Rapidly progressing giant invasive prolactinoma

Care, R H; Sunkaraneni, Vishnu; Theaker, J.M.; Harries, Phillip

doi:10.1017/s0022215112001296

Cited by 9 publications

(4 citation statements)

References 8 publications

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“…In very rare cases, a large anterior tumoural extension into the nasopharynx will produce nasal stuffiness, snoring, epistaxis and respiratory problems (20,34,53,54), and the diagnosis of prolactinoma may sometimes be made through biopsy of a nasal polypoid mass (54,55). Orbital invasion is another rare extrasellar extension of pituitary tumours and will cause exophthalmos and optic nerve compression at the orbital apex (31,46,56).…”

Section: Presenting Featuresmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Maiter

Delgrange

2014

European Journal of Endocrinology

159

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: Presenting Featuresmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Maiter

Delgrange

2014

European Journal of Endocrinology

159

166

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“…In very rare case, a large anterior tumoral extension into the nasopharynx has been described and can potentially produce nasal obstruction, epistaxis and respiratory problem [10][11][12][13]. If endocrinological disturbances are not obvious, this may lead to inappropriate biopsy of the tumour [12,14] which has occured in our case.…”

Section: Discussionmentioning

confidence: 80%

Unilateral Exophtalmos Caused by an Invasive Giant ProlactinomaC

Lassoued¹

2017

EMIJ

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We report the case of a 40-year-old male presenting with an unilateral exophtalmos due to a large tumoral mass invading the skull base. Magnetic resonance imaging (MRI) showed extension of a large tumour (8*6*6 cm) into the right orbit. Endocrine evaluation revealed elevated serum prolactin (PRL) levels (161 290 ng/mL, NR < 12.07) leading to the diagnosis of an invasive giant prolactinoma. Treatment with Bromocriptine resulted in rapid decrease of serum PRL (3 months after initiation of treatment), reduction of tumour size with improvement of the exophtalmos. With reference to this case, we review the features of invasive giant prolactinomas. We point out the use of Dopamine agonists in the treatment of prolactinomas with such atypical presentation.

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“…Poste-rior growth of the tumor can involve the cerebellum and cause ataxia [9]. Anterior growth of the tumor can result in invasion of the nasopharynx or orbits causing nasal stuffiness and snoring or exophthalmos and optic nerve compression respectively [15][16][17][18][19]. Giant prolactinomas can also invade the foramen of Monro and result in hydrocephalus [20].…”

Section: Discussionmentioning

confidence: 99%