Giant Prolactinoma

Contributor:

Dr. Krishna Kumar

Consultants:

Dr. Fred Gentili
Dr. Chris Ekong

Case 2

Age: 55

Sex: Male

History: Since June 2000: Cloudy vision on the left side, large blind spots on the right side and decreased sexual function. Since August 2000: Dizzy with bending. Chief complaint was blurred vision and HPI.

Examination:

• Alert GCS 15
• Right vision 20/40
• Left vision 20/50
• Right hemianopsia
• Left field defect - Superior medial and inferior lateral
• Pale discs
• Normal axillary hair

Comments:

Internet Neuro-Rounds Oct 25, 2000

Dr. Gentili and others felt that since his protactin level was over 500, he almost certainly had PROLACTINOMA. The concensus was that he will likely benefit from bromocriptin therapy alone.

Dr. S.S. Mann, Endocrinologist, Regina Nov 1, 2000

Patient commenced on Bromocrptine 1.25 mg daily.

E-mail to Dr. Ekong from a very grateful patient Nov 24, 2000

This e-mail is to inform you of my reaction to the medication prescribed by Dr. S.S. Mann for my condition. My vision had deteriorated to the point where I was unable to read except for very large print. My left eye had a cloud covering my complete field of vision, my right eye had some vision on the left quadrant but was to the point where I could only see the first two or three letters of any words.

I started medical treatment Nov 1, 2000. My dosage was ½ a tablet of 2.5 Bromocriptine daily at bedtime for one week then increases to 1 tablet daily for a week. The third week increases to 2 tablets per day and finally the fourth week increased to 3 tablets daily.

The morning after the first ½ pill I noticed the pressure in my head had decreased and by the 2nd morning I felt no pressure whatsoever. By the end of the first week I noticed the clarity of my right eye was noticeably improved to where I could see five or six letters of a word but my left eye was still very cloudy. By the end of the 2nd week of treatment I was able to read with my right eye while my left eye improved. My vision has continued to improve in both eyes since the second week of treatment. Nov, 23 began the 4th week of my treatment. My vision has reached the point where I can read equally well with both eyes and my field of vision seems to be normal, although I will need testing to verify this. I have no noticeable side effects from this medication.

I keep in touch with Dr. E. Tsoi, my local doctor. He informs me that you will want to see me for a follow-up by the end of the month. I look forward to that visit.

Thank you,

Your patient

D. V.

Protactin level:

• Nov 99 over 500
• Dec 2000 - 435
• Mar 2001 - 262

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