Endocrine Abstracts

Background: Prolactinomas are the most common hormone-secreting pituitary tumors and are a common cause of anovulation and infertility. Giant prolactinomas (0.5–4.4% of all pituitary tumors) are rare tumors characterized by their large size (>4 cm), compressive symptoms and extremely high prolactin secretion (>1000 ng/ml). Men are most commonly affected, with a reported male to female ratio of 9:1.

Case report: We present the rare case of 53-years-old female, with a history of amenorrhea from age 35, who was never investigated or treated. In December 2015 she was admitted in the neurosurgery department for severe headaches and visual impairment. On clinical examination, left eye mydriasis and left lateral nystagmus were noted. A head CT showed a pituitary tumor of 55 mm diameter, invading the sphenoid sinus, both cavernous sinuses, the left orbit and compressing the third ventricle, with mass effect. The blood tests revealed a very high serum prolactin of 32625 ng/ml (4–23) and low sexual and gonadotrophic hormones. Given the clinical and CT aspects, decompressive transcranial surgery was performed, resulting in rapid improvement of the neurological signs and lowering of the PRL levels to 1980 ng/ml. Nasal fistula and transient diabetes insipidus occurred after surgery and were cured by sphenoid sinus filling and treatment with desmopressin. For the residual prolactin secretion, Cabergoline treatment was started (1.5–2 mg/week) which resulted in prolactin suppression and diminuation of the tumoral remaint. The restoration of the gonadotrophic secretion resulted in numerous painful ovarian cysts that were cured by bilateral oophorectomy.

Conclusions: We present this rare case in order to highlight the importance of the etiological investigation of secondary amenorrhea in women. The patient almost died because of the mass effect of a benign tumor, easily manageable by medical treatment and suffered multiple complications due to the neglect of her secondary amenorrhea.