Prolactinoma - medically treated

Case contributed by Doaa Faris Jabaz
Diagnosis almost certain

Presentation

Decreased libido.

Patient Data

Age: 30 years
Gender: Male

First scan

mri
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T2
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FLAIR
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Coronal
T1 C+
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Sagittal
T1
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Axial
T1
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Coronal
T2
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Sagittal
T1 C+
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Info

An intrasellar mass in the right lateral aspect of the posterior portion of the anterior pituitary gland, it is relatively isointense on T1, hypointense on T2, and hypo enhancing as compared to the normal residual pituitary gland, with no cystic or hemorrhagic change. The mass almost completely encases the intra-cavernous segment of the right internal carotid artery (Knosp grade IV of cavernous sinus invasion); however, no significant carotid narrowing. The normal infundibulum and the pituitary gland deviate to the left.

The prolactin level was >470ng/ml.

6 months later

mri
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Sagittal
T1
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T2
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Coronal
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Coronal
T2
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Sagittal
T1 C+
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Axial
T1 C+
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Coronal
T1 C+
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Info

The previously noted mass shows a noticeable interval size reduction, it appears relatively hypointense on T1, hyperintense on T2, and hypo enhancing as compared to the normal residual pituitary gland, with no cystic or hemorrhagic change.

In the second scan, the patient was on medical treatment with cabergoline, and the serum prolactin was reduced almost to half of the baseline level.

9 months later

mri
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Sagittal
T2
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Axial
T2
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Sagittal
T1
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Coronal
T2
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Coronal
T1 C+
This study is a stack
Sagittal
T1 C+
This study is a stack
Coronal
T1 C+
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Info

The previously noted mass lesion has almost completely vanished, the patient was still on medical treatment, and the serum prolactin level was reduced to 29 ng/ml with noticeable clinical improvement.

Case Discussion

Feature of right-sided pituitary adenomas /neuroendocrine tumor (PitNET), mostly lactotroph adenoma/macroprolactinoma based on the clinical context, with interval size reduction to almost vanishing indicating excellent response to medical treatment, however, the decision to safely withdraw the medication necessitate clinical and laboratory correlation.

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