Skip to main content
SpringerLink
Log in

Hormone-active intradural spinal metastasis of a prolactinoma — A case report

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

A 44-year-old woman developed acute severe visual field defects and was operated on a macroprolactinoma. Since complete resection of the tumor was not possible, radiotherapy was performed and in addition to hormone replacement therapy, bromocriptine (up to 60 mg daily) was started without however complete normalization of PRL levels. Four years later PRL levels increased to 105 µU/ml despite continuation of dopamin agonist (mesulergin) treatment. As shown by ophthalmological examination and computer tomography there were no signs of regrowth of the pituitary tumor. At that time the patient complained of severe lumbar pain and myelography revealed a tumor mass in the spinal cord (L1–L2). Since the spinal tumor was not removable, laminectomy was performed. Histology and immunohistochemistry demonstrated a metastasis of the prolactinoma. Radiotherapy and bromocriptine in extreme doses (140 mg daily) together with an antiestrogen were not able to improve the neurological deficits (paraparesis) and to lower the PRL levels. This case of a metastasis of a prolactinoma after operation, radiotherapy, and dopamin agonist treatment stresses the importance of close surveillance of patients with prolactinomas without PRL normalization during dopamin agonist therapy and shows for the first time the possibility of ectopic PRL production due to an intradural spinal metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ACTH:

adrenocorticotropin

FSH:

folliclestimulating hormone

GH:

growth hormone

Gy:

Gray

L:

lumbar

LH:

luteinizing hormone

µU/ml:

microunits per milliliter

mU/ml:

milliunits per milliliter

PRL:

prolactin

TBG:

thyroxine-binding globulin

TSH:

thyrotropin

T4 :

thyroxine

T3 :

triiodothyronine

References

  1. Azria M, Kieckel JR, Lavene D (1979) Contribution a l'étude de l'interaction de la triacetyloleandomycine avec l'ergotamine ou la dihydroergotamine. J Pharmacol 10:431–436

    Google Scholar 

  2. Bassetti M, Spada A, Pezzo G, Giannattasio G (1984) Bromocriptine treatment reduces the cell size in human macroprolactinomas: A morphometric study. J Clin Endocrinol Metab 58:268–273

    Google Scholar 

  3. Breidahl HD, Topliss DJ, Pike JW (1983) Failure of bromocriptine to maintain reduction in size of a macroprolactinoma. Br Med J 287:451–452

    Google Scholar 

  4. Chiodini PG, Liuzzi A, Cozzi R, Verde G, Oppizzi G, Dallabonanza D, Spella B, Silvestrini F, Borghi GP, Luccarelli G, Rainer E, Horowsky R (1981) Size reduction of macroprolactinomas by bromocriptine and lisuride treatment. J Clin Endocrinol Metab 53:737–743

    Google Scholar 

  5. Cohen DL, Diengdoh JV, Thomas DGT, Himsworth RL (1983) An intracranial metastasis from a PRL secreting pituitary tumour. Clin Endocrinol 18:259–264

    Google Scholar 

  6. Dallabonanza D, Spelta B, Oppizzi G, Tonon C, Luccarelli G, Chiodini PG, Liuzzi A (1983) Reenlargement of macroprolactinomas during bromocriptine treatment: report of two cases. J Endocrinol Invest 6:47–50

    Google Scholar 

  7. Eversmann T, Fahlbusch R, Rjosk H, von Werder K (1979) Persisting suppression of PRL secretion after long-term treatment with bromocriptine in patients with prolactinoma. Acta Endocrinol (Kbh) 92:413–427

    Google Scholar 

  8. Feiring EH, Davidoff LM, Zimmermann HM (1953) Primary carcinoma of the pituitary. J Neuropathol Exp Neurol 12:205–223

    Google Scholar 

  9. Flückiger E, del Pozo E, von Werder K (1982) Physiology, Pharmacology and Clinical Findings. Monographs on Endocrinology. Springer, Berlin Heidelberg New York, p 196

