Presentación atípica de un prolactinoma gigante en un adolescente de 15 años

Abstract

Arch Argent Pediatr 2018;116(2):e325-e330 / e325Presentación de casos clínicos RESUMEN El prolactinoma gigante es un adenoma pituitario poco frecuente caracterizado por su gran invasión local. Se reporta el caso de un varón de 15 años de edad con dolor retroocular izquierdo y exoftalmos ipsilateral de 4 meses de evolución secundario a un tumor en la base del cráneo que invadía la órbita. Los estudios hormonales revelaron prolactina sérica de 6913,7 ng/ml (valor normal < 20), que confirmó el diagnóstico de prolactinoma gigante. El paciente inició un tratamiento con el agonista dopaminérgico cabergolina en dosis crecientes. Luego de 7 meses de seguimiento, la prolactina había descendido a 349,8 ng/ml y el volumen del tumor se redujo un 70%, sin efectos adversos al tratamiento. El paciente se encontraba asintomático y había reiniciado la pubertad. La rápida remisión de los síntomas sin necesidad de tratamientos invasores subraya la importancia de considerar el diagnóstico de prolactinoma entre los posibles diagnósticos diferenciales de tumor de la base del cráneo. Palabras clave: prolactinoma gigante, exoftalmos, adolescente, hiperprolactinemia, cabergolina. ABSTRACT Giant prolactinomas are rare pituitary adenomas characterized by their great local invasion. In this paper, we report a 15-year-old male with left retro-ocular pain and ipsilateral exophthalmos of 4 months of evolution, secondary to a tumour in the base of the skull that invaded the orbit. Hormonal studies revealed serum prolactin of 6913,7 ng/ml (normal value < 20), confirming the diagnosis of giant prolactinoma. The patient started treatment with the dopaminergic agonist cabergoline in increasing doses. After 7 months of follow-up the prolactin had decreased to 349.8 ng/ml and the tumor volume was reduced by 70%, without presenting adverse effects to the treatment. The patient was asymptomatic and had restarted puberty. The rapid remission of symptoms without the need for Presentación atípica de un prolactinoma gigante en un adolescente de 15 años Atypical presentation of a giant prolactinoma in a 15-year-old boyinvasive treatments underlines the importance of considering the diagnosis of prolactinoma among the possible differential diagnoses of tumor of the skull base.

Lost to Follow-Up: Complications of an Invasive Giant Prolactinoma

“…The patient's course also had unique clinical features. Orbital extension of prolactinomas is very rare; based on our review, there are only 14 other cases reported in the literature, with only 4 of them being in females [4][5][6][7][8][9][10][11]. In one reported case, the patient presented with isolated eye pain and proptosis in the absence of any other symptoms or evidence of hormone hypersecretion, making the diagnosis initially difficult [4].…”