%0 Journal Article
%T Pituitary Macroprolactinoma with Mildly Elevated Serum Prolactin: Hook Effect
%A Mahbube Ebrahimpur
%A Mahnaz Pejman Sani
%A Mohammad Reza Mohajeri-Tehrani
%J Archive of "Advanced Journal of Emergency Medicine".
%D 2018
%R 10.22114/AJEM.v0i0.84
%X A 45-year-old man was admitted in our department with complaints of severe headache for over 6 months period. He also suffered from several problems such as visual field defect, decreased energy and libido, body hair loss, cold intolerance, decreased appetite and dry skin. On physical examination, he was afebrile: blood pressure (BP): 110/70 mm/Hg, pulse rate (PR) :65 beat/min, body mass index (BMI): 24. He had no terminal hair on face or chest and subcutaneous adipose tissue mass had been decreased substantially. Laboratory tests revealed; Hb: 12 g/dL (N: 14每17 g/dL), Total testosterone: 1.2 ng/mL (N: 每-10 ng/mL), Luteinizing hormone (LH):3.3MIU/mL (N: 1每8 MIU/mL), Follicle Stimulating hormone (FSH): 1.3 MIU/mL (N: 1每7 MIU/mL), T4:3.4 micg/dL (N:4每12 micg/dL), TSH:0.6 MIU/mL (N: 0.5每5 MIU/mL), Prolactin:100 ng/mL (2每24 ng/mL), serum cortisol:6 MIU/mL (N: 4每21 MIU/mL), IGF1: 162 ng/mL (50每245). Pituitary MRI showed macroadenoma (29*16*14 mm) in left side of sella turcica which bulged to suprasellar cistern with pressure effect on left optic nerve (figure 1, 2). Visual field examination revealed mild temporal hemianopia. These findings are consistent with macroadenoma and mild prolactin elevation. We also observed a discrepancy between pituitary tumor size and prolactin level. The correct estimate of serum prolactin was obtained after serial dilutional measurement. Serum prolactin after dilution was 6470 ng/mL. With these findings pituitary macroprolactinoma was diagnosed and treatment with cabergoline (dopamine agonist) 0.5 mg/week was started. After one month follow-up he had no symptoms, visual field defect was improved and pituitary MRI showed significant shrinkage of tumor
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548154/