    Google Scholar 

  10. Jefferson G (1955) The invasive adenomas of the anterior pituitary. Sherrington Lectures No 3, University Press, Liverpool

    Google Scholar 

  11. King AB (1951) The diagnosis of carcinoma of the pituitary gland. Johns Hopkins Hosp Bull 89:339–353

    Google Scholar 

  12. Kraus JE (1945) Neoplastic diseases of the human hypophysis. Arch Pathol 39:343–349

    Google Scholar 

  13. Labrie F, Ferland L, DiPaolo T, Veilleux R (1980) Modulation of prolactin secretion by sex steroids and thyroid hormones. In: MacLeod RM, Scapagnini U (eds) Central and Peripheral Regulation of Prolactin Function. Raven Press, New York, p 97–113

    Google Scholar 

  14. Landolt AM (1975) Ultrastructure of human sella tumors. Acta Neurochir Suppl 22:94–103

    Google Scholar 

  15. Martin NA, Hales M, Wilson CB (1981) Cerebellar metastasis from a prolactinoma during treatment with bromocriptine. J Neurosurg 55:615–619

    Google Scholar 

  16. Ogilvy KM, Jakubowski J (1973) Intracranial dissemination of pituitary adenomas. J Neurol Neurosurg Psychiatry 36:199–205

    Google Scholar 

  17. Rogol AD, Rosen SW (1974) Prolactin of apparent large molecular size: The major immunoactive prolactin component in plasma of a patient with a pituitary tumor. J Clin Endocrinol Metab 38:714–717

    Google Scholar 

  18. Schwinn G, Dirks H, McIntosh C, Köbberling J (1977) Metabolic and clinical studies on patients with acromegaly treated with bromocriptine over 22 months. Eur J Clin Invest 7:101–107

    Google Scholar 

  19. Suh HK, Frantz AG (1974) Size heterogeneity of human prolactin in plasma and pituitary extracts. J Clin Endocrinol Metab 39:928–935

    Google Scholar 

  20. Thorner MO, Perryman RL, Rogol AD, Conway BP, MacLeod RM, Login IS, Morris JL (1981) Rapid changes of prolactinoma volume after withdrawal and reinstitution of bromocriptine. J Clin Endocrinol Metab 53:480–483

    Google Scholar 

  21. Völker W, Gehring WG, Berning R, Schmidt RC, Schneider J, von zur Mühlen A (1982) Impaired pituitary response to bromocriptine suppression: reversal after bromocriptine plus tamoxifen. Acta Endocrinol (Khb) 101:491–500

    Google Scholar 

  22. Wass JAH, Williams J, Charlesworth M, Kingsley DPE, Halliday AM, Doniach I, Rees LH, McDonald WI, Besser GM (1982) Bromocriptine in management of large pituitary tumours. Br Med J 284:1908–1911

    Google Scholar 

  23. von Werder K, Clemm C (1974) Evidence for “big” and “little” components of circulating immunoreactive prolactin in humans. FEBS Lett 47:181–184

    Google Scholar 

  24. von Werder K, Fahlbusch R, Landgraf R, Pickardt CR, Rjosk HK, Scriba PC (1978) Treatment of patients with prolactinomas. J Endocrinol Invest 1:47–58

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik Innenstadt, Universität München, Germany

    R. Landgraf & K. von Werder

  2. Neurologische Klinik, Universität München, Germany

    G. Rieder

  3. Neurochirurgische Klinik, Universität München, Germany

    P. Schmiedek

  4. Radiologische Klinik, Universität München, Germany

    D. Clados

  5. Institut für Neuropathologie, Universität München, Germany

    K. Bise

Authors
  1. R. Landgraf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Rieder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Schmiedek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Clados
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Bise
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. von Werder
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Landgraf, R., Rieder, G., Schmiedek, P. et al. Hormone-active intradural spinal metastasis of a prolactinoma — A case report. Klin Wochenschr 63, 379–384 (1985). https://doi.org/10.1007/BF01731658

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01731658

Key words

Search

Navigation