Apoplexy of a giant clival ectopic prolactinoma: A very rare case report

Anouar Jamal; Najat Draoui; Imane Assarrar; Siham Rouf; Hanane Latrech

doi:10.1016/j.ijscr.2024.109874

Apoplexy of a giant clival ectopic prolactinoma: A very rare case report

Int J Surg Case Rep. 2024 Jul:120:109874. doi: 10.1016/j.ijscr.2024.109874. Epub 2024 Jun 6.

Authors

Anouar Jamal¹, Najat Draoui¹, Imane Assarrar¹, Siham Rouf², Hanane Latrech³

Affiliations

¹ Department of Endocrinology-Diabetology-Nutrition, Mohammed VI University Hospital, Medical School, Mohamed the First University, Oujda, Morocco.
² Department of Endocrinology-Diabetology-Nutrition, Mohammed VI University Hospital, Medical School, Mohamed the First University, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, Mohamed the First University, Oujda, Morocco.
³ Department of Endocrinology-Diabetology-Nutrition, Mohammed VI University Hospital, Medical School, Mohamed the First University, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, Mohamed the First University, Oujda, Morocco. Electronic address: hlatrech@hotmail.fr.

Abstract

Introduction and importance: Ectopic pituitary neuroendocrine tumor (EPNET) is a very rare entity, seldom with apoplexy evolution. Only three cases of intracranial ectropic pituitary neuroendocrine tumor apoplexy were reported in the literature.

Case presentation: We report the case of a 45-year-old woman with a history of amenorrhea, and headaches. Neuroimaging showed a very aggressive giant mass within the clivus with the invasion of the sphenoidal sinus and encasement of internal carotid arteries with an empty sella. Endocrinology work-up revealed an exceedingly high level of prolactin surprisingly without galactorrhea. Immunohistochemical analysis after an endonasal biopsy confirmed the diagnosis of prolactinoma. One month after Cabergoline initiation, an apoplexy of the ectopic pituitary neuroendocrine tumor occurred. Conservational management with a decrease in cabergoline dose was performed.

Discussion: This article highlights data from various cases reported in the literature in addition to our case to confirm the extreme rarity of apoplexy as a complication of EPNET.

Conclusion: Pituitary apoplexy in ectopic pituitary neuroendocrine tumor is extremely rare. Therefore, in case of unusual localization of pituitary neuroendocrine tumor, a thorough follow-up is necessary to detect complications and ensure early management.

Keywords: Apoplexy; Cabergoline; Case report; Clivus; Ectopic pituitary neuroendocrine tumor; Giant prolactinoma.

Publication types

Case Reports