Prolactinoma Manifesting With Symptomatic Hydrocephalus

Abstract

Prolactinomas are the most common secretory adenomas of pituitary origin. They typically manifest with symptoms referable to their endocrinologic effects or, if of sufficient size, to visual changes due to compression of the optic chiasm. Pituitary adenomas manifesting with hydrocephalus are rare. To our knowledge, only three such P rolactin-producing tumors of the pituitary gland typically manifest with symptoms related to endocrine disturbances or, if large enough, to visual changes due to compression of visual pathways. We describe a case of a large prolactinoma manifesting with subacute progressive obtundation due to hydrocephalus. This mode of manifestation for pituitary adenomas is rare. To our knowledge, only three cases have previously been reported. We present a review of the literature and also discuss treatment options. REPORT OF CASE An Sl-year-old woman sought medical assessment because of a subacute and progressive decrease in level of consciousness during a 2-week period. Findings on the physical examination were unremarkable except for pronounced somnolence and confusion. The patient was noncooperative for assessment of gait or visual field testing. A computed tomographic scan with use of contrast medium revealed a third ventricular mass with an enlarged sella and associated hydrocephalus. That same day, magnetic resonance imaging confirmed a sellar mass with suprasellar extension filling the third ventricle and obstructing both foramen of Monro (Fig. I). An endocrine evaluation revealed a prolactin level of 6,800 ng/mL; results of other pituitary function studies were considered normal. Laboratory test results are listed in Table I. Bromocriptine was immediately initiated at a dose of 10 mg three times a day. By the next day, her level of consciousness had improved,

Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

“…These findings tend to confirm previous observations in men that DA sensitivity is independent from age (25). Noteworthy, a good response has been documented, even in massive prolactinomas inducing hydrocephalus or a confusional state in this age group (16)(17)(18). A still unresolved issue is the need for systematic pharmacological treatment of hyperprolactinaemia in post-menopausal women.…”

Comparison of the accuracy of isosulfan blue and technetium-99m lymphoscintigraphy to determine axillary lymph node metastasis in breast cancer

“…The false negative rate was 1 in 26 cases in the group treated with ISB, 2 in 23 cases in the colloid group, and 0% in the combined method group. This ratio was reported between 0.8% and 11% in various series (32,33,35,36,37,38). It was demonstrated that the false negative rate decreased with the increase in the experience of the surgeon.…”

“…As mentioned earlier, 9%-30% of metastases detected by re-examining the lymph nodes with serial sections could not be detected in routine pathologic infertility testing (10,41) This insufficiency could be removed by reducing the cross-sectional area from the lymph node and by cytokeratin immunohistochemical staining (i.e., specific monoclonal antibody) (41, 42). A learning curve (19,32) was reported in many related studies. An experienced surgeon who applied both methods together had an SLN detection rate of 94%, whereas this rate was 86% for newly recruited surgeons (43).…”

“…In the third group, in which the two techniques were used together, 2.5 SLNs were found on average, with a minimum of at least 1 and a maximum of 4. Cserni found an average of 1.3 SLNs using only vital stains (32). Bass found a mean score of 2.02 in the cohort study of both methods and 1.92 SLNs in Cox regression analysis (33,34,35).…”

Evaluation of the Patients with Hyperprolactinemia

“…Moreover, macroadenomas are more frequent due to late diagnosis, especially in postmenopausal female and male patients, and these patients may present with mass effect and neuroophthalmic complaints (headache and visual field defect) (17). Rarely, cases of prolactinomas with hydrocephalus and trigeminal neuralgia have been reported (32).…”