Giant Hemorrhagic Prolactinoma with Sparse Prolactin Expression Presenting with Thalamic Infarction—A Case Report

Abstract

Pituitary tumors are the most common form of intracranial neoplasms. However, clinically relevant pituitary tumors presenting with disturbances of hormonal secretion or mass effect are rare and they only represent about 10 % of all surgically resected intracranial neoplasms. Prolactinomas are the most common types of pituitary adenomas. Generally, hormonal expression patterns provided by immunohistochemistry (IHC) studies are correlated with the clinical features and endocrine activity of the patients. Nonetheless, exceptions occur where the immunocytochemical staining is not concordant with the clinical picture. Pituitary adenomas presenting with apoplexy are well known. However, pituitary adenomas causing cerebral stroke and resulting in hemiplegia are unusual. Here, we report an unusual case of prolactinoma with cerebral stroke and sparse prolactin (PRL) expression. A 25-year-old woman complaining of amenorrhea, dysphasia, and left hemiplegia presented with serum PRL level in excess of 4,700 ng/ml. Pre-operational radiology images revealed a giant macroadenoma and a thalamic infarct due to carotid compression. Transcranial surgery was performed. IHC study of the adenoma revealed no hormonal expression other than sparse PRL immunoreactivity. Therefore, a sparsely granulated PRL cell adenoma was diagnosed. The patient is still under follow-up with continuing cabergoline treatment.

Hyperprolactinaemia in a Patient with Acute Ischaemic Stroke

“…A macroprolactinoma is a prolactinoma measuring more than 1 cm in size, commonly occurs in man as an incidentaloma, and typically associated with serum prolactin level of 500 ng/ml and greater [1] [4] as occurred in this case. The prolactin level reported in this case was 21146 ng/ml, approximately 2 to 4 times above the levels of previously published case reports of prolactinoma and stroke, which were 8997 ng/ml [5] and 4700 ng/ml [6], respectively. The size of the tumour generally determines the degree of prolactin secretion [6].…”

“…The prolactin level reported in this case was 21146 ng/ml, approximately 2 to 4 times above the levels of previously published case reports of prolactinoma and stroke, which were 8997 ng/ml [5] and 4700 ng/ml [6], respectively. The size of the tumour generally determines the degree of prolactin secretion [6]. The larger the tumour size, the greater the prolactin secretion.…”