GIANT PROLACTINOMA: DIAGNOSIS AND MANAGEMENTA CASE REPORT

Introduction: Prolactinomas are the most common secreting pituitary tumors. Giant prolactinomas are defined by a diameter of 4 cm, and represent a therapeutic challenge involving both the neurosurgical and medical aspects of cabergoline.We present this case in order to highlight this special features.

Case report:43-year-old patient admitted for medical management of a pituitary macroadenoma, revealed by right retro-orbital and occipital headaches for 4 years, complicated by blindness on right side, decreased libido and erectile dysfunction with premature ejaculation. Pituitary MRI showed an intra and suprasellar lesion process measuring 28 * 29 * 40mm. Biological assessment showed a gonadotrope and corticotrope deficiency associated with a major hyperprolactinemia, and obvious damage to the visual field.A giant macroprolactinoma was retained and Managed with : Cabergoline at 1.5mg per week. He was also substituted with Hydrocortisone and levothyroxine, with spectacular improvement.

Discussion:Giant prolactinomas present an explosive clinical, radiological and biological symptoms. The therapeutic approach to them remains controversial, combining both neurosurgery and / or dopamine agonist.