Macroprolactinoma causing VI, X, XII cranial nerve palsies nearly 30 years after initial treatment

Endocrinology, Diabetes & Metabolism Case Reports
Anne de BrayNiki Karavitaki

Abstract

A 48-year-old man was diagnosed with a large macroprolactinoma in 1982 treated with surgery, adjuvant radiotherapy and bromocriptine. Normal prolactin was achieved in 2005 but in 2009 it started rising. Pituitary MRIs in 2009, 2012, 2014 and 2015 were reported as showing empty pituitary fossa. Prolactin continued to increase (despite increasing bromocriptine dose). Trialling cabergoline had no effect (prolactin 191,380 mU/L). In January 2016, he presented with right facial weakness and CT head was reported as showing no acute intracranial abnormality. In late 2016, he was referred to ENT with hoarse voice; left hypoglossal and recurrent laryngeal nerve palsies were found. At this point, prolactin was 534,176 mU/L. Just before further endocrine review, he had a fall and CT head showed a basal skull mass invading the left petrous temporal bone. Pituitary MRI revealed a large enhancing mass within the sella infiltrating the clivus, extending into the left petrous apex and occipital condyle with involvement of the left Meckel's cave, internal acoustic meatus, jugular foramen and hypoglossal canal. At that time, left abducens nerve palsy was also present. CT thorax/abdomen/pelvis excluded malignancy. Review of previous images sugges...Continue Reading

References

Aug 13, 1983·British Medical Journal·H D BreidahlJ W Pike
Jan 18, 2006·Pituitary·Mark E Molitch
Sep 23, 2006·European Journal of Endocrinology·Marleen KarsAlberto M Pereira
Jan 28, 2009·Endocrine Pathology·María Susana Mallea-GilDamasia Becu-Villalobos
May 24, 2011·European Journal of Endocrinology·Katarina BerinderAnna-Lena Hulting
Mar 1, 2012·Clinical Endocrinology·B C WhitelawS J B Aylwin
Aug 25, 2012·European Journal of Endocrinology·Laurent VroonenAlbert Beckers

❮ Previous
Next ❯

Methods Mentioned

BETA
X ray
hormone replacement

Related Concepts

Related Feeds

Cancer Imaging

Imaging techniques, including CT and MR, have become essential to tumor detection, diagnosis, and monitoring. Here is the latest research on cancer imaging.