GIANT PROLACTINOMA- CASE REPORT
Date Issued
2022
Author(s)
Biljana Todorova
Abstract
Introduction: Giant prolactinomas are rare tumors of pituitary gland with incidence in all prolactinomas of 1-5 %, with dimensions grater then 4 sm and hyperprolactinemia (1000 ng/ml).
They present with symptoms of hyperprolactinemia and neuro-ophthalmological symptoms as a result of the compressive and invasive effect of the tumor.
Case report: A 44-year-old male patient presented in our hospital to report decreased libido and erection for the last 12 months. Since 6 months ago, the patient has had intense headaches, decreased and double vision.
Frоm hormonal analyzes: PRL-1050 ng/ml,TSH-3,63 mU/l, fT4-11,0 pmol/l, cortisol-357 nmol/l, ACTH-20 pg/ml, FSH-2,12 mU/ml, LH-1,78 mU/ml, testosteron- 3,63 nmol/l.
MRI of the pituitary gland: parasellar and suprasellar mass with dimensions of 65x56mm, compression of thе optic chiasma and hypothalamus with protrusion into the sphenoid sinus and invasion of the bilateral cavernous sinuses.
Ophthalmological examination: perimetry with initial focal outbursts.
Fundus examination: PNO, ML and blood vessels -normal finding.
We made a consultation with a neurosurgeon and cabergoline 2 mg per week was started.
After 12 months of therapy we made MRI of the pituitary gland and we found macroadenoma 16x9mm, prolactin 22 ng/ml, testosterone-3.1 We continue with the medical treatment and testosterone therapy was started.
Discussion:
Dopamine agonist therapy as the first line of treatment in giant prolactinomas leads to improvement of vision, normalization of prolactin levels and a significant reduction in the size of the tumor mass, in our case 74%. Some of the patients also need testosterone replacement therapy due to damage to the gonadotropic cells from the long-term mass effect of the tumor.
Conculusion:
In almost all patients is required continuous dopamin agonist treatment to maintain prolactin supresion and prevent recidiv. Resistant prolactinomas can be treated with surgery, radiotherapy, temozolomide.
They present with symptoms of hyperprolactinemia and neuro-ophthalmological symptoms as a result of the compressive and invasive effect of the tumor.
Case report: A 44-year-old male patient presented in our hospital to report decreased libido and erection for the last 12 months. Since 6 months ago, the patient has had intense headaches, decreased and double vision.
Frоm hormonal analyzes: PRL-1050 ng/ml,TSH-3,63 mU/l, fT4-11,0 pmol/l, cortisol-357 nmol/l, ACTH-20 pg/ml, FSH-2,12 mU/ml, LH-1,78 mU/ml, testosteron- 3,63 nmol/l.
MRI of the pituitary gland: parasellar and suprasellar mass with dimensions of 65x56mm, compression of thе optic chiasma and hypothalamus with protrusion into the sphenoid sinus and invasion of the bilateral cavernous sinuses.
Ophthalmological examination: perimetry with initial focal outbursts.
Fundus examination: PNO, ML and blood vessels -normal finding.
We made a consultation with a neurosurgeon and cabergoline 2 mg per week was started.
After 12 months of therapy we made MRI of the pituitary gland and we found macroadenoma 16x9mm, prolactin 22 ng/ml, testosterone-3.1 We continue with the medical treatment and testosterone therapy was started.
Discussion:
Dopamine agonist therapy as the first line of treatment in giant prolactinomas leads to improvement of vision, normalization of prolactin levels and a significant reduction in the size of the tumor mass, in our case 74%. Some of the patients also need testosterone replacement therapy due to damage to the gonadotropic cells from the long-term mass effect of the tumor.
Conculusion:
In almost all patients is required continuous dopamin agonist treatment to maintain prolactin supresion and prevent recidiv. Resistant prolactinomas can be treated with surgery, radiotherapy, temozolomide.
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