Pregnancy, Ptosis, and a Prolactinoma: Prompt Neurological Recovery After Cabergoline Therapy

Abstract

Introduction: Pituitary macroprolactinomas pose unique challenges during pregnancy, as there is an increasing chance of tumor growth while medical therapy raises concerns about fetal safety. Neuro-ophthalmic deficits, particularly isolated ptosis, are exceedingly rare but may signal acute disease progression.

Case Summary: We describe a young pregnant woman with a history of hyperprolactinemia and primary hypothyroidism, previously controlled on Levothyroxine and Cabergoline. Following conception, she discontinued all treatment. At two months’ gestation, she presented with sudden-onset, complete left-sided ptosis. MRI of the sella revealed a pituitary macroadenoma with suprasellar extension and mass effect. She was admitted to the neurosurgery department with the plan for surgical intervention. But following endocrine consultation, Cabergoline therapy was reinstated. Remarkably, her ptosis improved after just two doses and resolved completely within days. Repeat imaging demonstrated significant tumor shrinkage.

Discussion: Prolactinomas are well known for their excellent response to dopamine agonists. Cabergoline acts by suppressing prolactin secretion, and inducing tumor shrinkage. The dramatic resolution of ptosis in this patient after a two doses of Cabergoline reflects the well-known sensitivity of prolactinomas to medical therapy and the rapid decompressive effect. Pregnancy poses additional challenges in such case, as discontinuation of therapy may allow tumor growth due to estrogen-induced lactotroph hyperplasia. Cranial nerve palsies, although rare, may occur due to lateral extension of macroprolactinoma into the cavernous sinus, compressing the oculomotor nerve as described in this case. Current guidelines recommend continuation or careful monitoring of dopamine agonists in patients with macroprolactinomas during pregnancy.

Conclusion: This case demonstrates the unique scenario of isolated ptosis due to macroprolactinoma in pregnancy and the dramatic therapeutic effect of Cabergoline. It underscores the need for vigilance in monitoring prolactinomas during pregnancy and supports the judicious use of dopamine agonists in patients to achieve rapid neurological recovery.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp. 229-230