Abstract
BACKGROUND: Prolactinomas are the most frequent functional pituitary tumors, accounting for at least 45% of all adenomas. These tumors are more frequently diagnosed in women during their reproductive life of 20-40 years of age, probably due to an early effect of the elevation of PRL causing menstrual irregularities. Hyperprolactinemia is responsible for one third of all cases of female infertility. Macroprolactinomas are less frequent. It presents in males much less frequently. Galactorrhea is seen more in females, very rarely in males. CLINICAL CASE: 53-year-old male with severe occipital cephalic pain and hyperprolactinemia, referred to us by the Department of Neurology for endocrinological research due to the finding of a 1.5 cm×1.1 cm Pituitary Macroadenoma (producer of PRL hormone). Treated with Cabergoline 0.5 mg weekly several months ago. Clinical Exam: Male with a height of 70". Weight 210 lbs. Very marked Gynecomastia to the extent that under digital pressure there is important milk secretion (Photo 1). Neck 42 cm. Thorax 42". Abdomen 40". TA120 / 80. RR16 p.m. HR72 p.m. BLOOD HORMONE TEST: IGF-1 230 ng / mL (NV: 64.0-218 ng / mL). Free Testosterone 9.38 pg / mL (NV: 4.25-30.37 pg / mL). ACTH a.m. 30.7 pg / mL (NV: 7.2-63.3 pg / mL). Cortisol a.m. 8.23 ug /dL (NV: 6.0-18.4 ug / dL). Total Estrogens 235 pg / mL (NV: 40-115 pg / mL). FSH 5.4 mIU / mL (NV: 1.5-12.4 mIU / mL). Baseline HGH: 0.2 ng/mL (NV: 0.0-1.2 ng / mL). LH 6.9 mIU/mL (NV: 1.7-8.6 mIU/mL). PRL 0.40 ng/mL (NV: 4.04-15.20 ng/mL) (taking Cabergoline 0.5 mg weekly). Total Testosterone 8.27 ng/mL (NV: 1.93-7.40 ng/mL). TSH 1.64 μIU/mL (0.27-4.20 μIU/mL). FT4 1.33 ng/dL (NV: 0.93-1.71 ng/dL). IMAGES: Campimetry: alterations in both eyeballs (Photo 2-3). Cephalic MRI: Pituitary mass 1.5 cm.×1.1 cm. that contacts the right internal carotid artery as a Macroadenoma (Photo: 3-4-5). CONCLUSIONS: 1.-Pituitary macroprolactinoma of 1.5 cm.×1.1 cm that contacts the right internal carotid artery accompanied by bilateral breast milk discharge in a male (extremely rare) whose PRL hormone is greatly decreased after prolonged therapy with Cabergoline 0.5 mg weekly. 2.-It will be evaluated by Neurosurgery to weight the possible transsphenoidal / transcranial surgery given the contact of the tumor with the right internal carotid artery. REFERENCES: Prolactinoma | The Pituitary Foundation. (n.d.). Pituitary.org.uk. Retrieved January 4, 2022, from https://pituitary.org.uk/information/pituitary-conditions/prolactinoma/ Prolactinoma - Diagnosis and treatment - Mayo Clinic. (2018). Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/prolactinoma/diagnosis-treatment/drc-20376962 Ma, Q., Su, J., Li, Y., Wang, J., Long, W., Luo, M., & Liu, Q. (2018). The Chance of Permanent Cure for Micro- and Macroprolactinomas, Medication or Surgery? A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 9. https://doi.org/10.3389/fendo.2018.00636 Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.