Endocrine Abstracts

Introduction: Prolactinomas are the most commun secreting adenomas of the pituitary gland. They are classified according to their sizes into microprolactinomas (<10mm long axis) and macroprolactinoma (>=10mm long axis). According to studies its prevalence is approximately 3.5-5 for 100000 inhabitants. The diagnosis is made by the blood prolactin assay as well as the pituitary magnetic resonance imaging (MRI) which is the radiological reference exam to evaluate the dimensions of the adenoma. The severity of these tumors mainly depends on their size.

Methods: we conducted a monocenter cross-sectional analytical study including 40 patients with confirmed prolactinoma followed in the Endocrinology Diabetology and neurosurgery departments of the Fattouma Bourguiba Hospital of Monastir during the period from January 2000 to march 2022.

Results: A 30-years-old patient with no medical history was reffered to our department for exploration of a pituitary macroadenoma. The circumstances of discovery were the onset of headaches with progressive decrease of visual acuity and bilateral amputation of the visual field for which he consulted an ophtalmologist. A brain CT revealed a sellar and parasellar tumor with hormonal assessment of hyperprolactinemia at 258ng/ml. The diagnosis of macroprolactinoma was made on the basis of hyperprolactinemia confirmed twice (258 and 296 ng/ml) and the presence on pituitary MRI of a macroadenoma measuring 25*26*40mm with extrasellar extension. The patient was treated with cabergoline withe a dose up to 2 mg/week. The evolution was marked bay the regression of the tumor size on the MRI in a year but we noticed the appearance of a cerebrospinal rhinorrhea complicated by pneumococcal meningoencephalitis for which he recieved an appropriate antibiotic therapy with a good clinical and biological progress. The pituitary scan showed the presence of a sphenoidal gap with lysis of sellar turcica. After that, the patient underwent transphenoidal surgery with biopsy of the adenomatous tissue and multilayer repair of the breach. The post operative evolution was simple with rhinorrhea drying up. The pathological and immunohistochimical study showed a lactotroph pituitary adenoma. The further evolution was marked by improvment of headaches and visual disturbances with a partial tumor response and biological remission under cabergoline 1 mg/week.

Conclusion: Prolonged and regular multidisciplinary collaboration seems to be essential for optimizing the management of these patients with endocrine, ophtalmological, neurosurgical, and radiological evaluation at initial diagnosis and throughout follow-up.