Giant prolactinomas presenting as skull base tumors.
BACKGROUND
Prolactinomas invading the skull base are rare, and could easily be confused with skull base tumors of nonpituitary origin.


METHODS
We report a series of 4 cases of giant prolactinomas invading the skull base and presenting with atypical symptoms. Case 1 presented with a short history of headache and nasal obstruction. Case 2 presented with progressive hypoacusia, dizziness, and ophthalmoplegia. In Case 3, the patient developed rapid progressive visual failure and psychiatric symptoms. Case 4 presented with a 1-year history of headache and retrorbital pain. The diagnosis of prolactinoma was made on the basis of tumor immunohistochemistry and/or high plasma prolactin levels (range from 650-6,500 ng/mL). Medical treatment with the dopamine agonist cabergoline was given; it was effective in normalizing prolactin levels and inducing tumor shrinkage.


CONCLUSIONS
Prolactin levels should be measured in all large skull base tumors involving the pituitary region before any surgery or inappropriate radiotherapy is performed.
Minniti
Giuseppe
G
INM-IRCCS Neuromed, Pozzilli, Italy.
Jaffrain-Rea
Marie Lise
ML
Santoro
Antonio
A
Esposito
Vincenzo
V
Ferrante
Luigi
L
Delfini
Roberto
R
Cantore
Giampaolo
G
D000328:Adult; D000077465:Cabergoline; D003937:Diagnosis, Differential; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010911:Pituitary Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D019292:Skull Base Neoplasms / Q000175:diagnosis*
D018491:Dopamine Agonists; D004873:Ergolines; D011388:Prolactin; D000077465:Cabergoline