ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Adult male with bicytopenia: Is this the first manifestation of a prolactinoma?

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Introduction: Pituitary mass related insufficiency may embrace different scenarios and some of the adult patients will have to visit first different medical specialists until hypopituitarism is adequately recognized and eventually treated.

Case report: This is the case of a 59 years non-smoking Caucasian male without any known chronic diseases who was initially referred for a hematological consult after he was seen on a primary care center. He presented pale skin, persistent asthenia in association with a weigh loss of 15 kilos during last two months. Low iron levels of 26 μg dL (normal ranges are between 60 and 180 μg dL) were found consistent with microcytic hypochromic anemia. A mild form of antral gastritis and some internal hemorrhoids were detected at upper endoscopy, respectively colonoscopy, partially explaining the anemic syndrome but not necessarily severe weight loss. The screening tumor markers ruled out a malignancy. An endocrine check-up was considered useful. Laboratory tests showed increased levels of prolactin (20 times above the normal superior limit) and panhypopituitarism. Magnetic Resonance Imagery revealed a pituitary tumor of 2 centimeters maximum diameter in contact with optic chiasm but without eye field anomalies. Prolactin suppressive medical treatment with dopamine agonists was started (2 mg of cabergoline twice per week) in addition to pituitary replacements for thyroid, glucocorticoid, and gonad axes. Daily iron supplements and gastric protection drugs (20 mg of daily pantoprazole) were continued. Close endocrine, hematologic and imagery check-up is recommended with a consecutive dose adjustment depending on evolution.

Conclusion: Anemia in males with macroprolactinoma-related hypopituitarism represents the part of an iceberg that lies outside of water. The pituitary condition recognition may be delayed because uncommon clinical package and sometimes hematological anomalies, especially anemia, may contribute to misdiagnosis.

List of abbreviations: mg = milligram, μg = microgram, mm = millimeter, FT4 = Free Thyroxine, IGF-1 = Insulin-like Growth Factor, MRI= Pituitary Magnetic Resonance Imagery TSH = Thyroid Stimulating Hormone

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