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  Prolactinoma: MRI Diagnosis, CT Imaging Features, Radiology Interpretation, and Modern Clinical Management Introduction A 33-year-old man arrives at the emergency department with progressively worsening headaches, left-sided weakness, and hearing impairment that has persisted for six months. Neurologic symptoms are becoming increasingly severe. Initial clinical suspicion includes intracranial malignancy, skull base tumor, meningioma, or aggressive inflammatory disease. However, advanced medical imaging using contrast-enhanced MRI reveals an unexpected diagnosis — a giant invasive prolactinoma. This clinical scenario highlights the importance of accurate radiology interpretation , especially in patients presenting with atypical neurological deficits. While prolactinomas are commonly associated with endocrine symptoms such as amenorrhea or galactorrhea, giant prolactinomas can mimic skull base malignancies and become critical emergency diagnosis challenges. In modern neuroradiolo...

Introduction Prolactinoma is the most common type of functional pituitary adenoma and represents a critical entity in neuroendocrinology, neuroradiology, and clinical neurosurgery. Despite its generally benign nature, large and invasive prolactinomas can present with dramatic neurological deficits and radiologic findings that mimic aggressive skull base tumors. This column presents a real-world case of a giant invasive prolactinoma, integrating pathophysiology, epidemiology, clinical presentation, imaging characteristics, differential diagnosis, treatment strategies, and prognosis, based on globally authoritative literature and a classic NEJM imaging case. Special emphasis is placed on MRI interpretation and dopamine agonist treatment response. Pathophysiology of Prolactinoma Prolactinomas arise from lactotroph cells of the anterior pituitary gland , characterized by autonomous prolactin secretion. Under normal physiology, prolactin release is tonically inhibited by dopamine via D2 r...