Prolactinomas in Children and Adolescents

Abstract

Prolactinomas are the most common pituitary adenomas in children and adolescents followed by adrenocorticotropic hormone-secreting and growth hormone-secreting adenomas. Females are slightly more affected than males (who have macroadenomas more frequently). Compared with the adult setting, in children macroadenomas are more frequent than microadenomas. Diagnosis is generally based on clinical symptoms of primary or secondary gonadal failure, growth delay and/or tumor compressive symptoms. Treatment is based on medical therapy with dopamine agonists, to control prolactin levels and reduce tumor size. Surgery is indicated in patients with tumors resistant to dopamine agonists as well as in those showing severe neurological symptoms at diagnosis. Radiotherapy should be limited to the cases with aggressive tumors, nonresponsive to dopamine agonists, because of the risk of neurological damage and hypopituitarism later in the lives of these patients.

Topoisomerase IIα as a prognostic factor in pituitary tumors

“…[27][28][29][30] In order to treat patients more effectively, rather than wait to confirm tumor recurrence by MRI, new markers of invasiveness and proliferation of pituitary adenomas are being sought to identify patients with atypical pituitary adenomas. In our group of 60 patients, 73% expressed topo IIα compared with 76% of the patients reported by Vidal et al 16 In agreement with Suzuki et al 15 and Wolfsberger et al, 17 we found that topo IIα expression did not depend on patient age.…”

Presentación atípica de un prolactinoma gigante en un adolescente de 15 años

“…5 La cabergolina es el AD de elección y debe iniciarse con dosis bajas e incrementarlas en forma gradual con el fin de evitar la reducción brusca de la masa tumoral. En las dosis muy elevadas, como la que reciben los pacientes con enfermedad de Parkinson, se ha reportado la insuficiencia de la válvula mitral.…”

“…2,3 La forma de presentación de los prolactinomas en los pacientes pediátricos es más agresiva e invasora, especialmente, en el sexo masculino, en el que se presenta más frecuentemente como macroprolactinomas, es decir, con un diámetro mayor de 10 mm o igual. [3][4][5] Cuando adquieren un tamaño mayor de 4 cm o igual, se denominan prolactinomas gigantes (PG). En estos casos, en general, los niveles séricos de prolactina son superiores a 1000 ng/ml y presentan una significativa invasión local.…”

Topoisomerase 2 alpha as a prognostic factor in pituitary tumors

“…Local invasion and infiltration of adjacent structures, post-operative regrowth or persistence of hormonal function are potential indicators of aggressiveness [26][27][28][29]. In order to treat patients more effectively, rather than to await confirmation of tumor recurrence by MR imaging, suitable markers of invasiveness and proliferation of pituitary adenomas are sought to select patients with atypical pituitary adenomas.…”