Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population

Abstract

Introduction:Prolactinomas are less frequent, but more invasive in males. Giant ones (≥4 cm) are extremely rare in literature. Their neurological, psychiatric and endocrine complications are life threatening. Our aim was to report the largest mono center series in order to analyze their frequency, their characteristics, and their complications.Subjects and Methods:All patients had clinical examination, hormonal, ophthalmological, and radiological assessment based on computed tomography scan and cerebral magnetic resonance imaging. Positive diagnosis was based on clinical symptoms, high prolactin ± immunohistochemy study. Mixed adenomas were excluded by hormonal exploration and immunohistochemy. For those who received medical treatment only, a reduction in tumor size was considered a supplementary positive point for the diagnosis.Results:Among 154 male prolactinomas seen between 1987 and 2013, we observed 44 giant tumors (28.5%). Median age = 36 years, and 38.3% were under 30. Median tumor height = 53.95 mm (40–130) and median prolactin = 15,715 ng/ml (n < 20). Solid and cystic aspect ± calcifications was observed in 25%. 42 had cavernous sinuses invasion. Other invasions were: Posterior= 65.9%, anterior= 63.6%, temporal= 15.9% and frontal = 9%. For endocrine complications: Hypogonadism = 98.4%, thyrotroph and corticotroph deficits were seen in respectively 34%, and 32%. Posterior pituitary insufficiency was observed in one case. For ophthalmological complications: Optic atrophy = 46%, Ptosis = 6.8%, diplopia/strabismus = 4.5%. Neurological complications were: Memory loss and/or unconsciousness = 18.2%, epilepsy = 15.9%, frontal syndrome = 9% and obstructive hydrocephalus = 6.8%.Conclusion:Giant prolactinomas account for 28% in our population. Severe neurological complications are frequent. But, obstructive hydrocephalus is rare, which argues for a slow progression.

Clinical Features, Therapeutic Trends, and Outcome of Giant Prolactinomas: A Single-Center Experience Over a 12-Year Period

“…Many series showed male preponderance. 21,22,26 The overrepresentation of women has been reported in other series. 28 Our study had more men with giant prolactinomas; this discrepancy maybe because of the late presentation of male patients.…”

Giant Prolactinoma Causing Hydrocephalus and Intracranial Hypertension as First Manifestations of Multiple Endocrine Neoplasia Type 1

“…Four cases with giant prolactinomas underwent transsphenoidal surgery for intracranial hypertension and giant macroadenomas in a series of 18 patients with prolactinomas larger than 60 mm (9). In turn, Chentli et al described three cases of obstructive hydrocephalus in a series of 44 patients (6.8%) with giant prolactinomas (30). The very low prevalence of hydrocephalus and intracranial hypertension in giant prolactinomas could be resultant of very slow tumor growth (30).…”

“…In turn, Chentli et al described three cases of obstructive hydrocephalus in a series of 44 patients (6.8%) with giant prolactinomas (30). The very low prevalence of hydrocephalus and intracranial hypertension in giant prolactinomas could be resultant of very slow tumor growth (30). Again, MEN1 genetic analysis was not available and no MEN1 case was diagnosed in both series (9, 30).…”

“…The very low prevalence of hydrocephalus and intracranial hypertension in giant prolactinomas could be resultant of very slow tumor growth (30). Again, MEN1 genetic analysis was not available and no MEN1 case was diagnosed in both series (9, 30). Most cases of giant prolactinoma with hydrocephalus were diagnosed in young males, as seen in our case (29, 31, 32, 34–38).…”

“…Based on criteria adopted for most series and authors (8–10, 12–14, 40–45), this latter case was not defined as giant prolactinoma as prolactin was lower than 1,000 ng/ml. However, this is controversial as other authors has considered lower prolactin cut-offs as 200 or 250 ng/ml to define giant prolactinoma (30, 46–48).…”