title: Giant Prolactinoma Presenting with Neck Pain and Structural Compromise of the Occipital Condyles.
abstract: Prolactinomas are the most common form of endocrinologically active pituitary adenoma; they account for ∼ 45% of pituitary adenomas encountered in clinical practice. Giant adenomas are those > 4 cm in diameter. Less than 0.5% of pituitary adenomas encountered in neurosurgical practice are giant prolactinomas. Patients with giant prolactinomas typically present with highly elevated prolactin levels, endocrinologic disturbances, and neurologic symptoms from mass-induced pressure. Described here is an unusual case of a giant prolactinoma presenting with neck pain and structural compromise of the occipital condyles. Transnasal biopsy of the nasopharyngeal portion of the mass obtained tissue consistent with an atypical prolactinoma with p53 reactivity and a high Ki-67 index of 5%. Despite the size and invasiveness of the tumor, the patient had resolution of his clinical symptoms, dramatic reduction of his hyperprolactinemia, and near-complete disappearance of his tumor following medical treatment.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Derek
authors.initials: D
authors.lastname: Yecies
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Abdulrazag
authors.initials: A
authors.lastname: Ajlan
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: John
authors.initials: J
authors.lastname: Ratliff
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ziskin
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Hwang
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Hannes
authors.initials: H
authors.lastname: Vogel
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States ; Department of Medicine, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Laurence
authors.initials: L
authors.lastname: Katznelson
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
authors.forename: Griffith
authors.initials: G
authors.lastname: Harsh
keywords: giant prolactinoma; invasive adenoma; occipital condyles; occipitocervical instability; pituitary adenoma