Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population.
BACKGROUND
Prolactinomas are less frequent, but more invasive in males. Giant ones (≥4 cm) are extremely rare in literature. Their neurological, psychiatric and endocrine complications are life threatening. Our aim was to report the largest mono center series in order to analyze their frequency, their characteristics, and their complications.


METHODS
All patients had clinical examination, hormonal, ophthalmological, and radiological assessment based on computed tomography scan and cerebral magnetic resonance imaging. Positive diagnosis was based on clinical symptoms, high prolactin ± immunohistochemy study. Mixed adenomas were excluded by hormonal exploration and immunohistochemy. For those who received medical treatment only, a reduction in tumor size was considered a supplementary positive point for the diagnosis.


RESULTS
Among 154 male prolactinomas seen between 1987 and 2013, we observed 44 giant tumors (28.5%). Median age = 36 years, and 38.3% were under 30. Median tumor height = 53.95 mm (40-130) and median prolactin = 15,715 ng/ml (n < 20). Solid and cystic aspect ± calcifications was observed in 25%. 42 had cavernous sinuses invasion. Other invasions were: Posterior= 65.9%, anterior= 63.6%, temporal= 15.9% and frontal = 9%. For endocrine complications: Hypogonadism = 98.4%, thyrotroph and corticotroph deficits were seen in respectively 34%, and 32%. Posterior pituitary insufficiency was observed in one case. For ophthalmological complications: Optic atrophy = 46%, Ptosis = 6.8%, diplopia/strabismus = 4.5%. Neurological complications were: Memory loss and/or unconsciousness = 18.2%, epilepsy = 15.9%, frontal syndrome = 9% and obstructive hydrocephalus = 6.8%.


CONCLUSIONS
Giant prolactinomas account for 28% in our population. Severe neurological complications are frequent. But, obstructive hydrocephalus is rare, which argues for a slow progression.
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Farida
F
Chentli
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Said
S
Azzoug
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Katia
K
Daffeur
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Lina
L
Akkache
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Hadjer
H
Zellagui
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Meriem
M
Haddad
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
Nadia
N
Kalafate
Giant prolactinomas; male; neurological life threatening complications; optic atrophy; pituitary insufficiency