September 2026

ENDOCRINOLOGY

CASE REPORT: TREATMENT-RESISTANT PROLACTINOMA MANAGED SURGICALLY TO SUPPORT FERTILITY

Featuring: Vijay G. Eranki, MD,  Wenyu Huang, MD, PhD, Stephen T. Magill, MD, PhD, Kevin C. Welch, MD
Most prolactinomas respond well to dopamine agonist therapy, but a subset of patients present with clinical, biochemical and radiographic findings that challenge conventional management.

A 32-year-old woman presented with persistent hyperprolactinemia, galactorrhea, amenorrhea and infertility following childbirth. While laboratory findings strongly suggested a prolactinoma, the initial MRI was inconclusive. Despite an initial response to cabergoline, prolactin levels later increased and symptoms returned, raising concerns about treatment resistance and prompting repeat evaluation.

A repeat MRI approximately one year later revealed a 5 x 3-millimeter pituitary microadenoma, supporting the suspected diagnosis. Given the patient's fertility goals and suboptimal response to medical therapy, endocrinologists Vijay G. Eranki, MD, and Wenyu Huang, MD, PhD, worked with Neurosurgeon Stephen T. Magill, MD, PhD, and Otolaryngologist Kevin C. Welch, MD, to reevaluate treatment options.

Given the resistance of the patient’s prolactinomas to cabergoline, a multidisciplinary evaluation supported surgical intervention to normalize prolactin, support fertility goals and preserve pituitary function. The patient subsequently underwent endoscopic endonasal resection of the tumor by Dr. Magill, with Dr. Welch providing surgical access through the nose.

After surgery, prolactin levels normalized and pituitary function was preserved. Within weeks, her menstrual cycle returned and she discovered she was pregnant; she later delivered a healthy baby.

The case underscores the importance of continued evaluation when clinical suspicion remains high despite negative imaging and demonstrates how multidisciplinary collaboration between endocrinology, neurosurgery and otolaryngology can help tailor individualized treatment for patients with complex pituitary disease.
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Key Clinical Takeaways
  • Persistent hyperprolactinemia may warrant ongoing surveillance, even when initial MRI findings are inconclusive.
  • Not all prolactinomas respond adequately to dopamine agonist therapy.
  • Repeat imaging can be valuable when biochemical and clinical findings remain discordant with radiographic results.
  • Multidisciplinary collaboration among endocrinology, neurosurgery and otolaryngology can help identify individualized treatment strategies for complex patients.
  • In select cases, surgery may offer a path to remission for prolactinoma while preserving normal pituitary function and supporting reproductive goals.
​Vijay Eranki, MD, endocrinologist at Northwestern Medicine
​Wenyu Huang, MD, PhD, Associate Professor, Endocrinology at Northwestern Medicine
​Stephen Magill, MD, PhD, Assistant Professor, Neurological Surgery at Northwestern Medicine
​Kevin Welch, MD, Professor, Otolaryngology - Head and Neck Surgery at Northwestern Medicine

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