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J Neurol Surg Rep 2015; 76(02): e297-e301
DOI: 10.1055/s-0035-1566124
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Giant Prolactinoma Presenting with Neck Pain and Structural Compromise of the Occipital Condyles

Derek Yecies
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Abdulrazag Ajlan
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
John Ratliff
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Jennifer Ziskin
2   Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
,
Peter Hwang
3   Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Hannes Vogel
2   Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
,
Laurence Katznelson
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
4   Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
,
Griffith Harsh IV
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
› Author Affiliations
Further Information

Publication History

17 July 2014

28 August 2015

Publication Date:
29 October 2015 (online)

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Abstract

Prolactinomas are the most common form of endocrinologically active pituitary adenoma; they account for ∼ 45% of pituitary adenomas encountered in clinical practice. Giant adenomas are those > 4 cm in diameter. Less than 0.5% of pituitary adenomas encountered in neurosurgical practice are giant prolactinomas. Patients with giant prolactinomas typically present with highly elevated prolactin levels, endocrinologic disturbances, and neurologic symptoms from mass-induced pressure. Described here is an unusual case of a giant prolactinoma presenting with neck pain and structural compromise of the occipital condyles. Transnasal biopsy of the nasopharyngeal portion of the mass obtained tissue consistent with an atypical prolactinoma with p53 reactivity and a high Ki-67 index of 5%. Despite the size and invasiveness of the tumor, the patient had resolution of his clinical symptoms, dramatic reduction of his hyperprolactinemia, and near-complete disappearance of his tumor following medical treatment.

Keywords

pituitary adenoma - giant prolactinoma - occipitocervical instability - occipital condyles - invasive adenoma
 

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