Prolactinoma Mimicking Migraine

Authors:
Breonna E. Holland and Sanjeev K. Sharma, MBBS
Creighton University School of Medicine, Omaha, Nebraska

Citation:
Holland BE, Sharma SK. Prolactinoma mimicking migraine [published online September 4, 2018]. Neurology Consultant.

A 26-year-old man presented to a family medicine clinic for a routine annual physical examination. He had a self-diagnosed history of “migraines with vision changes.”

History. Six weeks before presentation, he reported having experienced a headache with blurry vision that had lasted approximately 1 week. He had considered it a typical migraine and did not seek treatment. Later, he had noticed that his vision was still blurry in the absence of a headache. He had decided to seek treatment when he realized that he could not see to read a restaurant menu.

Physical examination. Physical examination findings were unremarkable, except for complete blindness in the right eye. He was immediately sent for magnetic resonance imaging (MRI) of the brain, and an ophthalmologist was consulted. Upon detailed questioning, the patient reported having polydipsia, nocturia, and fatigue. He denied having decreased libido, erectile dysfunction, galactorrhea, and changes in hat size or shoe size.

Diagnostic tests. Results of the ophthalmology consult revealed 70% vision loss in the left eye, in addition to complete vision loss in the right eye.

MRI results revealed a 5.5-cm solid and cystic mass with multiple fluid levels in the sellar and suprasellar areas, displacing and compressing the optic nerves and optic chiasm (Figures 1-3).

Figure 1. Sagittal precontrast T1-weighted image showing a 5.5-cm cystic and solid mass expanding into the sella. The fluid level in the hyperintense cystic component suggests internal hemorrhage.

Figure 2. Sagittal postcontrast T1-weighted image showing enhancement of the nodular solid component anteriorly. Arrows indicate loculations of fluid.

Figure 3. Coronal T2-weighted image showing expansion of the sella and displacement of optic nerves superiorly.

Craniopharyngioma was reported as the most likely neoplasm. Endocrinology laboratory test results were notable for a very high prolactin level (>1000 ng/mL) and low levels of free thyroxine, AM cortisol, luteinizing hormone, and testosterone (Table 1).

Table 1. Endocrine Laboratory Test Results

NEXT: Diagnosis and Discussion

Authors:
Breonna E. Holland and Sanjeev K. Sharma, MBBS
Creighton University School of Medicine, Omaha, Nebraska

Citation:
Holland BE, Sharma SK. Prolactinoma mimicking migraine [published online September 4, 2018]. Neurology Consultant.

A 26-year-old man presented to a family medicine clinic for a routine annual physical examination. He had a self-diagnosed history of “migraines with vision changes.”

History. Six weeks before presentation, he reported having experienced a headache with blurry vision that had lasted approximately 1 week. He had considered it a typical migraine and did not seek treatment. Later, he had noticed that his vision was still blurry in the absence of a headache. He had decided to seek treatment when he realized that he could not see to read a restaurant menu.

Physical examination. Physical examination findings were unremarkable, except for complete blindness in the right eye. He was immediately sent for magnetic resonance imaging (MRI) of the brain, and an ophthalmologist was consulted. Upon detailed questioning, the patient reported having polydipsia, nocturia, and fatigue. He denied having decreased libido, erectile dysfunction, galactorrhea, and changes in hat size or shoe size.

Diagnostic tests. Results of the ophthalmology consult revealed 70% vision loss in the left eye, in addition to complete vision loss in the right eye.

MRI results revealed a 5.5-cm solid and cystic mass with multiple fluid levels in the sellar and suprasellar areas, displacing and compressing the optic nerves and optic chiasm (Figures 1-3).

Figure 1. Sagittal precontrast T1-weighted image showing a 5.5-cm cystic and solid mass expanding into the sella. The fluid level in the hyperintense cystic component suggests internal hemorrhage.

Figure 2. Sagittal postcontrast T1-weighted image showing enhancement of the nodular solid component anteriorly. Arrows indicate loculations of fluid.

Figure 3. Coronal T2-weighted image showing expansion of the sella and displacement of optic nerves superiorly.

Craniopharyngioma was reported as the most likely neoplasm. Endocrinology laboratory test results were notable for a very high prolactin level (>1000 ng/mL) and low levels of free thyroxine, AM cortisol, luteinizing hormone, and testosterone (Table 1).

Table 1. Endocrine Laboratory Test Results

NEXT: Diagnosis and Discussion

Authors:
Breonna E. Holland and Sanjeev K. Sharma, MBBS
Creighton University School of Medicine, Omaha, Nebraska

Citation:
Holland BE, Sharma SK. Prolactinoma mimicking migraine [published online September 4, 2018]. Neurology Consultant.

A 26-year-old man presented to a family medicine clinic for a routine annual physical examination. He had a self-diagnosed history of “migraines with vision changes.”

History. Six weeks before presentation, he reported having experienced a headache with blurry vision that had lasted approximately 1 week. He had considered it a typical migraine and did not seek treatment. Later, he had noticed that his vision was still blurry in the absence of a headache. He had decided to seek treatment when he realized that he could not see to read a restaurant menu.

Physical examination. Physical examination findings were unremarkable, except for complete blindness in the right eye. He was immediately sent for magnetic resonance imaging (MRI) of the brain, and an ophthalmologist was consulted. Upon detailed questioning, the patient reported having polydipsia, nocturia, and fatigue. He denied having decreased libido, erectile dysfunction, galactorrhea, and changes in hat size or shoe size.

Diagnostic tests. Results of the ophthalmology consult revealed 70% vision loss in the left eye, in addition to complete vision loss in the right eye.

MRI results revealed a 5.5-cm solid and cystic mass with multiple fluid levels in the sellar and suprasellar areas, displacing and compressing the optic nerves and optic chiasm (Figures 1-3).

Figure 1. Sagittal precontrast T1-weighted image showing a 5.5-cm cystic and solid mass expanding into the sella. The fluid level in the hyperintense cystic component suggests internal hemorrhage.

Figure 2. Sagittal postcontrast T1-weighted image showing enhancement of the nodular solid component anteriorly. Arrows indicate loculations of fluid.

Figure 3. Coronal T2-weighted image showing expansion of the sella and displacement of optic nerves superiorly.

Craniopharyngioma was reported as the most likely neoplasm. Endocrinology laboratory test results were notable for a very high prolactin level (>1000 ng/mL) and low levels of free thyroxine, AM cortisol, luteinizing hormone, and testosterone (Table 1).

Table 1. Endocrine Laboratory Test Results

NEXT: Diagnosis and Discussion