Atypical Giant Suprasellar Prolactinoma Presenting With Visual Field Changes in the Absence of Symptoms of Hyperprolactinemia

Abstract

Prolactinomas are benign tumors that make up the majority of all pituitary adenoma cases and present most commonly in women. Prolactinomas presenting in adolescents and children, however, are extremely rare. We report a case of a 17-year-old male who presented with a six-month history of headaches and a previously unrecognized visual field deficit on examination. Neuroimaging revealed a large suprasellar tumor with imaging, more characteristic of a craniopharyngioma or suprasellar low-grade glioma impinging, on the left intracranial optic nerve causing right-sided hemianopsia. Due to the extensive mass effect and bitemporal hemianopsia on examination, the decision to proceed with initial surgical debulking was made following informed consent. A subtotal resection was performed where the pathology was consistent with a prolactinoma that correlated with markedly elevated prolactin (PRL) levels obtained pre and post-operatively that have not resulted until five days post procedure. The patient was subsequently treated with dopamine agonist (DA) cabergoline therapy and is now five-years disease-free with normal neurological examination and no residual tumor on neuroimaging. DA therapy has shown high clinical efficacy and should be considered prior to any surgical intervention; however, extensive mass effect may appropriate surgical debulking to increase therapy efficacy. Our case highlights an atypical appearance of a giant prolactinoma that may mimic other more common suprasellar tumors, a presentation associated with unrecognized visual field deficits, and the importance of rapid turnaround testing for serum PRL that may aid in the upfront diagnosis and management of prolactinomas.

Resolution of Visual Field Defect in Macroprolactinoma After Treatment With Cabergoline

“…Common clinical features associated with macroprolactinoma are classified based on their causes: elevated circulating prolactin causes hypogonadism, amenorrhea, infertility, and galactorrhea while visual field defects and headache are due to mechanical compression derived from extrasellar extension of the tumor primarily by macroprolactinoma (>1 cm) or giant prolactinoma (> 4 cm) [6]. A large prolactinoma is associated with an increased risk of vision problems.…”

Computer vision and machine learning for medical image analysis: recent advances, challenges, and way forward

“…In the medical domain, imbalanced datasets are often seen due to the limited availability of samples, generally patient data, belonging to the group of interest [143] . For example, the data of patients with benign tumours may greatly outnumber the data of cases with malignant tumours, which is a natural phenomenon of many existing types of tumours that the overwhelming majority of these tumours are benign [144][145][146] . Predictive analysis of other diseases such as heart disease, cerebral stroke, Parkinson' s, and epilepsy are also good examples of imbalanced data classification tasks [143,147,148] .…”