ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P280 | DOI: 10.1530/endoabs.63.P280

Acute lethargy, the main symptom of macroprolactinoma

Esther Delgado Garcia, Emilia Gomez Hoyos, Ana Ortolá Buigues, Susana Garcia Calvo, Cristina Serrano, Rebeca Jimenez Sahagun, Juan Jose Lopez Gómez, Beatriz Torres Torres, Gonzalo Diaz Soto & Daniel De Luis Roman

Endocrinology Department of University Hospital of Valladolid, Valladolid, Spain.

Introduction: The most common pituitary adenoma is a prolactinoma.The most relevant clinical manifestations are amenorrhoea galactorrhoea infertility gonadal and sexual dysfunction. Macroprolactinoma are more often in men because they had more difficulty for asking the sintomatology. Initial treatment of macroadenoma wasinitiated with a dopamine agonist with control of PRL concentration and size of tumor

Clinical case: A 52-year-old manpresented at the emergency roomby acute lethargy. He has acongenital blindness, deafness and chronic depression with history of suicide attempt in three times. He had only taken lorazepam. He didn’t complain ofdecreased libido, impotence, or infertility.On examination, he had blilateralasymptomatic ginecomastia. There were no other stigmata of endocrine dysfunction. Pituitary MRI found a pituitary macroadenoma (27 × 17 × 15 mm) and laboratory evaluations showedhyperprolactinemia(PRL 1998 ng/ml) and central hypogonadism, adrenal insufficiency. The patient was prescribed the dopamine agonist cabergoline (0.5 mg twice a week) hydroaltesone 30 mg. After 4 months of treatment, PRL level decreased to 47.17 ng/ml, normalitation of testosterone and tumor size wasn’t suffer any change. After a year of treatment PRL concentration was normal (8.20 ng/ml) and tumor size has been reduced by one third (10 × 6 × 5 mm)

Conclusion: Our clinical case is an atypical manifestation of pituitary adenoma. The treatment with dopamine agonist allowed restore only gonadal funtion and control size of tumor.