Proptosis as the Presenting Sign of Giant Prolactinoma in a Prepubertal Boy: Successful Resolution of Hydrocephalus by Use of Medical Therapy

Abstract

We report the case of a 13-year-old prepubertal boy who presented with a left-sided proptosis, bilateral papilloedema and hydrocephalus who was subsequently diagnosed with a giant prolactinoma invading the left orbit. He was commenced on dopamine receptor agonists in the form of quinagolide and cabergoline, and made an excellent response to medical therapy alone, with resolution of hydrocephalus, restoration of normal vision and a 98% reduction in serum prolactin. The rapid improvement achieved negated the requirement for surgery and this highlights the efficacy of the dopamine agonists in the management of giant prolactinomas, even in the presence of neurological symptoms.

Keywords:

• cabergoline
• giant prolactinoma
• hydrocephalus
• hyperprolactinemia
• hypopituitarism
• proptosis
• quinagolide

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Acknowledgements

The authors would like to thank B Walker, Professor of Endocrinology at the Western General Hospital in Edinburgh, R Gibson, Consultant Neuroradiologist, J Steers, Consultant Neurosurgeon and P Statham, Consultant Neurosurgeon from the Department of Clinical Neurosciences at the Western General Hospital in Edinburgh for their involvement in the management of this difficult case.

Additional information

Funding

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.