Prolactinoma Presenting Research Articles

Prolactinoma Presenting with Secondary Amenorrhoea in a Young Girl

Prolactinoma is the most common secreting pituitary adenoma. It has different clinical presentation in men and women which varies with age. Young women present with menstrual problems, infertility and galactorrhoea, whilst older women and men may present with loss of libido, visual disturbances and in late cases, ith osteoporosis. In approaching a young woman with secondary amenorrhoea, other cuses such as pregnancy, functional hypothalamic amenorrhea, pituitary adenoma, Polycystic Ovarian Syndrome (PCOS) or primary ovarian insufficiency should be ruled out. Prolactinoma can be confirmed in the presence of high serum prolactin level and adenoma on pituitary gland magnetic resonance imaging (MRI). Dopaminergic agonist, cabergoline is efficacious in restoring gonadal and sexual functions by normalising prolactin levels. We presented a case report onan 18-year-old girl who presented with secondary amenorrhoea for six months. On further evaluation she was noted to have galactorrhoea with substantially high prolactin level of 466.9 ng/mL (normal range: 4.0- 23) and the MRI showed a pituitary tumour measuring 1.2 x 1.1 x 1.4 cm. A diagnosis of macroprolactinoma was made and she was managed with cabergoline with gradual dose increment. At 6 months of treatment, her menstrual cycle and serum prolactin had normalised. A repeat MRI pituitary one year later showed reduction in tumour size.

Case of a giant prolactinoma presenting as a clival mass

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pediatric Giant Prolactinoma Presenting With Acute Obstructive Hydrocephalus and Intracranial Hypertension.

Pediatric Giant Prolactinoma Presenting With Acute Obstructive Hydrocephalus and Intracranial Hypertension.

A rare case of metastatic prolactinoma presenting with cervical myelopathy

A rare case of metastatic prolactinoma presenting with cervical myelopathy

Pediatric Giant Prolactinoma Presenting With Acute Obstructive Hydrocephalus and Intracranial Hypertension

Background: Pediatric prolactinomas (PP) are rare but represent 50% of all pediatric pituitary adenomas. Girls are affected more frequently than boys, although PP tend to be larger and more aggressive (earlier age, larger mass, and higher prolactin levels) in boys. Thus, microadenomas (tumors < 10 mm in diameter) are typical in females and macroadenomas (10–40 mm in diameter) are typical in males. Giant prolactinomas (> 40 mm in maximum diameter), an unusual subset of macroprolactinomas, are also commonly found in boys. In a large case series, the largest tumor volume reported was 93.5 cm3. Here we report a giant prolactinoma in a female requiring V/P shunt for decompression. Clinical Case: A 16-year old female presented with 2 weeks of intractable headache, nausea and vomiting, vision impairment, and changes in balance described as running into stationary household objects. Historical review revealed primary amenorrhea and short stature. On initial exam, the patient had a right eye afferent pupillary defect, concern for loss of color vision, and bilateral optic nerve edema with blurred disc margins. Brain MRI showed a large lobulated mass centered in the suprasellar cistern, measuring approximately 6.4 x 5.8 x 5.7 cm with a tumor volume of 105 cm3. There was extension superiorly, anteriorly, and laterally, with homogeneously enhancing and cystic components, and mass effect resulting in obstructive hydrocephalus. Differential diagnoses included craniopharyngioma, germinoma, and adenoma. Initial tests demonstrated prolactin of >2,000 ng/mL, with diluted result of 17,811.16 ng/mL. Morning fasting labs confirmed multiple anterior pituitary hormone deficiencies including central hypothyroidism, ACTH deficiency, GH deficiency, and hypogonadotropic hypogonadism. The patient was started on hydrocortisone and levothyroxine. Due to obstructive hydrocephalus and vision impairment, she underwent VP shunt placement for decompression. She was started on cabergoline for medical treatment of the tumor and did not require surgical resection. Repeat prolactin measurements have shown striking improvement (to 2,350 ng/ml, 824 ng/ml, and 152 ng/ml at 1 week, 1-month, and 2-month-follow-up, respectively) with central vision improved in both eyes, papilledema resolved, and resolution of headaches. Conclusion: Giant prolactinomas presenting with hydrocephalus and intracranial hypertension are very rare in pediatrics, especially in girls, and can vary greatly in mass characteristics and resulting hormone deficiencies. Our patient is unique with her large tumor volume and the extent of pituitary hormone deficiencies. Prolactin levels should be measured with all sellar masses, as this may prevent unnecessary invasive intervention and possibly provide prompt response to medical management.

