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[57-year-old patient with diplopia and headache]
A Seidler1, M R Fischer, G Leinsinger
1Klinikum der Universität München, Medizinische Klinik-Innenstadt. Alrun.Seidler@medinn.med.uni-muenchen.de
Der Internist
|September 12, 2003
Summary
Oculomotor nerve paresis, an unusual prolactinoma symptom, resolved with dopamine agonist therapy. This case highlights delayed diagnosis in men with macroprolactinoma, often linked to hypogonadism symptoms.
Area of Science:
- Neuro-oncology
- Endocrinology
Background:
- Macroprolactinomas, pituitary tumors producing prolactin, can present with varied symptoms.
- Delayed diagnosis in male patients is common, often associated with hypogonadotropic hypogonadism.
Observation:
- A 57-year-old male presented with headache and diplopia due to left oculomotor nerve paresis.
- MRI revealed an extensive intra-, para-, and suprasellar tumor with elevated serum prolactin, identifying it as a macroprolactinoma.
- The patient reported a 7-year history of decreased libido and virility.
Findings:
- Dopamine agonist treatment significantly reduced prolactin levels (to 0.5% of initial) and caused substantial tumor regression within three months.
- Oculomotor nerve paresis is an atypical presentation for prolactinoma.
Implications:
- This case underscores the importance of considering macroprolactinoma in male patients with neurological symptoms and hypogonadism.
- Early diagnosis and treatment of macroprolactinoma can prevent severe complications and improve outcomes.
- Effective medical management with dopamine agonists can lead to significant tumor regression and symptom resolution.