, Volume 14, Issue 4, pp 340–344 | Cite as

Unusual clinical presentations of giant prolactinomas

  • Simona Grozinsky-Glasberg
  • Ilan Shimon
Case Report


Giant prolactinomas are rare pituitary tumors which have scarcely been reported in the literature. We describe three men with unusual presenting features of prolactin-secreting giant pituitary adenomas: prolonged and increasingly disturbing intolerance to light and noise; strange behavior and mood disturbances; and rhinorrhea followed by a finding of cerebrospinal fluid leakage. Treatment with dopamine agonist alleviated all symptoms, with concomitant suppression of plasma prolactin levels and a significant reduction in tumor mass. These cases emphasize the importance of considering unusual symptoms in the differential diagnosis of giant prolactinomas and the effectiveness of medical treatment.


Giant prolactinomas Unusual symptoms Photophobia Mood changes CSF leak 



The authors thank Gloria Ginzach and Melanie Kawe for their editorial assistance.


  1. 1.
    Luciano AA (1999) Clinical presentation of hyperprolactinemia. J Reprod Med 44:1085–1090PubMedGoogle Scholar
  2. 2.
    Sclechte J, Dolan K, Sherman B et al (1989) The natural history of untreated hyperprolactinemia: a prospective analysis. J Clin Endocrinol Metab 68:412–418CrossRefGoogle Scholar
  3. 3.
    Corsello SM, Ubertini G, Altomare M et al (2003) Giant prolactinomas in men: efficacy of cabergoline treatment. Clin Endocrinol (Oxf) 58:622–670. doi: 10.1046/j.1365-2265.2003.01770.x CrossRefGoogle Scholar
  4. 4.
    Shrivastava RK, Arginteanu MS, King WA, Post KD (2002) Giant prolactinomas: clinical management and long-term follow-up. J Neurosurg 97:299–306PubMedCrossRefGoogle Scholar
  5. 5.
    Velkeniers B, Hooghe-Peters EL (1998) From prolactin cell to prolactinoma: implications of ontogenic mechanisms in diagnosis and management. Endocr Relat Cancer 5:27–36. doi: 10.1677/erc.0.0050027 CrossRefGoogle Scholar
  6. 6.
    Shimon I, Benbassat C, Hadani M (2007) Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men. Eur J Endocrinol 156:225–231. doi: 10.1530/EJE-06-0646 PubMedCrossRefGoogle Scholar
  7. 7.
    Kars M, Roelfsema F, Romijn JA, Pereira AM (2006) Malignant prolactinoma: case report and review of the literature. Aur J Endocrinol 155:523–534. doi: 10.1530/eje.1.02268 CrossRefGoogle Scholar
  8. 8.
    Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27:485–534. doi: 10.1210/er.2005-9998 PubMedCrossRefGoogle Scholar
  9. 9.
    Leong KS, Foy PM, Swift AC et al (2000) CSF rhinorrhoea following treatment with dopamine agonists for massive invasive prolactinomas. Clin Endocrinol (Oxf) 52:43–49. doi: 10.1046/j.1365-2265.2000.00901.x CrossRefGoogle Scholar
  10. 10.
    Pia HW, Grote H, Hildebrandt G (1985) Giant pituitary adenomas. Neurosurg Rev 8:207–220. doi: 10.1007/BF01815445 PubMedCrossRefGoogle Scholar
  11. 11.
    Symon L, Jakubowski J, Kendall B (1979) Surgical treatment of giant pituitary adenomas. J Neurol Neurosurg Psychiatry 42:973–982. doi: 10.1136/jnnp.42.11.973 PubMedCrossRefGoogle Scholar
  12. 12.
    Schlechte JA (2003) Clinical practice. Prolactinoma. N Engl J Med 349:2035–2041. doi: 10.1056/NEJMcp025334 PubMedCrossRefGoogle Scholar
  13. 13.
    Molitch ME, Elton RL, Balckwell RE et al (1985) Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study. J Clin Endocrinol Metab 60:698–705PubMedCrossRefGoogle Scholar
  14. 14.
    Odin P, Oehlwein C, Storch A et al (2006) Efficacy and safety of high-dose cabergoline in Parkinson’s disease. Acta Neurol Scand 113:18–224. doi: 10.1111/j.1600-0404.2005.00514.x PubMedCrossRefGoogle Scholar
  15. 15.
    Zanettini R, Antonini A, Gatto G et al (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356:39–46. doi: 10.1056/NEJMoa054830 PubMedCrossRefGoogle Scholar
  16. 16.
    Wakil A, Rigby AS, Clark AL et al (2008) Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease. Eur J Endocrinol 159:R11–R14. doi: 10.1530/EJE-08-0365 PubMedCrossRefGoogle Scholar
  17. 17.
    Ciric I, Mikhael M, Stafford T et al (1983) Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg 59:395–401PubMedCrossRefGoogle Scholar
  18. 18.
    Davis JR, Sheppard MC, Heath DA (1990) Giant invasive prolactinoma: a case report and review of nine further cases. Q J Med 74:227–238PubMedGoogle Scholar
  19. 19.
    Oruckaptan HH, Senmevsim O, Ozcan OE, Ozgen T (2000) Pituitary adenomas: results of 684 surgically treated patients and review of the literature. Surg Neurol 53:211–219. doi: 10.1016/S0090-3019(00)00171-3 PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Institute of Endocrinology & Metabolism, Rabin Medical Center, Beilinson HospitalPetah TiqwaIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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