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98.3.27-Case Discussion Giant Prolactinoma
GIANT MACROPROLACTINOMA
- A 43-year-old man
- Progressive headache
- Bilateral blurred vision
- High Serum prolactin Level
- Pituitary mass in MRI
- What are the appropriate treatments for Giant prolactinoma?
- What are the effects of different therapies in this patient?
- Is surgery required in the patient to be introduced?
- Follow up of these patients after choosing the appropriate treatment options
- Clinical symptoms in men with prolactinomas usually occur as a result of tumour mass effect (visual field abnormalities and/ or headaches), together with symptoms resulting from hyperprolactinaemia (impotence and decreased libido) associated or not with hypopituitarism
- The goals of therapy for men with prolactinomas are to normalize serum prolactin (PRL) levels, restore gonadal and pituitary function, and decrease tumour size, especially in those patients with symptoms derived from tumour mass effect
- Medical management with dopamine agonists (DA) is effective and safe in men with prolactinomas, and it has been considered as first-line therapy including men bearing large macroprolactinomas
- Transsphenoidal surgery (TSS), radiation therapy or radiosurgery is usually reserved for patients with intolerance or resistance to DA to control tumour growth and hyperprolactinaemia
- This study shows that the majority (approximately 80%) of prolactinomas in men are macroprolactinomas (giant prolactinomas approximately 30%), with a mean age of presentation of about 40 years, without differences between micro- and macroprolactinomas
