Prolactinomas are the most common functional pituitary tumors and present with elevated serum prolactin levels. This may or may not be accompanied by mass-related clinical symptoms. Dopamine agonists are its principal treatment. Data on prolactinoma remission and relapse after treatment withdrawal are limited. Here we report a patient presenting with headache, amenorrhea, galactorrhea, visual field impairments and a high serum prolactin level. After a definitive diagnosis of pituitary macroadenoma, the patient was treated with bromocriptine. Twelve months after treatment, tumor size markedly reduced, there was resolution of symptoms and patient was eventually lost to follow-up. After 10 months without treatment, tumor recurred. Bromocriptine was resumed for 5 more years and discontinued thereafter. Since then, the patient has been asymptomatic for the past 12 years; surveillance imaging showed no tumor recurrence with annual prolactin level all within normal range. This case adds to the limited data confirming that dopamine agonists in patients with prolactinomas can be successfully discontinued with a high remission rate, provided that there is adequate duration of treatment and sufficient follow-up.
Over recent years empty sella turcica has become more frequently diagnosed with high resolution coniputerized tomography and the associated clinical abnornialities have been better described. In this article the spectrum of clinical presentation is based on a review of 26 cases with six illustrative case reports. Reconimendations for management and further assessment are presented. It is important for clinicians to be aware of the varying presentations of this syndrome, since it should not be considered simply as an incidental finding. A patient diagnosed with empty sella syndrome requires clinical and endocrine evaluation, and appropriate follow‐up as determined by initial test results.
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