GALACTORRHOEA AND HYPOGONADISM ASSOCIATED WITH A RADIOLOGICALLY-INAPPARENT PROLACTIN-SECRETING PITUITARY TUMOUR

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Abstract
A 38 yr old man was investigated because of impotence, gynecomastia and galactorrhea. Hyperprolactinemia and hypogonadism were documented. Pituitary function was otherwise normal as was tomographic examination of the sella turcica. In the absence of direct evidence of pituitary involvement (hyperprolactinemia can suppress gonadal function) and to exclude ectopic prolactin production, venous blood was drawn at multiple sites. The highest prolactin levels were found in the superior vena cava and above, indicating an intracranial source. At transsphenoidal hypophysectomy a microadenoma was removed. Tumor cells contained typical prolactin secretory granules on EM. In the light of this report the appropriateness of dividing hyperprolactinemia into tumorous and idiopathic subgroups on the basis of sella size must be reconsidered. Functional tests do not distinguish between the subgroups although prolactin levels tend to be higher when the sella is enlarged. Only a quantitative rather than a qualitative difference may exist between the subgroups.