Prolactinoma compromising visual acuity and causing adrenal insufficiency in a young male patient: case report and literature review

Abstract

This article reports on a case study of a 27-year-old male patient with prolactinoma, a pituitary adenoma that secretes prolactin, leading to a loss of visual acuity. The data were obtained from the patient’s clinical history, as well as complementary exams and procedures. The article emphasizes the importance of correct and early diagnosis, particularly in young patients, as the patient in this case had a relevant family history of brain tumors and experienced a year of symptoms before diagnosis. The patient was diagnosed with prolactinoma after a canon magnetic resonance imaging revealed a macroadenoma pressing on the optic chiasm, causing visual complaints, weight gain, milk production, and erectile dysfunction. The patient’s serum prolactin level was higher than 200 ng/mL, and he began treatment with Cabergoline after discovering adrenal insufficiency. While the patient reported an improvement in symptoms after two months of medication, his vision did not return. The report highlights the importance of proper screening and thorough evaluation, including atypical patients who may not fit the typical epidemiology of the disease. It took a year of research in the ophthalmological area to realize that the patient’s symptoms were neurological, and this delay in diagnosis may have allowed complete blindness in the left eye and progression with mild symptoms in the right eye. However, proper treatment led to significant improvement in symptoms. In conclusion, the article emphasizes the importance of early and assertive diagnosis, particularly in young patients, whose complaints are often neglected. The case study illustrates the consequences of delayed diagnosis and the need for a complete anamnesis and correct screening.