Giant prolactinoma: the sound of silence

Abstract

Prolactinomas typically present with oligoamenorrhea or galactorrhea in woman and headaches, visual changes or impotence in men with auditory symptoms being a rare presentation. We describe a case of a man who presented with bilateral hearing loss and was found to have a giant prolactinoma. Initial audiogram indicated an air-bone conduction gap suggesting a mixed sensorineural and conductive hearing loss. Measured prolactin was 3711.0 ng/mL and an a magnetic resonance revealed a 3.0×3.0×3.3 cm heterogeneously enhancing mass arising from the sella turcica compressing the left half of the optic chiasm. Several months after treatment, prolactin was 26 ng/mL and the patient reported marked improvement in his vision with mild improvement of his hearing. Although prolactinomas typically present with classic symptoms, one must be aware of unusual presentations. Further investigation is needed to access the correlation between prolactin and hearing loss, which may impact potential audiology screening for those with elevated prolactin.