A 27-year-old Chinese male presented with a 2-year history of headache and a right temporal field defect. A magnetic resonance imaging (MRI) scan revealed a 5cm tumour in the sphenoid with bilateral cavernous sinus extension and posterior-extension to the clivus (Figured A). This was reported as an erosive skull base tumour and he was referred to neurosurgery. His serum prolactin was measured at 283 909 mU/l (normal range 45-375 mU/l), confirming a giant prolactinoma. After a single dose of 250 meg cabergoline, there was an improvement in his visual field, tumour reduction ajid fall in prolactin to 57 539 mU/l (Figure 1 B). An increased dose of 250 meg twice weekly resulted in further tumour shrinkage, a fall in prolactin and normalization of his visual fields (Figure 1C and D). This case highlights the importance of measurement of serum prolactin in the evaluation of potential skull base tumours and the rapid shrinkage of giant prolactino-mas with primary medical therapy obviating the need for surgery.
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