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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(07): 544-548
DOI: 10.1590/0004-282X20160083
ARTICLES

Prolactinomas may have unusual presentations resulting from massive extrasellar tumor extension

Prolactinomas podem ter apresentações incomuns resultantes de maciça extensão tumoral extrasselar
Marise Ribeiro de Sousa Berriel
1   Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
,
Giovanna Aparecida Balarini Lima
1   Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
,
Alessandro Severo Alves de Melo
2   Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Departamento de Radiologia, Niterói RJ, Brasil.
,
Maria Laura Vasconcelos dos Santos
1   Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
,
Hassan Rahhal
1   Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
,
Giselle Fernandes Taboada
1   Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
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ABSTRACT

The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18–54 years); median serum prolactin level was 4,562 ng/ml (1,543–18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41–60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7–84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.

RESUMO

O objetivo desta série de casos é relatar oito pacientes com prolactinomas gigantes enfatizando as formas de apresentação e uma complicação do tratamento. O estudo incluiu seis homens e duas mulheres. A mediana de idade foi 29 anos (18–54); e dos níveis de prolactina foi 4.562 ng/ml (1.543–18.690); três pacientes (37,5%) apresentaram pan-hipopituitarismo; a mediana do máximo diâmetro tumoral foi 50 mm (41–60 mm). Cinco pacientes (62,5%) apresentaram alterações no campo visual e três tiveram melhora durante o tratamento; seis pacientes (75%) alcançaram normalização da prolactina em 10,5 meses (7–84) com dose mediana de cabergolina de 2,0 mg / semana (1,0 a 3,0). Um paciente se apresentou como um verdadeiro incidentaloma. Um paciente apresentou uma fistula liquórica durante o tratamento medicamentoso e recusou correção cirúrgica. No entanto a fistula foi resolvida com medidas conservadoras. Esta série de casos ilustra um subtipo raro de macroprolactinomas, a importância de considerar apresentações incomuns no diagnóstico, a eficácia do tratamento farmacológico e suas possíveis complicações.

prolactinoma - dopamine agonists - hyperprolactinemia
prolactinoma - agonistas de dopamina - hiperprolactinemia


Publication History

Received: 05 January 2016

Accepted: 16 May 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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