Category: Pituitary Disorders/Neuroendocrinology
Objective : To present the case of a giant prolactinoma (GP) in a 45-year-old male.
Methods : The clinical and paraclinical manifestations of the patient are described.
Results : Male, 45 yo. No history of importance. He was admitted to ER after presenting the first episode of generalized tonic-clonic seizure and fracture of the humerus falling product. MRI: sellar mass of 55x39x54mm with suprasellar expansion until 3rd ventricle and parasellar with areas of necrosis and cystic degeneration. MRI Left shoulder: Complex sub-capital fracture of the humerus. Neurology: indicated IV corticosteroids and anti-convulsants; Neuro-ophthalmology: no commitment to visual fields. He referred us to symptoms of hypogonadism and headache of years of evolution; Analytical: PRL: 14250ng/ml, Cortisol: <1.0ug/ml, ACTH: <5.0pg/ml (receiving Dexa EV); LH: 3.5mIU/ml; Free testo: 3.32pg/ml; TSH / T4L / IGF1: Normal. No clinical or hormonal manifestations of MEN1 at the time. BMD: Z score L4: -4.2, Z score femoral neck: -3.8. In view of hemodynamic stability and absence of visual compromise, medical management and neurosurgical expectant management were decided upon, receiving Dexa EV 12mg/d and initiating cabergoline (CBG) 1.5mg/w. He left the hospital high with dexa PO 4mg /d, CBG 2mg/w plus calcium and vitamin D supplements. At 12ss ophthalmology ratifies absence of optic chiasm commitment. PRL: 421ng/ml. MRI: 36 mm greater diameter of the sellar mass. Improved libido and physical performance. CBG was increased to 4mg/w.
Discussion : GP should be considered in the differential diagnosis of suprasellar tumors. It is not necessary to perform a biopsy, a procedure that may be counterproductive. Treatment with CBG begins with low doses and increases gradually in order to avoid abrupt reduction of the tumor mass. The secondary causes of OP are more frequent to find in men. Epidemiological studies show that they can be identified in 40-60% of men who suffered a fracture and among the most prevalent are: hypogonadism, malabsorption syndromes, chronic corticotherapy, hypovitaminosis D, hypercalciuria, smoking and alcoholism. Although, up to now, the response to treatment in our patient is optimal, the follow-up time is short.
Conclusion : In GP, a higher incidence of resistance to dopa-agonists has been reported, and alternative treatments such as temozolamide, surgery or radiotherapy have been proposed. For this reason, these patients need chronic and multidisciplinary follow-up
Jose PAZ-IBARRA– ENDOCRINOLOGIST, HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU, Lima, Lima, Peru
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