A rare case of a malignant prolactinoma presenting with skull metastasis after two years of a masked diagnosis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Ectopic Prolactinoma Presenting as Bacterial Meningitis: A Diagnostic Conundrum

Prolactinomas may rarely present with meningitis and cerebrospinal fluid (CSF) rhinorrhea secondary to erosion of the wall of the sella turcica. It is even more uncommon for this abnormal communication to be caused by an ectopic prolactinoma arising from the sphenoid sinus and eroding into the sella. This atypical growth pattern makes diagnosis very difficult because there may be no displacement of the normal pituitary gland. The first reported case of a patient with an ectopic prolactinoma originating within the sphenoid sinus presenting primarily with meningitis is presented, and the management strategy and surgical and nonsurgical treatment options are discussed. A 48-year-old woman presented with confusion, low-pressure headache, and fever. A lumbar puncture revealed Streptococcus pneumoniae meningitis, and she was placed on intravenous penicillin G. After initiation of antibiotics, she noticed salty tasting postnasal fluid leakage. Imaging was remarkable for bony erosion of the sphenoid sinus wall by a soft tissue mass growing from within the sinus, with no disruption of the normal pituitary gland. A biopsy was then performed with an endoscopic transnasal transsphenoidal approach, and the CSF leak was repaired with a pedicled nasoseptal flap. The final pathology was prolactinoma, and she was placed on cabergoline. Ectopic prolactinomas may rarely present as meningitis secondary to retrograde transmission of bacteria through a bony defect in the sphenoid sinus, and must be included in the differential diagnosis of any sphenoid sinus mass. Management should first address the infection, followed by surgical repair of the bony defect.

Prolactinoma Presenting as Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing Syndrome.

Prolactinoma Presenting as Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing Syndrome.

Abstract #929: Giant Prolactinoma Presenting as Skull Base Tumor Causing Instability of the Craniovertebral Junction

Abstract #929: Giant Prolactinoma Presenting as Skull Base Tumor Causing Instability of the Craniovertebral Junction

Giant Invasive Prolactinoma Presenting with Unilateral Exophthalmos in a Patient with MEN1

Objective: Management of an unusual case of a giant invasive prolactinoma in a patient with multiple endocrine neoplasia type 1 (MEN1).

Keep calm and give cabergoline: a giant prolactinoma presenting with seizures

Keep calm and give cabergoline: a giant prolactinoma presenting with seizures

Giant prolactinoma: case report and review of literature

“Invasive giant prolactinoma” is a large prolactinoma (>4 cm in dimension) presenting with serum prolactin levels of >1000 ng/dL and mass related clinical symptoms. Here we report a patient with a giant prolactinoma presented with central hypogonadism, suppressed adrenal and thyroid function, supra sellar extension, visual field impairment and high prolactin level.The patient was treated with cabergoline, levothyroxin and prednisolone. After 18 months, tumor size markedly reduced, associated with adrenal function and visual field improvement, but central hypogonadism and secondary hypothyroidism persisted.Previous studies showed normalization of thyrotropin secretion after treatment but it remained low in our patient even after 18 months follow up.

