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A case of an ectopic prolactinoma
Ilgin Yildirim Simsir1, Gokcen Unal Kocabas, Serap Baydur Sahin
1Ege University Medical Faculty, Deparment of Internal Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey. ilginyildirim@hotmail.com
Summary
A uterine mass caused elevated prolactin (PRL) levels and galactorrhea in a patient. Surgical removal of the mass resolved hyperprolactinemia, indicating a link between uterine fibroids and high PRL.
Area of Science:
- Endocrinology
- Gynecology
- Oncology
Background:
- Secondary amenorrhea and galactorrhea are symptoms that can be associated with hyperprolactinemia.
- Hyperprolactinemia is often caused by pituitary adenomas, but other ectopic sources should be investigated if initial treatments fail.
Observation:
- A patient with persistent hyperprolactinemia despite medical management (cabergoline, bromocriptine) was found to have a uterine mass.
- The mass was identified via abdominal computerized tomography and confirmed with octreotide scintigraphy.
Findings:
- Hysterectomy led to a rapid normalization of prolactin levels (from 151.89 ng/ml to 0.4 ng/ml).
- Pathology revealed a low-grade malignant mesenchymal tumor of the uterus, though prolactin was immunohistochemically negative.
- The resolution of galactorrhea and normalization of PRL post-surgery strongly suggest the uterine mass was the cause of hyperprolactinemia.
Implications:
- This case highlights uterine myomas as a potential ectopic source of hyperprolactinemia, particularly when resistant to standard treatments.
- Uterine masses should be considered in the differential diagnosis of unexplained hyperprolactinemia.
- Surgical intervention may be curative for hyperprolactinemia originating from uterine pathology.
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