Broad clinical spectrum and diverse outcomes of prolactinoma with pediatric onset: medication-resistant and recurrent cases

Abstract

Prolactinoma is a benign tumor of the pituitary gland that rarely occurs in children and adolescents; thus, the clinical spectrum and long-term prognosis in these patients remain unknown. This study was performed to investigate the long-term outcomes of medical treatment and the prognostic factors for remission and relapse in children and adolescents with prolactinoma. Three male subjects and four female subjects between the ages of 7- and 17-years-old were included in this study. The mean initial serum prolactin level was 443 ± 251.8 ng/mL (range, 152-946 ng/mL). During the follow-up period (range, 0.6-20 years), a dopamine agonist was administered, and surgery or radiotherapy was performed in cases of resistance to medical treatment or relapse. Unlike female subjects with macroadenoma who often exhibit a good clinical course, two male subjects with early onset macroadenoma presented with visual disturbances. These subjects showed resistance to medical therapy and relapsed, eventually requiring surgical removal and radiotherapy; one of the subjects manifested a metastatic thrombus in the internal jugular vein. In conclusion, pediatric prolactinoma exhibits a broad clinical spectrum, a relatively high incidence of macroadenoma, resistance to medical therapy, and frequent tumor relapses. In addition, a poor prognosis appears to be correlated with male sex, age at disease onset, and histopathological characteristics.

A middle cerebral artery ischemic stroke occurring in a child with a large prolactinoma

“…The indications for surgery among their cohort included impending visual loss or failure of medication to reduce tumor volume [13]. Kim and colleagues followed a similar approach in 7 patients with pediatric prolactinoma as well [14]. Banerjee et al found that, even in the setting of infarction, declining or severe visual field deficit was the most important factor for deciding when to proceed with surgical resection [8].…”

Prolactinoma e hiperprolactinemia. Posicionamiento de la SMNE

“…En los primeros, el cuadro clínico es similar al de adultos caracterizado en la mujer por amenorrea primaria o secundaria en el 45%, galactorrea en el 50%; mientras que en el hombre las manifestaciones se relacionan con los efectos de masa del tumor, como cefalea en el 40%, alteración oftalmológica por compresión quiasmática en el 60% y detención de la pubertad, entre otros 147 . Mientras que en los prepúberes las manifestaciones clínicas más frecuentes se deben a los efectos de masa como la cefalea, alteraciones oftalmológicas, así como a deficiencias hormonales que causan ausencia o detención del crecimiento y desarrollo, es importante señalar que no hay diferencia en el cuadro clínico por dimorfismo sexual en esta etapa pediátrica 148 . El diagnóstico en la población pediátrica, al igual que en los adultos, tiene como base una concentración de PRL > 200 ng/ml, aunque se debe sospechar con una cifra > 150 ng/ml.…”