

  29. de Herder WW, Kwekkeboom DJ, Feelders RA, van Aken MO, Lamberts SW, van der Lely AJ, Krenning EP (2006) Somatostatin receptor imaging for neuroendocrine tumors. Pituitary 9:243–248

    PubMed  Article  Google Scholar 

  30. Goglia U, Ferone D, Sidoti M, Spaziante R, Dadati P, Ravetti JL, Villa G, Bodei L, Paganelli G, Minuto F, Giusti M (2008) Treatment of a pituitary metastasis from a neuroendocrine tumour: case report and literature review. Pituitary 11(1):93–102

    PubMed  Article  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to F. Ferraù.

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S. Baldari, F. Ferraù, and C. Alafaci contributed equally to the paper.

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Baldari, S., Ferraù, F., Alafaci, C. et al. First demonstration of the effectiveness of peptide receptor radionuclide therapy (PRRT) with 111In-DTPA-octreotide in a giant PRL-secreting pituitary adenoma resistant to conventional treatment. Pituitary 15 (Suppl 1), 57–60 (2012).

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  • Giant prolactinoma
  • PRL-secreting pituitary adenoma
  • Cabergoline resistance
  • Peptide receptor radionuclide therapy
  • 111Indium-DTPA-octreotide