Invasive Giant Prolactinoma Presenting as a Nasal Polyp

A previously healthy, 14-year-old obese boy (body mass index 33 kg/m2) presented with progressive weight gain, nasal stuffiness, snoring, and a polypoid mass in his left nostril. Imaging studies revealed a homogenously enhancing mass extending from the floor of sella to the nasopharynx, measuring 8.7 × 7.6 cm transversely, 9.9 × 5.4 cm sagittally, and 5.5 × 8.0 cm coronally. The mass occupied the entire nasopharynx and extended bilaterally into inferior orbital fissures and pterygopalatine fossae (Figure). It abutted the basilar artery, temporal lobe parenchyma, and the inferior margin of the sella turcica, and it elevated the anterior pituitary lobe. It also invaded the cavernous sinuses, clivus, and sphenoid bones. The initial prolactin level was markedly elevated at 29 415 ng/mL (normal range 3-18). Biopsy was consistent with pituitary adenoma, with further staining confirming it to be a prolactinoma. His prolactin level was reduced to 12 059 ng/mL while on cabergoline, 0.5 mg/wk for 2 weeks, and subsequently to a present value of 316 ng/mL, on a cabergoline dose of 12 mg/wk. There has also been a significant reduction in the tumor size in 5 years (Figure). Invasive giant prolactinomas present with extrasellar extension and massive serum prolactin elevations.1Symon L. Jakubowski J. Kendall B. Surgical treatment of giant pituitary adenomas.J Neurol Neurosurg Psychiatry. 1979; 42: 973-982Crossref PubMed Scopus (111) Google Scholar Giant prolactinomas (≥4 cm) constitute only 0.5%-4.4% of all pituitary tumors.2Corsello S.M. Ubertini G. Altomare M. Lovicu R.M. Migneco M.G. Rota C.A. et al.Giant prolactinomas in men: efficacy of cabergoline treatment.Clin Endocrinol (Oxf). 2003; 58: 662-670Crossref PubMed Scopus (101) Google Scholar, 3Shrivastava R.K. Arginteanu M.S. King W.A. Post K.D. Giant prolactinomas: clinical management and long-term follow up.J Neurosurg. 2002; 97: 299-306Crossref PubMed Scopus (128) Google Scholar, 4Yu C. Wu Z. Gong J. Combined treatment of invasive giant prolactinomas.Pituitary. 2005; 8: 61-65Crossref PubMed Scopus (35) Google Scholar Clinical and imaging in our case raised the suspicion of nasopharyngeal carcinoma, rhabdomyosarcoma, small round blue cell tumor, and esthesioneuroblastoma. This case highlights the importance of assessing serum prolactin in erosive skull base tumors, as prolactinomas respond to cabergoline obviating the need for extensive surgical resection.

Rapidly progressing giant invasive prolactinoma

We report an extremely rare case of a giant invasive prolactinoma presenting as a nasopharyngeal tumour. Case report and literature review regarding giant prolactinoma. Giant prolactinoma is a rare form of prolactinoma which accounts for 0.5-4.4 per cent of all pituitary tumours. It is more common in men and generally presents with symptoms of endocrine disturbance or neurological deficit. To our knowledge, this is the first report of giant prolactinoma presenting with symptoms of sinusitis and nasopharyngeal tumour.

Prolactinoma presenting as unilateral galactorrhea in a man exposed to radioactivity from the Chernobyl accident: radiation‐induced pituitary tumor?

Prolactinoma presenting as unilateral galactorrhea in a man exposed to radioactivity from the Chernobyl accident: radiation‐induced pituitary tumor?

Prolactinoma presenting as chronic anaemia with osteoporosis: a case report

IntroductionUnexplained anaemia is a rare mode of presentation for prolactinoma. We describe a case of a man, with chronic anaemia ascribed to old age. Six years later, he was evaluated and diagnosed with a prolactinoma and resultant osteoporosis. Prolactinoma in old people may present insidiously with chronic anaemia and osteoporosis with or without sexual dysfunction.Case presentationWe describe the case of a 70-year-old Caucasian man who presented with mild anaemia and tiredness. His anaemia was investigated and ascribed to senescence. Endocrine causes were not considered or tested for. Six years later, he was again referred. Reassessment and direct questioning revealed long-standing sexual dysfunction. It was also discovered that our patient had fractured his radius twice, with minor trauma, during the preceding year. His serum prolactin was massively increased and a magnetic resonance imaging (MRI) scan of the head demonstrated a pituitary mass consistent with a prolactinoma. Dual X-ray absorptiometry revealed osteoporosis. Treatment of the prolactinoma led to a reduction in his serum prolactin with a rise in his haemoglobin to normal levels. This suggested that the prolactinoma was present during the initial presentation and was the cause of his anaemia.ConclusionThis case highlights the importance of fully evaluating and investigating unexplained anaemia in older people and that endocrine causes should be considered. Osteoporosis also requires evaluation with secondary causes considered.

