title: Prolactinomas may have unusual presentations resulting from massive extrasellar tumor extension.
abstract: The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18-54 years); median serum prolactin level was 4,562 ng/ml (1,543-18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41-60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7-84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
authors.forename: Marise Ribeiro de Sousa
authors.initials: MR
authors.lastname: Berriel
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
authors.forename: Giovanna Aparecida Balarini
authors.initials: GA
authors.lastname: Lima
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Departamento de Radiologia, Niterói RJ, Brasil.
authors.forename: Alessandro Severo Alves de
authors.initials: AS
authors.lastname: Melo
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
authors.forename: Maria Laura Vasconcelos Dos
authors.initials: ML
authors.lastname: Santos
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
authors.forename: Hassan
authors.initials: H
authors.lastname: Rahhal
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil;
authors.forename: Giselle Fernandes
authors.initials: GF
authors.lastname: Taboada
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077465:Cabergoline; D065634:Cerebrospinal Fluid Leak / Q000473:pathology; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D012658:Sella Turcica / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D018491:Dopamine Agonists; D004873:Ergolines; D011388:Prolactin; D000077465:Cabergoline