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A 22-year old maths university student presented with a few weeks history of mild headaches. He additionally reported a year’s long history of gradual and progressive short memory deterioration evidenced by poor performance at recent exams. In attempt to compensate for rapidly progressing memory problems the patient started using smartphone messages and other memory ques. Subsequently he was receiving messages to remind him of messages which he could not recall and realised that he had a serious problem. This unusual and unexplained rapid decline in mentation prompted urgent MRI brain which showed a large 48 x 52 x 28mm midline hypervascular cystic sellar mass causing significant brain oedema and extending into suprasellar region with cavernous sinus invasion and chiasmal compression. Retrospectivley, he also complained of erectile dysfunction decrease shaving frequency but no galactorrhoea. He was clinically hypogonadal with significant gynaecomastia, sparse facial, chest and abdominal hair, and Tanner stage 4 pubic hair. His testes were soft and ~20mls in volume. Humphrey’s visual field assessment showed a subtle left superior quadrantanopia, extraocular eye movements were intact.. Humphrey’s perimetry confirmed subtle left superior quadrantanopia. Visual acuity was normal. Urgent anterior pituitary function revealed marked hyperprolactinaemia 515,217 mIU/L (0-450), central hypogonadism, normal thyroid, adrenal and somatotroph axes. Diagnosis of giant invasive cystic prolactinoma was therefore made. He was commenced on cabergoline 250mcg daily. Prolactin levels reduced to 119,583 after the first two doses, and to 56,061 mIU/L on day 4. A 3-months follow-up MRI showed significant tumour size reduction. Detailed psychometric reassessment showed complete resolution of cognitive dysfunction. The patient has since successfully resumed Master in Mathematics course. 1. Colao A, et al. N Engl J Med 2003;349:2023-2033.

Resolution of severely impaired cognitive function following medical treatment of cystic invasive giant prolactinoma