Prolactinoma Male Patient with Clinical Manifestations of Hypopituitarism and Gynecomastia

Prolactinomas are the most common benign neoplasms (about 40%) among pituitary tumors. The definitive
diagnosis of prolactinomas is quite difficult and almost all cases require additional checks of prolactin
levels, radioimmunoassay, Computerized Tomography scan and Magnetic Resonance Imaging.
Prolactinomas may cause some symptoms related to hormonal effects due to excess prolactin and space-
occupying effects of the tumor itself. Prolactinoma develops slowly and clinically depends on age, sex,
duration, and degree of hyperprolactinemia. Gynecomastia is a benign tumor characterized by breast
enlargement in males caused by the proliferation of glandular tissue and local fat deposition. This is a report
of a 43 year old man complaining of having blurry eyes, headache, decreased libido and breast growth.
Hormonal examination found an increase in prolactin level accompanied by secondary hypocortisol and
secondary hypothyroid. From the examination, Multi Slice Computed Tomography found a
macroprolactinoma. Surgery was performed using the transsphenoidal technique with 5 mg of Prednisone
twice a day orally, 50 mcg of Euthyrox once a day orally and Bromocriptine with a dose of 2.5 mg. One
month postoperative there was elimination of headache complaints, vision improved and breasts diminished
even though libido had not returned. Prolactin levels returned to normal but there was still hypothyroid and
hypocritical with a good prognosis with regular taking of hormone replacement drugs.