Endocrine Abstracts

Introduction: Prolactinomas are more invasive in males. Giant ones (height ≥4 cm) are relatively rare in literature.

Our aim is to analyze their frequency, their radiological aspects, and their neurological, endocrine and ophthalmological complications.

Methods: All of them had clinical exam, hormonal, ophthalmological, and radiological assessment based on cerebral MRI. Mixed adenomas were excluded. Positive diagnosis was based on clinical presentation, high prolactin concentration, positive response to dopamine agonists±immunohistochemy study.

Results: Among 154 male prolactinomas seen in our department between 1984–2012 we have observed 44 giant tumors (28.5%). Mean age=36 years, 38.3% were under 30. Mean tumor height=53.95 (40–97) mm and mean volume=66.2 mm³ (15.5–184). Mean prolactin =15 715 ng/ml (n<15). Solid and kystic aspect, with or without calcifications, mimicking craniopharyngiomas was observed in 28.5%. Cavernous sinuses were invaded in all except two. Other invasions were: posterior=69.4%, anterior =58.3%, and frontal=5.5%. For endocrine complications we observed gonadic deficit in 98.4%. Thyreotro and corticotrop insufficiencies were seen in respectively 34%, and 32%. 47% had multiple deficits. Posterior pituitary deficit was observed in 2.2%. Ophthalmological complications were: Optic atrophy in 46%, ptosis=8%, diplopia±strabismus =5.4%. For neurological abnormalities we observed memory loss and/or unconsciousness=24%, epilepsy=15.5%, compressive hydrocephaly=8% and frontal syndrome=5%.

Conclusion: In this study concerning giant male prolactinomas, optic atrophy is the most common abnormality. Severe and life threatening neurological troubles are very frequent too as they were observed in nearly 40%. But, multi pituitary deficits and compressive hydrocephaly are relatively rare, which argues for a low progression.