Prolactin-producing adenoma. clinical presentation in adult Sudanese patients

ABSTRACT

To describe the clinical features of prolactin-producing pituitary adenoma [prolactinoma] in adult patients. In a prospective hospital-based study, adult patients with prolactinoma presenting to the National Center for Neurological diseases and the National Center for cancer in Khartoum, Sudan were enrolled in the period from January 2001 to February 2005. The diagnosis was based on finding a pituitary adenoma on cranial MRI and an associated elevated blood prolactin level above 200 micro g/L. The size of the adenoma was classified as either microadenoma [<10 mm without sellar enlargement or extrasellar extension] or macroadenoma [>/= 10 mm]. The hormone profile done on each patient included blood level of prolactin and other pituitary trophic hormones, free triiodothyronine and free thyroxine hormones. Sixteen [14 females and 2 males] were identified as having a prolactinoma. The female to male ratio was 71. Their mean age was 24 +/- 5.1 years. The prolactinoma was inacroadenoma in 9 cases and microademoma in 7. Galactorrhea, amenorrhea and infertility [primary or secondary] were the commonest presenting symptom followed by headache. Affection of the visual pathway, either as bitemporal hemianopia [41.2%] or optic atrophy [11.8%], was the major neurological deficit. The mean prolactin level in macroadenoma was 2053 +/- 442.6 micro g/L and in microadenoma was 853.6 +/- 77.8 micro g/L. Our prolactinoma patients, when reaching the appropriate medical attention, are more likely having an expanded macroadeoma that is compromising the visual pathway. Early recognition and referral to specialized clinics is necessary and that should have a favorable prognostic implication