Bromocriptine or cabergoline induced pituitary apoplexy: Rare but life-threatening catastrophe

Sir,

Prolactin secreting pituitary tumor is one of the common causes of infertility in males and females.[1] Prolactin level is also high in non-prolactin secreting pituitary adenoma (e.g., growth hormone secreting) due to stalk effect.[2] Most of the prolactinomas can be managed medically with bromocriptine or cabergoline which are largely used as primary treatment for prolactinomas, as they help to normalize serum prolactin levels and induce reduction in the tumor size, promoting restoration of gonadal function, cessation of galactorrhea and improvement in visual defects in the majority of patients.[1,2] Bromocriptine or cabergoline induced pituitary apoplexy is a life-threatening complication which is rare but well known.[2–5] This condition is characterized by sudden onset of headache, visual loss or deterioration, meningismus, altered mental status, and rarely, even death.[1,2] This pathology is caused by hemorrhagic necrosis of tumor or pituitary gland infarction, in which pituitary function is compromised, necessitating rapid administration of corticosteroids and endocrine evaluation.[1] Rapid surgical decompression is required if there is sudden constriction of visual fields, and/or rapid deterioration of acuity, or neurological deterioration due to hydrocephalus.[1,2] These reports point toward the possibility of bromocriptine or cabergoline induced pituitary apoplexy, which should be kept in mind when a patient is neurologically deteriorating after starting these drugs. Careful follow-up is required when treatment with bromocriptine or cabergoline is attempted for prolactinoma in reproductive medicine clinic for infertility management in male and female patients.