Introduction: The coexistence of pituitary adenoma and meningiomas is very rare. It is debatable if meningiomas result as a consequence of hormone dependent growth or secondary to radiation.
We report a rare case of coexisting brain tumors: a prolactin secreting pituitary adenoma and two meningiomas in a 54-year-old female patient.
Case report: Onset at 46 years with bitemporal hemianopsia, without other clinical complaints. MRI confirmed a pituitary macroadenoma (22/19/35 mm) with suprasellar evolution.
Hormonal balance revealed secondary thyroid and gonadal insufficiency with hyperprolactinemia for which Cabergoline was started with initial good evolution. Three years later, acute intracranial hypertension was solved by partial transcranial adenomectomy. Gamma knife radiation completed the treatment, with subsequent secondary adrenal and thyroid insufficiency. Same year, the patient underwent a subtotal thyroidectomy for nodular goiter. After 4 years of treatment with variable doses of cabergoline, the progressive tumor growth imposed a new intervention transsphenoidal adenomectomy, with initially good evolution. One year later (01.2016), intensive vertiginous syndrome imposed reinvestigations and cerebral MRI identified two cerebral meningiomas, one of them located at the cranio-spinal junction, which needed urgent excision.
Postoperatory, the patient complains of gait dysfunction, nausea, and headache. Clinically, left cranial nerves paresis X, XI, and Xll was objectified. Remnant pituitary adenoma of 19/21/18 mm located in left cavernous sinus was seen on MRI. Hormonal investigations confirmed pituitary insufficiency (thyroid, adrenal and gonadotrope axes), with normal prolactin levels. Currently, she is on thyroid and corticoid substitution, without dopamine agonists, with specific neurologic symptomatic treatment.
Conclusions: Recent studies have revealed the existence of prolactin receptors in meningioma, thus explaining the proliferative effect. In our case we may explain the growth of meningiomas not only secondary to the invasive prolactinoma, but as well as radiation induced.