Cystic Prolactinoma: A Surgical Disease?

Abstract

Objective: Since the advent of dopamine agonists, prolactinomas have been primarily treated medically. However, studies show conflicting data on whether these agents are as effective as surgery for predominantly cystic prolactinomas. We present a case of a patient with a cystic prolactinoma for which surgery was selected as first-line therapy. Methods: Literature review. Results: A 26-year-old African American man presented to an outside hospital with complaints of dull right-sided headaches for 1 week. The headache worsened over the next few days, which prompted him to go to the emergency room. The evaluation included a head computed tomography, which demonstrated a 4-cm solid/cystic pituitary mass with possible hemorrhagic conversion and compression of the optic chiasm. He was transferred to University of Maryland Medical Center for neurosurgical evaluation. He denied symptoms of pituitary hormone excess or deficiency. He denied visual symptoms, though formal visual field testing demonstrated temporal hemianopia. Hormonal evaluation revealed hyperprolactinemia