A 27-year-old man present with complaints of loss of libido and erectile dysfunction since a year. On questioning, he gives history of headache, dull aching, global, not associated with nausea or vomiting, usually relieved by painkillers, present on 5 days a week. He has also noticed that sometimes he bumped into objects on his sides while walking. He has also noticed constipation and weight gain. On examination, he is 160 cm tall with a BMI 25 kg/m2. Blood pressure 110/70 mm of Hg, no postural drop. Confrontation test reveals bilateral temporal hemianopia. Testicular volume 15 mL soft bilateral. No galactorrhea is elicited. Ankle jerks delayed. Laboratory investigations are as follows: Hemoglobin 10.5 g/dL, normocytic normochromic anemia. Testosterone 100 ng/dL, LH 0.01 IU/L, FSH 0.01 IU/L, TSH 2 microIU/L, free T4 0.68 ng/dL. Cortisol 2.8 mg/dL. Prolactin 47 ng/mL from one lab and 1780 ng/mL from another lab. Automated perimetry reveal bitemporal hemianopia. Magnetic resonance imaging of the hypothalamic pituitary region reveals 2.4 cm tall, pituitary mass with suprasellar extension with compression of the optic chiasm without parasellar extension. A diagnosis of pituitary macroadenoma probably macroprolactinoma with hypopituitarism is made.
Could it be that this patient is harboring a nonfunctioning tumor and the elevated prolactin is due to stalk compression?
Medicine
Hyperprolactinemia in the presence of an MRI-detected pituitary adenoma is consistent with but not unequivocally diagnostic of a prolactinoma, because any pituitary mass that compresses the pituitary stalk may cause hyperpro- lactinemia. A therapeutic trial with dopamine agonists for a period of time leading to decrease in prolactin levels serially and shrinkage in tumor size is diagnostic of prolactinoma. All patients with a macroadenoma with elevated prolactin warrant a treatment course with dopamine agonist.
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