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A rare case of a giant prolactinoma with atypical histological features: 5 years of follow-up

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Abstract

Background

Giant prolactinomas are rare in childhood and adolescence and represent a challenge in diagnosis and management.

Case presentation

A 15.7-year-old male adolescent presented with short stature and delayed puberty. On clinical examination, mild right central VII paresis, gait instability, decreased visual acuity, and impaired visual fields were noted. Investigations showed hyperprolactinemia (2209 ng/mL), secondary hypothyroidism, hypogonadotropic hypogonadism, and growth hormone deficiency. Imaging studies showed an enormous invasive skull base mass. Craniotomy was undertaken to debulk the tumor and perform biopsies. Histology revealed a very large atypical, prolactin-secreting pituitary macroadenoma, i.e., a giant prolactinoma. After commencing cabergoline treatment, prolactin concentrations decreased in 5 months and normalized 18 months later, while significant shrinkage of the tumor was observed. The diagnostic work-up for genetic syndromes often associated with sporadic macroadenomas was negative.

Conclusion

Giant prolactinomas presenting with multiple pituitary hormone deficiencies in childhood or adolescence are rare and require prompt diagnosis and multidisciplinary management.

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Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, Thivon & Levadeias Str., 11527, Athens, Greece

    Ioannis-Anargyros Vasilakis,  George Paltoglou &  Evangelia Charmandari

  2. University Research Institute of Maternal and Child Health & Precision Medicine, Thivon & Levadeias Str., 11527, Athens, Greece

    George Paltoglou

  3. Division of CT and MRI, Radiology Department, ‘Aghia Sophia’ Children’s Hospital, Thivon & Levadeias Str., 11527, Athens, Greece

    Maria Gavra

  4. Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece

    Evangelia Charmandari

Authors
  1. Ioannis-Anargyros Vasilakis
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  2. George Paltoglou
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  3. Maria Gavra
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  4. Evangelia Charmandari
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Corresponding author

Correspondence to George Paltoglou.

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Vasilakis, IA., Paltoglou, G., Gavra, M. et al. A rare case of a giant prolactinoma with atypical histological features: 5 years of follow-up. Hormones 21, 323–327 (2022). https://doi.org/10.1007/s42000-022-00350-5

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  • DOI: https://doi.org/10.1007/s42000-022-00350-5

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