GIANT PROLACTINOMA- CASE REPORT

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.