title: Obstructive hydrocephalus, fifth nerve and hypothalamus involvement: acute presentation of a giant prolactinoma.
abstract: BACKGROUND
  Pituitary tumors from lactotrope cells account for about 40% of all functioning pituitary cancers. Men tend to present with a larger, more invasive and rapid growth prolactinomas than women, possibly because hypogonadism features are less evident.
  
  
  METHODS
  A 27-year-old, previously asymptomatic Saudi man presented with a 3-day history of emesis with severe left-sided frontal headache, left face and right upper limb numbness, with signs of obstructive hydrocephalus. Brain Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed a giant pituitary mass occupying several regions (sellar, infra-sellar, and supra-sellar) measuring 6.5 × 5.7 × 5.9 cm, and invading the sphenoid sinus as well as the cavernous sinuses bilaterally, with intra-pituitary hemorrhage compressing the third ventricle causing obstructive hydrocephalus. Prolactin levels were >200,000 mIU/L, consistent with invasive giant prolactinoma (IGP). He was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of IGP.
  
  
  CONCLUSIONS
  This is a rare case of obstructive hydrocephalus with super-imposed intra-pituitary hemorrhage secondary to IGP, highlighting the importance of a full hormonal assessment for proper diagnosis and management.
authors.affiliation: King Saud University, King Khalid University Hospital, Medicine Department Endocrine Division, Riyadh, Saudi Arabia.
authors.forename: Shadin
authors.initials: S
authors.lastname: Alkatari
authors.forename: Naji
authors.initials: N
authors.lastname: Aljohani