Rare Progression of Microprolactinoma to Macroprolactinoma: A Case Report
https://doi.org/10.15605/jafes.041.S1
- Author:
Shinye Eng
1
;
Rabeah Md Zuki
1
Author Information
1. Medical Department, Hospital Sultan Abdul Halim
- Publication Type:Journal Article
- MeSH:
Prolactinoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):88-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Prolactinomas are the most common functioning pituitary
adenomas, accounting for 50% of all pituitary tumors.
Microprolactinomas (<10 mm) are the most frequent
subtype and usually follow a benign course, with tumor
progression reported in only 5% of cases. We report a
rare case of microprolactinoma that progressed to macroprolactinoma over 16 years.
A 39-year-old female was initially diagnosed with a
microprolactinoma at the age of 23 during evaluation
for irregular menses since menarche. Baseline pituitary
magnetic resonance imaging (MRI) at that time revealed
a lesion measuring 2 × 2 × 0.8 mm. She was treated with
bromocriptine for 2 months but subsequently lost to followup. The patient had been married for 10 years without
conceiving and continued to have irregular menses.
She decided to repeat prolactin before seeking fertility
treatment after 16 years. Laboratory investigations revealed
markedly elevated serum prolactin (>42,000 mIU/L) with
suppressed gonadotropins, while thyroid and adrenal
axes were normal. She reported no galactorrhea, headache,
or visual disturbances and notably did not develop
amenorrhea. Visual field assessment was normal. Repeat pituitary MRI demonstrated that the previously
diagnosed microprolactinoma had progressed to a macroprolactinoma, measuring 2.1 × 2.3 × 1.6 cm, with extension
into the left cavernous sinus and encasement of the left
internal carotid artery, without optic chiasm compression.
Oral cabergoline 0.25 mg twice weekly was initiated. She was
counselled regarding potential risks of dopamine agonist
therapy and advised to use mechanical contraception
during treatment. At the 2-week follow-up, she tolerated
therapy well. Follow-up imaging and prolactin monitoring
were planned at 3 months to assess treatment response
and guide fertility planning.
Conclusion:This case highlights the rare progression of microprolactinoma to macroprolactinoma, underscoring the importance
of long-term monitoring in patients with prolactinoma.
A careful balance between tumor control and fertility
management is essential for optimizing care in women of
reproductive age.
- Full text:2026080414393249860EP_A124.pdf
