Endocrine Abstracts

Introduction: Prolactinoma are the most frequent pituitary adenoma, considered benign tumor and well respond to medical treatment, but sometimes, in men prolactinoma may be invasive and aggressive occurring neurological signs.

Case 1: Male 53 years old, went to ophtalmology consulting for progressive vision problems associated with headaches from more than a year but denied. On examination visual field showed poor vision in left eye and temporal defect on right one.

CT scan and MRI showed a large invasive mass in the skull base with destruction of sella turcica and compression of brain parenchyma with hydrocephaly (80 mm).

He was sent in neurosurgery, the first hypothesis chordoma or meningioma. He had hypogonadism and hypothyroidy clinical signs. The hormonal evaluation revealed an hyperprolactinemia 22 000 ng/ml. treatment with dopamine agonist was begun with anti epileptic drugs.

The evolution prolactin levels stabilized, MRI showed partial reduction of the volume at 1 year (30%) and more than 80% at 4 years.vision problems improve but did not recover. Hypothyroidism is treated.

Case 2: Male 36 years old, went consulting to neurology for progressive headaches, dizziness, time and space disorientation, double vision and recently blindness in right eye. MRI revealed a large invasive lesion extending to the supra sella cistern, the optic chiasma and the brain parenchyma in left temporal lobe 75/60 mm.

He was evaluated in endocrinology, tests revealed an hyperprolactinemia 12 000 ng/ml, hypocortisolism and hypogonadism.

He was don dopamine agonist at 2 months he presented an apoplexy with ophtalmoplegy and convulsion with rapid recovery.

At 1 year partial tumor reduction (50%) and prolactin level stabilized. At 3 year we obtained an empty sella turcica, an improvement of visual problems.

Conclusion the importance of hormonal evaluation in cerebral tumors. the responsiveness of these tumor to dopamine agonists confirm the medical option in prolactinoma even when invasive.