Cataplexy in a patient treated for prolactinoma: Case report

Marina Nikolić-Djurović; Albero M. Pereira; Zvezdana Jeumović; Dragan Pavlović; Dragana Janković; Milan Petakov; Milorad Čivčić; Olga Vasović; Svetozar Damjanović

doi:10.2298/VSP160118102N

Marina Nikolić-Djurović Clinic of Endocrinology, Clinical Center of Serbia, dr Subotica 13, 11000 Belgrade
Albero M. Pereira Leiden University Medical Center, Department of Medicine, Division of Endocrinology, Leiden, The Netherlands
Zvezdana Jeumović Clinical Centre of Serbia, Clinic of Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
Dragan Pavlović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Dragana Janković Clinical Centre of Serbia, Clinic of Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
Milan Petakov Clinical Centre of Serbia, Clinic of Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Milorad Čivčić Clinical Centre of Serbia, Clinic of Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
Olga Vasović Institute for Gerontology and Palliative Care, Belgrade, Belgrade, Serbia
Svetozar Damjanović Clinical Centre of Serbia, Clinic of Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160118102N

Keywords: prolactinoma, pituitary neoplasms, cataplexy, comor-bidity, diagnosis, magnetic resonance imaging, genet-ics, medical, treatment outcome,

Abstract

Introduction. Isolated cataplexy, without the presence of narcolepsy, is a relatively rare condition, and can be regarded as attacks of motor inhibition with loss of muscle tone and areflexia. The diagnosis of cataplexy relies on the clinical presentation and medical history and it is rarely confirmed by video-polygraph. We here described a female patient treated for prolactinoma who developed isolated cataplexy. Case report. A 53-year-old female treated with bromocriptine for a macroprolactinoma presented with sudden episodes of weakness and toneless legs leading to falls and injuries on several occasions. Cardiovascular evaluation was completely normal. Psychiatric evaluation showed no psychotic phenomenology or suicidal ideas. Pituitary imaging showed empty sella with a remnant sellar mass with infra- and parasellar extension. Neurological examination revealed mild obstructive sleep hypopnea/apnea. Electroencephalographic monitoring during sleep and awakening did not show appearance of epi potentials. HLA haplotyping was positive for HLA-DR3,16;DR51;DQ1 allele, confirming a diagnosis of isolated cataplexy. Treatment included tricyclic antidepressants and reduction of bromocriptine dosage with resolution of cataplexy. Conclusion. We reported the first case of isolated cataplexy most probably associated with dopamine agonist treatment for prolactinoma.

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