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Case Reports
. 2021 Apr 14;5(9):bvab069.
doi: 10.1210/jendso/bvab069. eCollection 2021 Sep 1.

Giant Prolactinoma Presenting With Facial Nerve Palsy and Hemiparesis

Aleksandra Sliwinska  1 , Fatima Jalil  1   2 , Lori De La Portilla  1   2 , Michael Baldwin  3 , Joseph Lorenzo  1   2 , Ketan R Bulsara  4 , Faryal S Mirza  1   2
Affiliations
Case Reports

Giant Prolactinoma Presenting With Facial Nerve Palsy and Hemiparesis

Aleksandra Sliwinska et al. J Endocr Soc. .

Abstract

Background: Giant prolactinomas are an exceedingly uncommon type of pituitary adenomas that usually occur in men, and cause extremely high prolactin levels and mass-related symptoms. Rarely, patients may experience neurological deficits resembling ischemic events.

Methods: We describe an unusual case of a young man who presented with stroke-like symptoms and was found to have a giant prolactinoma.

Clinical case: A 25-year-old man presented with left facial droop and gradually progressing upper and lower extremity weakness for evaluation of stroke. He reported recent weight gain and erectile dysfunction. Physical examination revealed left homonymous hemianopsia, left VII nerve palsy, and left hemiparesis. Magnetic resonance imaging of the brain showed an enormous mass in the sella turcica, which invaded the sphenoid sinus and right side of the skull base. Prolactin level was elevated at 13 580 ng/mL, and the testosterone level was low. The patient was started on cabergoline and had marked improvement in his symptoms in a few months. Fifteen months after starting treatment, he has had more than 90% reduction in tumor volume and a 93% reduction in prolactin level.

Conclusion: Giant prolactinomas are uncommon and present with compressive symptoms that can be mistaken for a stroke. Our case is a unique report of a facial nerve palsy and hemiparesis secondary to giant prolactinoma in the absence of stroke or pituitary apoplexy.

Keywords: Giant prolactinoma; facial palsy; hemiparesis; hyperprolactinemia.

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Figures

Figure 1.
Figure 1.
Initial MRI of the brain: sagittal T1 precontrast (1), sagittal T1 postcontrast (2), and coronal T1 postcontrast view (3) demonstrating enormous sellar mass.
Figure 2.
Figure 2.
Trend line of prolactin (nanogram/millimeter, ng/mL) and total testosterone (nanogram/deciliter, ng/dL) level from the diagnosis until 22-month follow-up.
Figure 3.
Figure 3.
MRI of the brain at 15-month follow-up: sagittal T1 precontrast (1), sagittal T1 postcontrast (2), and coronal T1 postcontrast view (3) demonstrating significant reduction in the size of the tumor.
See this image and copyright information in PMC

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References

    1. Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxf). 1994;41(3):):359–364. - PubMed
    1. Schlechte J, Sherman B, Halmi N, et al. . Prolactin-secreting pituitary tumors in amenorrheic women: a comprehensive study. Endocr Rev. 1980;1(3):):295–308. - PubMed
    1. Carter JN, Tyson JE, Tolis G, Van Vliet S, Faiman C, Friesen HG. Prolactin-screening tumors and hypogonadism in 22 men. N Engl J Med. 1978;299(16):):847–852. - PubMed
    1. Shimon I. Giant prolactinomas. Neuroendocrinology 2019;109(1):51–56. - PubMed
    1. Shrivastava RK, Arginteanu MS, King WA, Post KD. Giant prolactinomas: clinical management and long-term follow up. J Neurosurg. 2002;97(2):):299–306. - PubMed

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