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Management of giant prolactinoma causing craniocervical instability: illustrative case
BACKGROUND: Giant prolactinomas (>4 cm) are a rare entity, constituting less than 1% of all pituitary tumors. Diagnosis can usually be achieved through endocrinological analysis, but biopsy may be considered when trying to differentiate between invasive nonfunctioning pituitary adenomas and prima...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Neurological Surgeons
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9394694/ https://www.ncbi.nlm.nih.gov/pubmed/36046515 http://dx.doi.org/10.3171/CASE2158 |
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author | Chugh, Arunit J. S. Patel, Mohit Chua, Lorayne Arafah, Baha Bambakidis, Nicholas C. Ray, Abhishek |
author_facet | Chugh, Arunit J. S. Patel, Mohit Chua, Lorayne Arafah, Baha Bambakidis, Nicholas C. Ray, Abhishek |
author_sort | Chugh, Arunit J. S. |
collection | PubMed |
description | BACKGROUND: Giant prolactinomas (>4 cm) are a rare entity, constituting less than 1% of all pituitary tumors. Diagnosis can usually be achieved through endocrinological analysis, but biopsy may be considered when trying to differentiate between invasive nonfunctioning pituitary adenomas and primary clival tumors such as chordomas. OBSERVATIONS: The authors presented a rare case of a giant prolactinoma causing significant clival and occipital condyle erosion, which led to craniocervical instability. They provided a review of the multimodal management. Management involved medical therapy with dopamine agonists, and surgery was reserved for acute neural compression or dopamine agonist resistance, with the caveat that surgery was extremely unlikely to lead to normalization of serum prolactin in dopamine agonist–resistant tumors. LESSONS: Adjunctive surgical therapy may be necessary in cases of skull base erosion, particularly when erosion or pathological fractures involve the occipital condyles. Modern posterior occipital-cervical fusion techniques have high rates of arthrodesis and can lead to symptomatic improvement. This procedure should be considered early in the multimodal approach to giant prolactinomas because of the often dramatic response to medical therapy and potential for further craniocervical instability. |
format | Online Article Text |
id | pubmed-9394694 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Association of Neurological Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-93946942022-08-30 Management of giant prolactinoma causing craniocervical instability: illustrative case Chugh, Arunit J. S. Patel, Mohit Chua, Lorayne Arafah, Baha Bambakidis, Nicholas C. Ray, Abhishek J Neurosurg Case Lessons Case Lesson BACKGROUND: Giant prolactinomas (>4 cm) are a rare entity, constituting less than 1% of all pituitary tumors. Diagnosis can usually be achieved through endocrinological analysis, but biopsy may be considered when trying to differentiate between invasive nonfunctioning pituitary adenomas and primary clival tumors such as chordomas. OBSERVATIONS: The authors presented a rare case of a giant prolactinoma causing significant clival and occipital condyle erosion, which led to craniocervical instability. They provided a review of the multimodal management. Management involved medical therapy with dopamine agonists, and surgery was reserved for acute neural compression or dopamine agonist resistance, with the caveat that surgery was extremely unlikely to lead to normalization of serum prolactin in dopamine agonist–resistant tumors. LESSONS: Adjunctive surgical therapy may be necessary in cases of skull base erosion, particularly when erosion or pathological fractures involve the occipital condyles. Modern posterior occipital-cervical fusion techniques have high rates of arthrodesis and can lead to symptomatic improvement. This procedure should be considered early in the multimodal approach to giant prolactinomas because of the often dramatic response to medical therapy and potential for further craniocervical instability. American Association of Neurological Surgeons 2021-06-07 /pmc/articles/PMC9394694/ /pubmed/36046515 http://dx.doi.org/10.3171/CASE2158 Text en © 2021 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). |
spellingShingle | Case Lesson Chugh, Arunit J. S. Patel, Mohit Chua, Lorayne Arafah, Baha Bambakidis, Nicholas C. Ray, Abhishek Management of giant prolactinoma causing craniocervical instability: illustrative case |
title | Management of giant prolactinoma causing craniocervical instability: illustrative case |
title_full | Management of giant prolactinoma causing craniocervical instability: illustrative case |
title_fullStr | Management of giant prolactinoma causing craniocervical instability: illustrative case |
title_full_unstemmed | Management of giant prolactinoma causing craniocervical instability: illustrative case |
title_short | Management of giant prolactinoma causing craniocervical instability: illustrative case |
title_sort | management of giant prolactinoma causing craniocervical instability: illustrative case |
topic | Case Lesson |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9394694/ https://www.ncbi.nlm.nih.gov/pubmed/36046515 http://dx.doi.org/10.3171/CASE2158 |
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