Korean J Med.  2016 Dec;91(3):300-305. 10.3904/kjm.2016.91.3.300.

Multiple Endocrine Neoplasia Type 1 Presenting with an Invasive Giant Prolactinoma

• Cha J
• Kim JS
• Han JS
• Park YW
• Kim MJ
• Ku YH
• Kim HI

• KMID: 2361438
• DOI: http://doi.org/10.3904/kjm.2016.91.3.300

Abstract

Pituitary tumors occur in 15-50% of patients with multiple endocrine neoplasia of type 1 (MEN1). To the best of our knowledge, no MEN1 case in which the initial lesion was an invasive giant prolactinoma has been reported from Korea. We describe a patient in whom a skull-base tumor involved the sellar and parasellar spaces. A 49 year-old female presented with headache and diplopia. The tumor was ultimately identified as a giant prolactinoma; the serum prolactin concentration increased from 155.6 ng/mL to 3,234.3 ng/mL after cranial irradiation. She was evaluated in terms of incidental hypercalcemia and was found to have parathyroid hyperplasia. Genetic analysis revealed a missense mutation in the MEN1 gene (c.643G>A, p.Val215Met). Two years of treatment with a dopamine agonist reduced, but did not normalize, the serum prolactin concentration. We highlight the aggressive behavior of the giant skull-base tumor, and the diagnostic delay caused by a high-dose hook effect of the MEN1-related prolactinoma.

Keyword

Multiple endocrine neoplasia type 1; Giant prolactinoma; High-dose hook effect

MeSH Terms

Cranial Irradiation
Diplopia
Dopamine Agonists
Female
Headache
Humans
Hypercalcemia
Hyperplasia
Korea
Multiple Endocrine Neoplasia Type 1*
Multiple Endocrine Neoplasia*
Mutation, Missense
Pituitary Neoplasms
Prolactin
Prolactinoma*
Dopamine Agonists
Prolactin