Aggressive giant prolactinoma: a case report

• Published in: Journal of medical case reports 2022-04, Vol.16 (1), p.170-170, Article 170
• Main Authors: Borhan, Marisa Khatijah, Tan, Florence Hui Sieng
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aggressive prolactinoma; Cabergoline; Cabergoline - therapeutic use; Case Report; Case reports; Development and progression; Diagnosis; Endocrinology; Female; Giant prolactinoma; Hormone replacement therapy; Humans; Hypothalamus; Menstruation; Neoplasm Recurrence, Local - drug therapy; Patients; Pituitary gland; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - diagnostic imaging; Prolactin; Prolactinoma - diagnosis; Prolactinoma - diagnostic imaging; Radiation therapy; Surgery; Temozolomide; Temozolomide - therapeutic use; Tumors; Young Adult
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-022-03390-y

Managing treatment-resistant aggressive giant prolactinoma can be challenging, as the diagnosis is often complex, and treatment beyond dopamine agonists, surgery, and radiotherapy is limited. A 21-year-old Malay woman first presented to our hospital at the age of 16 years with 1-year history of reduced vision and 2 years of amenorrhea. Her baseline prolactin level was 255,894 µIU/mL with secondary hypogonadism, and pituitary magnetic resonance imaging revealed a giant prolactinoma (2.8 × 3.2 × 4.2 cm ) with suprasellar extension and optic chiasmal compression. She was initially treated with cabergoline, and reductions in the prolactin level and tumor mass were achieved, leading to vision improvement and resumption of normal menstruation. However, she developed recurrent tumor growth and hyperprolactinemia, causing relapse of symptoms, and she needed surgery. Eventually, despite three tumor debulking surgeries and escalation of cabergoline doses up to 1 mg/day, her tumor progressed with aggressive characteristics. Following a multidisciplinary meeting, the patient is initiated on temozolomide therapy after considering the long-term side effects of radiotherapy in her case. This case highlights the importance of early identification of treatment-resistant prolactinoma and the need for a multidisciplinary approach in managing aggressive prolactinoma in young patients, particularly regarding timely implementation of temozolomide therapy.