Prolactinomas, the most common type of pituitary tumor, are prevalent in women. Macroprolactinomas, which often present with misleading and polymorphic symptoms, occur mainly in men. We review the literature on pituitary prolactincarcinomas in women, and include a case-report of a 27 year old woman who underwent radical trans-sphenoidal excision of a large invasive macroprolactinoma. Postoperative evaluation of pituitary function showed normal PRL levels associated to hypopituitarism. Three years later, PRL levels increased associated with gross visual defects and a second operation with radiotherapy was done. Bromocriptine normalized PRL levels, and no recurrence was seen on CT/MRI for seven years. When she was 37 years old, the patient became resistant to dopamine-agonists, and the adenoma recurred with invasion of the cavernous sinus and a left frontal mass. Surgical removal of the frontal PRL-secreting metastasis reduced PRL levels to normal associated with quinagolide treatment. Two years later, a progressive increase in PRL levels heralded further expansion of the pituitary mass. The patient underwent a surgical debulking procedure followed by gamma-knife radiosurgery. Two months later, sudden rhinorrhea and visual loss occurred followed by coma. New growth of the pituitary neoplasm was evident. Three months later she died of thromboembolic events. Various causes of resistance to dopamine agonists are known. We suggest that the sudden loss of sensitivity to chronic dopamine-agonist treatment is a sign of the malignant transformation of a macroprolactinoma.
|Number of pages||7|
|Publication status||Published - 2001|
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