Endocrine Abstracts

Background: Apart from signs of hyperprolactinaemia, patients with macroadenomas with extrasellar extension generally seek medical attention due to mass effect. Macroprolactinomas, particularly in men, may occasionally exhibit a very aggressive clinical course.

Case report: Male 37 years old that went to a Neurology consultation complaining of progressively more frequent self-limiting episodes of restraint, silence and time and space disorientation in the last 3.5 years. CT scan revealed a large and infiltrative mass lesion centered to the skull base, associated with destruction of surrounding bone structures, including the limits of the sella turcica and sphenoid body, and compression of brain parenchyma (left temporal lobe) and bulge, with marked deformation of these structures. He was immediately sent to the emergency room of this hospital by the Imaging Center, to be examined by a neurosurgeon. No significant changes were detected on neurological examination, although he mentioned minor hearing impairment and lower visual acuity for objects in the right visual field. MRI favored the hypothesis of chordoma. He was evaluated by endocrinology and hormonal study revealed hyperprolactinemia (>2000 ng/ml). He had no signs or symptoms of hypothyroidism, hypocortisolism or hypogonadism. Treatment with dopamine agonist and an anti-epileptic was begun. Prolactin levels stabilized at 1.5 times the upper limit of normal. We also observed partial reduction (30%) of tumour volume, recovery of visual acuity and remission of seizures.

Conclusion: With this case, we stress the importance of hormonal evaluation in the differential diagnosis of tumors of the diencephalon–pituitary region. The clinical response, analytical and imaging data, 1.5 years after starting treatment, reinforces the diagnosis of invasive prolactinoma. The extent of the injury prevents, at present, its surgical resection. The good response to therapy reaffirms the concept long ago established that there are patients in whom surgical treatment is never an option.