Prolactinoma Invasion of Superior Ophthalmic Vein

Angyal, Emese; Lee, Huey‐Jen; Wolansky, Leo; Koenigsberger, M. Richard; Nathanson, Daniel R.; Zimmer, Aleksandra

doi:10.1097/00004728-199311000-00020

Cited by 4 publications

(2 citation statements)

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“…Among 16 cases collected from the literature and fulfilling all definition criteria of a true giant prolactinoma (55,56,72,95,105,106,107,108,109,110,111,112,113,114), there were 15 boys with a mean age of 10.8 years (range: 6-14 years) and a mean tumour diameter of 65 mm (range: 40-99 mm) and only one 14.5-year-old girl (95). These giant tumours may also lead to the same various neurologic complications as in adults, such as blindness and cranial nerve palsies (106), hydrocephalus (56,72), proptosis (56,105,108) or nasopharyngeal symptoms (71,114), and they should be considered in the differential diagnosis of every large and erosive paediatric skull base tumour.…”

Section: Giant Prolactinoma In Childrenmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Maiter

Delgrange

2014

European Journal of Endocrinology

158

166

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Giant prolactinomas are rare tumours, representing only 2-3% of all prolactin (PRL)-secreting tumours and raising special diagnostic and therapeutic challenges. Based on several considerations developed in this review, their definition should be restricted to pituitary adenomas with a diameter of 40 mm or more, significant extrasellar extension, very high PRL concentrations (usually above 1000 mg/l) and no concomitant GH or ACTH secretion. Giant prolactinomas are much more frequent in young to middle-aged men than in women, with a male to female ratio of about 9:1. Endocrine symptoms are often present but overlooked for a long period of time, and diagnosis is eventually made when neurologic complications arise from massive extension into the surrounding structures, leading to cranial nerve palsies, hydrocephalus, temporal epilepsy or exophthalmos. PRL concentrations are usually in the range of 1000-100 000 mg/l, but may be underestimated by the so-called 'high-dose hook effect'. As in every prolactinoma, dopamine agonists are the first-line treatment allowing rapid alleviation of neurologic symptoms in the majority of the cases, a significant reduction in tumour size in three-fourths of the patients and PRL normalization in 60-70%. These extensive tumours are usually not completely resectable and neurosurgery has significant morbidity and mortality. It should therefore be restricted to acute complications such as apoplexy or leakage of cerebrospinal fluid (often induced by medical treatment) or to patients with insufficient tumoural response or progression. Irradiation and temozolomide are useful adjuvant therapies in a subset of patients with aggressive/invasive tumours, which are not controlled despite combined medical and surgical treatments. Because of these various challenges, we advocate a multidisciplinary management of these giant tumours in expert centres.

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Section: Giant Prolactinoma In Childrenmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Maiter

Delgrange

2014

European Journal of Endocrinology

158

166

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“…Therefore, a clear picture of the retrobulbar vasculature is very important for the diagnosis to several sight threatening diseases, such as ocular ischemic syndrome , central retinal artery occlusion , and diabetic retinopathy . To date, there has not been a medical imaging modality that can provide satisfying results for viewing these vessels: CT and digital subtraction angiography (DSA) is limited by radiation exposure and lack of reference anatomic structures ; Doppler ultrasound is operator dependent and only works with the largest OA ; optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT) have very limited penetration and cannot image vessels behind the eyeballs . High resolution MR angiography (MRA) has great potential with benefits of high resolution, full field of view and noninvasiveness, and is currently the most widely used angiography imaging modality.…”

Section: Introductionmentioning

confidence: 99%

Retrobulbar magnetic resonance angiography using binomial off‐resonant rectangular (BORR) pulse

Lewis

et al. 2014

Magnetic Resonance in Med

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A giant prolactinoma presenting with unilateral exophthalmos: Effect of cabergoline and review of the literature

Berwaerts

Verhelst

Abs

et al. 2000

J Endocrinol Invest

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We report the case of a 45-year-old male presenting with unilateral exophthalmos due to a large tumoral mass invading the skull base. Ophthalmologic examination did not show any visual field defects. Imaging techniques demonstrated extension of a huge tumor (approx. 8x8x8 cm) into the right orbit and nasopharynx. Endocrine work-up revealed grossly elevated serum prolactin (PRL) levels (26,466 microg/l, nl. < 12), pointing to a large, invasive macroprolactinoma. Stimulation tests indicated associated partial adrenal and growth hormone deficiencies. Planned surgery was abandoned, and the patient was instead treated with the long-acting dopamine agonist, cabergoline. Over a period of one year, serum PRL dropped to 131 microg/l, while the tumor mass shrank to less than 50% of its original volume (with 3.5 mg/week of cabergoline). The exophthalmos disappeared, and the patient did not develop rhinorrhea or any other side effects from treatment with cabergoline. The efficacy was maintained throughout the second year (ultimate serum PRL 74 microg/l, and final size less than 10% of the original). With reference to this case, we review other macroprolactinomas reported in the recent literature for associated exophthalmos, grossly elevated serum PRL levels (> or = 15,000 microg/l), and/or "giant" size (> or = 4 cm in maximum diameter). We highlight the use of dopamine agonists in the treatment of prolactinomas with such unusual characteristics.

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Prolactinoma Invasion of Superior Ophthalmic Vein

Cited by 4 publications

References 0 publications

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Retrobulbar magnetic resonance angiography using binomial off‐resonant rectangular (BORR) pulse

A giant prolactinoma presenting with unilateral exophthalmos: Effect of cabergoline and review of the literature

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