Beat the giant: case of a giant prolactinoma during pregnancy on cabergoline

Abstract

Giant prolactinomas are a rare entity; during pregnancy, the risk for complications associated with these tumors is higher. Here, we report a case of a young woman who had an invasive, giant prolactinoma post resection with residual disease who became pregnant. This patient was treated with cabergoline to prevent tumor expansion in pregnancy, resulting in the uneventful delivery of a healthy baby boy.

Learning points: Giant prolactinoma can cause both diagnostic and therapeutic challenges given their atypical presentation.Accurate diagnosis is paramount to avoid unnecessary surgical intervention or pituitary irradiation.This case demonstrates the effectiveness and safety of CAB therapy during pregnancy.

Figure 1

(A and B) Preoperative MRI scan of the pituitary showing a large sellar/suprasellar mass, which invaded the bilateral cavernous sinuses and skull base bones and extended to the nasal cavity, paranasal sinuses and pterygopalatine fosse. (C and D) Postoperative MRI scan of the pituitary showing a residual lesion that appeared to be stable in size and signal intensity at the sellar and suprasellar component, invading the skull base and extending to the nasopharynx. The optic chiasm and optic nerves appear unremarkable; the bilateral internal carotid arteries are again noted to be encircled by the tumor and are still patent.

Figure 2

(A and B) Intrapartum (26 weeks’ gestation) MRI scan of the pituitary showing a minimal increase in the size of the macroadenoma in the anterior–posterior dimension. The supratentorial component of the tumor just reaches the margin of the optic chiasm. The optic chiasm is thin and moderately atrophied with a mild T2 hyperintense signal abnormality, unchanged as compared with prior studies. (C and D) Postpartum MRI scan of the pituitary showed interval tumor progression since the previous MRI scan. The tumor currently shows more progression extracranially, affecting the intratemporal region and eroding the floor of the right-middle cranial fossa. It subsequently developed into a dural-based enhancing lesion that was noted in continuity with the previous tumor, causing compression and displacement to the right temporal pole. Furthermore, interval progression was noted in the size of the tumor at the roof of the nasopharynx.