Prolactin-Producing Adenoma. Clinical Presentation in Adult Sudanese Patients

Objectives: To describe the clinical features of prolactin-producing pituitary adenoma (prolactinoma) in adult patients. Methods: In a prospective hospital-based study, adult patients with prolactinoma presenting to the National Center for Neurological diseases and the National Center for cancer in Khartoum, Sudan were enrolled in the period from January 2001 to February 2005. The diagnosis was based on finding a pituitary adenoma on cranial MRI and an associated elevated blood prolactin level above 200 pig/L. The size of the adenoma was classified as either microadenoma ( &lt; 10 mm without sellar enlargement or extrasellar extension) ormacroadema (&gt;10 mm). The hormone profile done on each patient included blood level of prolactinand other pituitary trophic hormones, free triiodothyronine and free thyroxine hormones. Results: Sixteen (14 females and 2 males) were identified as having a prolactinoma. The female to male ratio was 7:1. Their mean age was 24 ± 5.1 years. The prolactinoma was macroadenoma in 9 cases and microademoma in 7. Galactorrhea, amenorrhea and infertility (primary or secondary) were the commonest presenting symptom followed by headache. Affection of the visual pathway, either as bitemporal hemianopia (41.2%) or optic atrophy (11.8%), was the major neurological deficit. The mean prolactin level in macroadenoma was 2053 ± 442.6 jig/L and in microadenoma was 853.6 ± 77.8 jig/L. Conclusions: Our prolactinoma patients, when reaching the appropriate medical attention, are more likely having an expanded macroadeoma that is compromising the visual pathway. Early recognition and referral to specialized clinics is necessary and that should have a favorable prognostic implication.

Unusual orbital invasion by a giant prolactinoma

Intra-orbital extension of giant pituitary adenomas is an extremely uncommon event. We describe the imaging appearances of a giant prolactinoma presenting with proptosis owing to an unusual pattern of intraorbital extension and extensive skull base involvement. The CT and MRI findings of a middle-aged man presenting with proptosis are described. The orbital component of the tumour closely resembled a dilated superior ophthalmic vein on CT, which was subsequently clarified on MRI. The patient was treated with cabergoline, with good clinical and radiological recovery. In conclusion, radiologists should be wary of such an unusual pattern of intraorbital extension of giant pituitary adenomas, which may mimic an enlarged superior ophthalmic vein on axial CT imaging. MRI is the best tool for evaluating skull base and orbital invasion.

Prolactinoma presenting as a failed vasectomy reversal

To present a case of prolactinoma presenting as a failed vasectomy reversal. Case report. University-affiliated teaching hospital. A 46-year-old male with severe oligospermia after bilateral vasovasostomy and his 31-year-old female partner who had normal cycles. Bromocriptine, carbegoline, and l IVF. Correction of hyperprolactinoma, improved semen analysis, and pregnancy achieved by assisted reproductive technologies. Semen analysis showing low volume (0.65 mL) and severe oligospermia (16 sperm) with zero motility on presentation. Endocrine evaluation showed prolactin of 650 ng/mL, T 0.37 ng/mL, and FSH 2.0 mIU/mL. A head CT scan showed a 1.2 cm pituitary adenoma. This was managed initially with bromocriptine, but due to side effects he was switched to carbegoline. In 1 month his PRL decreased to 16.9 ng/mL. Testosterone and FSH normalized. Repeat semen analysis after 5 months showed a volume of 4.5 mL and a concentration of 15 million/mL with 1% motility. Antisperm antibodies were positive. Because of antisperm antibodies and oligoasthenospermia, intracytoplasmic sperm injection with ejaculated sperm and, later, testicular extraction, were attempted without success. Donor sperm was eventually used. This is the first reported case of prolactinoma as a cause of infertility after vas reversal and demonstrates that not all cases of suspected failed vasectomy reversals are due to recurrent obstruction.

Metastatic prolactinoma presenting as a cervical spinal cord tumour in multiple endocrine neoplasia type one (MEN‐1)

Metastatic prolactinoma presenting as a cervical spinal cord tumour in multiple endocrine neoplasia type one (MEN‐1)