Category: Pituitary Disorders/Neuroendocrinology

Monitor: 12

12 - INTENSE HEADACHE IN A 51-YEAR-OLD WOMAN REFERRED AS COMPLICATED ARTERIOVENOUS MALFORMATION

Thursday, Apr 25
1:00 PM – 1:30 PM

Objective :

To present the case of a giant prolactinoma in a 51-year-old woman.


Methods : The clinical and paraclinical characteristics of the patient are described.


Results : A 51-year-old woman with no significant family history. With a personal history of hyperprolactinemia diagnosed at 21 years of age, due to the study of infertility, galactorrhea and mastalgia, he received treatment with dopamine agonists for 2 months, suspending due to clinical improvement. After the suspension presents with oligomenorrhea and galactorrhea. It has been amenorrhea for 10 years. He is diagnosed with Hypothyroidism in January 2018 receiving Levothyroxine 100ug / d. She was admitted to a center in February 2018 due to sudden severe and oppressive global headache, associated with nausea, vomiting and asthenia. She underwent CT scans and was referred to our hospital with a diagnosis of intracerebral hemorrhage to be considered AVM. In emergency, they perform MRI evidencing a large selar and suprasellar mass of 40x59x37mm, to consider infiltrating macroadenoma with signs of bleeding. The analytical showed: PRL: 10889ng/ml, TSH: 0.091uIU/ml, T4L: 1.4ng/dl, Cortisol: 1.77ug/ml, IGF1: 82.2ng/ml. In view of the hemodynamic stability and absence of visual compromise, medical management and neuro-surgical expectant management was decided: Dexamethasone IV 4mg tid, LT4 100ug/d, and cabergoline 1.5 mg/week titred up to 3mg/week, LT4 and hydrocortisone PO. At 3 months Ophthalmology ruled out involvement of optic chiasm. PRL: 13.8 ng/ml. MRI: macroadenoma 45 mm larger diameter. Currently asymptomatic.


Discussion : The PRLomas are the most common type of hypophyseal adenoma, more than 90% are microPRLomas, the rest being macroPRLomas (> 1cm in diameter). Giant PRLomas are> 4cm and represent 2-3% of PRL-secreting tumors, occurring mainly in men with a H / M ratio of 9: 1. The symptoms depend not only on hyperPRL, but also on the effect of tumor mass and neuro-ophthalmological complications. Diagnosis is made by serum PRL measurement (generally> 1000 ng / ml) and pituitary MRI. Regarding treatment, dopamine agonists are the first-line treatment, leaving the transsphenoidal adenomectomy for patients who show resistance or intolerance to medical treatment. Medical treatment reduces PRL levels, restores gonadal function and reduces tumor size.


Conclusion : The treatment of giant prolactinoma can be pharmacological depending on the patient's clinical status,

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Jose L. PAZ-IBARRA

ENDOCRINOLOGIST
HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU
Lima, Lima, Peru

PERUVIAN ENDOCRINOLOGIST, UNIVERSITY TEACHER, ACTIVE MEMBER OF AACE, AREAS OF INTEREST NEUROENDOCRINOLOGY, THYROID, ENDOCRINOLOGY OF REPRODUCTION AND BONE MINERAL METABOLISM

Natalia Awramiszyn

ENDOCRINOLOGY RESIDENT
HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru

RESIDENT IN ENDOCRINOLOGY

Maria L. Trujillo

ENDOCRINOLOGY RESIDENT
HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru

RESIDENT OF ENDOCRINOLOGY WITH INTEREST IN CONTINUING LEARNING