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Acromegaly with moderate hyperprolactinemia caused by an intrasellar macroadenoma

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 408–412 (2006)Cite this article

Abstract

Background A 31-year-old woman presented 12 months after discontinuing the oral contraceptive pill with progressive headache to her primary-care physician. She had previously presented with irregular menses to her obstetrician–gynecologist 4 months after discontinuing the oral contraceptive pill. Her serum prolactin levels were 153 µg/l and a pituitary MRI revealed a 13 mm intrasellar mass consistent with an adenoma. The patient was given 0.5 mg cabergoline twice weekly, and after 6 weeks her prolactin levels fell to 31 µg/l. After 6 months, however, she complained of persistent frontal headache and a repeat MRI revealed that the adenoma had increased in size to 16 mm. The patient was referred to an endocrinologist for further evaluation.

Investigations Serum insulin-like growth factor 1 levels and growth hormone levels measured 2 h after ingestion of 75 g of oral glucose.

Diagnosis Acromegaly and hyperprolactinemia caused by a mixed-cell adenoma, secreting growth hormone and prolactin.

Management Trans-sphenoidal surgery followed by medical therapy with 20 mg intramuscular octreotide–LAR monthly.

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Figure 1: Algorithm to show evaluation and treatment of patients with a pituitary mass and hyperprolactinemia

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Authors and Affiliations

  1. Professor of Medicine at Cedars Sinai Medical Center,

    Vivien S Bonert & Shlomo Melmed

  2. Senior Vice President for Academic Affairs at Cedars Sinai Medical Center and the Associate Dean at the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Vivien S Bonert & Shlomo Melmed

Authors
  1. Vivien S Bonert
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  2. Shlomo Melmed
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Correspondence to Shlomo Melmed.

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Competing interests

The authors received research grant funding from Novartis.

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Bonert, V., Melmed, S. Acromegaly with moderate hyperprolactinemia caused by an intrasellar macroadenoma. Nat Rev Endocrinol 2, 408–412 (2006). https://doi.org/10.1038/ncpendmet0222

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