INITIAL EXPERIENCE OF ATYPICAL PRESENTATIONS OF PROLACTINOMA IN A TERTIARY CARE INSTITUTE IN INDIA

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 167-198-Hypothalamus-Pituitary Development & Biology
Basic/Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-173
Sadish Kumar Kamalanathan*1, Jaya Prakash Sahoo2, Karthik Balachandran2, Suja P Sugumar2, Ashok Kumar Das2 and Vijaya Bhaskar Reddy3
1JIPMER, Puducherry, India, 2JIPMER, 3IGGH
BACKGROUND: Prolactinoma typically presents with features of hypogonadism and infertility in females and that of mass effects in males. METHODS: All patients with atypical features/associations of prolactinoma in three years of Endocrinology department in JIPMER, India were retrospectively analysed. The clinical presentation along with biochemical profile and radiological features were reassessed .All cases were medically managed in our institute with dopamine agonist bromocriptine or cabergoline. RESULTS: Among 47 cases of prolactinoma which presented to our institute, 5 had atypical features/associations. First two female cases of age 62 and 27 years,  presented with associated features of MEN1 syndrome. The older, presented with features of hypoglycaemia due to insulinoma and the younger, with hypercalcemia due to primary hyperparathyroidism. Prolactinoma was diagnosed when they were evaluated for associated hormonal imbalances. The third case presented with central diabetes insipidus secondary to hypophysitis induced probably by concomitant microprolactinoma with serum prolactin of 24,490 pmol/l (normal non-pregnant  range 122-1231). With cabergoline therapy, requirement of anti-diuretic therapy has significantly decreased. The fourth case, a 32 year old man presented with long standing bilateral gross gynecomastia. He had low serum testosterone with azoospermia. He was on chronic low dose bromocriptine. He had a serum prolactin of 1363925 pmol/l(normal male range 93-779). The fifth case, a 35 year old female presented with secondary amenorrhea of 19 years duration   along with headache and left nasal block for 2 years. The mass invaded the suprasellar, parasellar and infrasellar areas into the sphenoid sinus to present as choanal mass. She had prolactin of 330841 pmol/l and is currently on gradual titration with cabergoline as not to provoke CSF rhinorrhoea following shrinkage of the tumour with treatment. CONCLUSION: Atypical presentations of prolactinoma are not uncommon.

Nothing to Disclose: SKK, JPS, KB, SPS, AKD, VBR

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm