Endocrine Abstracts

Obesity is growing fast worldwide. Although environmental factors play a major role, endocrine dysfunction may contribute to the weight gain. We report an invasive macroprolactinoma diagnosed in obesity setting. A 35-year-old male was referred to our endocrine outpatient department due to grade 2 obesity (IMC 38.4 Kg/m2). His weight was increasing since the beginning of his professional activity at the age of 20 due to a sedentary lifestyle. On physical examination he had an hypogonadal facies, with sparse beard, pale skin with fine wrinkles on the corner of the mouth and eyes and bilateral gynecomastia without galactorrhea. Descending testis of 4×3 cm were found, but a micropenis (3 cm) was evident. Patient complained of decreased libido and erectile dysfunction. He denied headache or visual disturbances. When blood analysis were performed, hyperprolactinemia of 1121 ng/ml (Reference range: 4–23 ng/ml) and hypogonadotrophic hypogonadism were found. No other pituitary defects were established and serum calcium was within normal values. Selar magnetic resonance (sMRI) showed a macro adenoma of 26 mm in the highest diameter slightly invading the right cavernous sinus and growing downward to the sphenoidal bone. One month after starting of cabergoline 0.5 mg 3 times a week, serum prolactin markedly decreased to 34.8 ng/ml and the patient lost 5% of body weight. He is awaiting a sMRI re-evaluation. Although the relation between hyperprolactinemia and obesity is established, pathophysiologic mechanism is not clearly understood. This case highlights that even when facing an epidemic disease, careful examination is mandatory and clinical suspicion must be paid.