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A “giant” prolactinoma
  1. UWE REUTER,
  2. SUSAN MEHRAEIN,
  3. GUY ARNOLD
  1. Department of Neurology
  2. Humboldt University
  3. Berlin
  4. Germany
  5. Department of Neuroradiology
  6. Humboldt University
  7. Berlin
  8. Germany
  1. Dr U Reuter, Department of Neurology, Charité Hospital, Humboldt University, 10098 Berlin, Germany.
  1. RÜDIGER LEHMANN
  1. Department of Neurology
  2. Humboldt University
  3. Berlin
  4. Germany
  5. Department of Neuroradiology
  6. Humboldt University
  7. Berlin
  8. Germany
  1. Dr U Reuter, Department of Neurology, Charité Hospital, Humboldt University, 10098 Berlin, Germany.

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Sagittal and frontal T1 weighted MRI before (A, B) and after (C, D) treatment with bromocriptine

A 43 year old man with a history of epilepsy was admitted after a grand mal seizure. Physical examination showed bilateral loss of visual acuity, a bilateral lateral rectus palsy, and bilateral optic disc pallor. Secondary sexual characteristics were normal. Brain MRI disclosed an enhancing intrasellar and perisellar tumour (8 × 8 × 8 cm) with displacement and compression of the optic chiasm as well as the mesencephalon and diencephalon (figure, A and B). A raised serum prolactin concentration of 24 500 ng/ml (normal <15 ng/ml), the tumour location, and size were consistent with a “giant” prolactinoma. After four weeks of treatment with bromocriptine (15 mg/day) the bilateral lateral rectus palsies had remitted completely and vision had slightly improved. At that time the serum prolactin concentration had fallen to 1160 ng/ml. A further brain MRI showed a dramatic reduction of tumour size with residual tumour only in the sphenoid and ethmoidal bone (figure, C and D).

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