We present a case of a 71-year-old gentleman who presented with a clivoid mass to the opthalmologists.
The patient presented with left retro-orbital pain. He was generally fit and well, but his past medical history included cancer of the prostate and gout. An MRI brain was performed, which demonstrated a lesion between the left internal carotid artery and the clivus. CT chest/abdomen/pelvis confirmed no evidence of metastatic prostate cancer.
Interval scanning was performed at four months and demonstrated an increasing lesional size involving the clivus. The pituitary was of normal in size, shape and position. The patient was referred to the Neurosurgeons. The differential diagnosis of a chordoma or clival tumour were considered. An excision biopsy was performed via image-guided endoscopy. There were no postoperative complications.
Histology was consistent with a prolactinoma. Prolactin levels were then measured and found to be elevated at 9500 μ/l (reference range <650 μ/l). The pituitary gland was not felt to have been disturbed during surgery.
The patient was referred to Endocrinology for follow up and dynamic testing. He was commenced on Cabergoline with a reduction in the serum prolactin to 1677 μ/l.
Tumours arising at the clivus are uncommon. However, the differential diagnoses to be considered are chordomas, meningiomas, metastases, and pituitary macroadenomas. Investigation of these patients should always include measurement of serum prolactin in order to prevent unnecessary and potentially harmful surgical intervention.