Incidental Aggressive Oligosymptomatic Macroprolactinoma in 25-Year-Old Man and Covid-19 Quarantine Conditioned Management Difficulties: Case Report
| Author | Affiliation |
|---|---|
Urbanavičius, Vaidotas | Vilniaus universitetas |
| Date |
|---|
2022-09-05 |
Session-1
ISBN 978-625-8213-52-2
In men, prolactinomas are diagnosed in around their 40- 50- ties, and only incidentally – in younger persons. The main symptoms of prolactinoma in men are non-specific: headache, decrease of libido, erectile dysfunction and sign – gynaecomasty. Here we descibe an incidental aggressive oligosymptomatic macroprolactinoma in a 25-yearold man, with very good response to medical treatment as well as predictable consequences (2 ) of COVID-19 – related restrictions on the chronically ill patients. Case report. A 25 years old man was admitted to the hospital after falling off the harvester during fieldwork in 19 May 2018. An MRI scan revealed a large (30.3x23.4x22mm) previously unsuspected heterogeneous mass of a pituitary tumour with the invasion into the right cavernous system with the prolabation of the tumour into sphenoid synus. Prolactin was 100 fold upper limit of normal. LH, FSH, testosterone were low. DHEAS was 1.75 fold upper limit of normal. The treatment with bromocriptine had been initiated 2,5 mg/d, gradually increasing to 5 mg/d. Macroadenoma shrank by 45% with decrease of invasion to cavernous space. Serum prolactin decreased to normal levels. LH, FSH and T levels, despite the gradual increase, remained low. As the patient’s mother explained, following the limitations of movement and healthcare access during the Covid-19 pandemic, the patient experenced difficulties continuing his regular visits to the endocrinologist and stopped bromcriptine intake. He intrerupted bromocriptine for 3 months, and repeated MRI scan revealed the increase of the tumour by 50% comparing to the latest scan. Progression of invasion to the right cavernous sinus was also prominent.. After the patient restarted the treatment with bromocriptine (5 mg/d), prolactin quickly decreased to normal levels (70 mU/l). Among many other lessons, COVID-19 pandemic made medical professionals reanalyse and improve medical care in conditions of reduced direct contact to assure the optimal management for patients with chronic illnesses. This is especially important for majority of endocrine diseases, which are oligosymptomatic or asymptomatic.