Big and Blurry: Giant Prolactinoma Case Series
https://doi.org/10.15605/jafes.041.S1
- Author:
Nur Farrah Anima
1
;
Qing Ci Goh
1
;
Vanusha Devaraja Pillai
1
;
Siow Ping Lee
1
Author Information
1. Endocrinology Unit, Department of Medicine, Hospital Melaka
- Publication Type:Journal Article
- MeSH:
Prolactinoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):91-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Giant prolactinomas represent 2–3% of prolactin-secreting
pituitary adenomas and show a male predominance. They
present with mass effect symptoms and hypogonadism, but
may be overlooked, leading to delayed diagnosis. Although
dopamine agonists are first-line therapy, management
remains challenging due to the large size and invasive
behavior. This study aims to describe the clinical and
radiological features, treatment modalities, and outcomes
of three cases of giant prolactinomas. We retrospectively
reviewed three men with giant prolactinomas, including
their clinical, biochemical, and radiological features, along
with treatment and outcomes.
Cases:Three male patients aged 35–59 years with giant
prolactinomas were included. Two patients presented
with visual disturbances, headache, and features of hypogonadism, while one patient had acute confusion and visual
loss secondary to obstructive hydrocephalus requiring
ventriculoperitoneal shunt insertion. Imaging in all cases
demonstrated large invasive pituitary macroadenomas with
extensive local extension. Baseline serum prolactin levels
were markedly elevated, ranging from 86,568 to 441,116
uIU/mL (86–324 uIU/mL). All patients had secondary
hypogonadism, while secondary hypothyroidism and
hypocortisolism were each identified in two patients.
One patient also had poorly controlled diabetes mellitus
at presentation. Dopamine agonist therapy was initiated
as the primary therapy for all the patients. Two patients
developed cerebrospinal fluid leak following initiation of
low-dose dopamine agonist therapy (one patient received cabergoline 0.25 mg weekly, while another received 0.5 mg
weekly), which resolved spontaneously with conservative
management. Serum prolactin levels decreased markedly,
with significant improvement in symptoms related to
mass effect following treatment.
Conclusion:Giant prolactinomas may present with significant mass
effect and multiple pituitary hormone deficiencies.
Dopamine agonists remain the cornerstone of management
and can result in substantial biochemical and clinical
improvement even in large invasive tumors. However,
rapid tumor shrinkage may lead to complications such
as cerebrospinal fluid leak, highlighting the importance
of close monitoring during treatment initiation.
- Full text:2026080414575910430EP_A129q.pdf
