2025 Clinician Corner - Long-term survival in a patient with metastatic prolactinoma: a 12-year follow-up

Abstract 

Metastatic prolactinomas are an extremely rare type of neuroendocrine tumors, comprising <0.2% of all pituitary tumors. These tumors are typically associated with poor prognosis, with an average survival of 10 months. Temozolomide, an alkylating chemotherapy agent, has previously been shown to be effective in treating these rare cases once first-line medical and surgical therapies have failed. We present a patient with metastatic prolactinoma to the cerebellopontine angle, thoracic spine, and lumbar spine who has achieved 12 years of survival with clinical improvement and stabilization after 4 years of temozolomide therapy.    

Keywords:  Lactotroph-secreting pituitary carcinoma; pituitary neoplasm; prolactinoma; temozolomide 

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on November 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Recommend treatment option for patients with prolactinomas and metastatic spread of disease
  • Identify the indications for temozolomide treatment in the setting of metastatic prolact8noma

Key Points 

  • Metastatic prolactinomas are extremely rare but aggressive entities within the spectrum of pituitary tumors, comprising 0.1% to 0.2% of all pituitary tumors. 
  • Metastatic prolactinomas are often indistinguishable from aggressive benign adenomas until metastases are detected. The prognosis for patients with metastatic prolactinomas is generally poor, with a mean survival time of around 10 months following the diagnosis of metastatic spread. 
  • Temozolomide is an alkylating chemotherapy agent used as an off-label treatment for metastatic prolactinoma, although patients’ responses to therapy can vary significantly.  

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
11/01/2025
Course expires: 
11/01/2026
Cost:
$25.00
Rating: 
0
  • William J. Hlavinka, BS - Department of Medical Education, Texas A&M School of Medicine/Baylor University Medical Center, Dallas, Texas, USA 
  • Robert H. Mbilinyi, MS - Department of Medical Education, Texas A&M School of Medicine/Baylor University Medical Center, Dallas, Texas, USA 
  • Tarun R. Sontam, BS - Department of Medical Education, Texas A&M School of Medicine/Baylor University Medical Center, Dallas, Texas, USA 
  • Emmanuel C. Mantilla Jr., DO - Baylor Scott & White Neuro-Oncology Associates, Dallas, Texas, USA 
  • Divya B. Mella, MD - Baylor Scott & White Neuro-Oncology Associates, Dallas, Texas, USA 

Corresponding author: Divya B. Mella, MD, Baylor Scott & White Neuro-Oncology Associates, 3410 Worth St., Ste. 820, Dallas, TX 75246 (e-mail: [email protected]) 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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