Prolactinomas in Children and Adolescents. Clinical Presentation and Long-Term Follow-Up

Abstract

In this study, we report the clinical presentation, response to medical treatment, and long-term follow-up of 26 patients with prolactinoma (15 macro- and 11 micro-adenomas) diagnosed at the age of 7-17 yr. All patients were first treated with bromocriptine (BRC) at doses ranging from 2.5-20 mg/day orally. BRC was discontinued for intolerance and/or resistance to the drug and was replaced by quinagolide (CV) at doses ranging from 0.075-0.6 mg/day or by cabergoline at doses ranging from 0.5-3.5 mg/week orally. Two patients received external conventional radiotherapy after surgery. In 7 prepubertal males and 6 females with macroprolactinoma, headache and/or visual defects were the first symptoms. All females presented with primary or secondary amenorrhea. Growth arrest was observed in a male patient with microadenoma, whereas all the remaining patients had normal heights, and pubertal development was appropriate for their age. Spontaneous or provocative galactorrhea was observed in 12 patients (3 males and 9 females) and gynecomastia in 4 males. Mean serum PRL concentration (+/-SE) at the time of diagnosis was 1080 +/- 267 microg/L in patients with macroadenoma and 155 +/- 38 microg/L in patients with microadenoma. In 10 patients, BRC normalized PRL levels and caused variable, but significant, tumor shrinkage. CV normalized PRL concentrations and reduced tumor size in 5 patients. Cabergoline normalized PRL concentrations in 7 of 10 patients resistant to CV. Pregnancy occurred in 2 patients while on treatment. Pregnancies were uncomplicated, and the patients delivered normal newborns at term. Only 4 patients are still moderately hyperprolactinemic. Impairment of other pituitary hormone secretion was documented at the time of diagnosis in 7 patients, 5 of whom underwent surgery. Four patients became GH deficient in adult age. In conclusion, the medical treatment with dopaminergic compounds is effective and safe in patients with prolactinoma with onset in childhood, allowing preservation of the anterior pituitary function.

Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents

“…However, the mechanism by which hyperprolactinemia leads to bone loss is likely not limited to its effects on the hypothalamic-pituitary-gonadal axis since eugonadal patients with hyperprolactinemia may exhibit bone loss and fail to completely recover bone mass after treatment [Schlechte et al 1983;Greenspan et al 1989]. Moreover, adolescents with prolactin-secreting adenomas exhibit significantly reduced BMD for age despite progressing through puberty normally [Colao et al 1998[Colao et al , 2000.…”

Giant Prolactinoma Presented as Unilateral Exophthalmos in a Prepubertal Boy: Response to Cabergoline

“…As reported in adults, also in children, prolactinomas occur mostly in females [13]. In this report, we present a case of a giant prolactinoma in a 7-year-old boy, which was complicated by unilateral exophthalmos.…”

A Case of Hyperprolactinemia At Childhood

“…Geç çocukluk çağı ve adolesan dönemlerinde âdet düzensizlikleri ile ortaya çıkar (5) . Klinik belirti ve semptomlar yaş, cinsiyet, tümör büyüklüğü ve prolaktin düzeylerine göre farklılık gösterir.…”

“…Çapı 10 mm'den küçük olan adenomlar mikroadenom, 10 mm'den büyük olanlar ise makroadenom olarak adlandırılır. Erişkin dönemde prolaktinomaların % 90'ından fazlası mikroprolaktinoma olmakla birlikte, erişkin çağdan farklı olarak çocukluk çağı ve adolesan dönemde makroprolaktinoma daha sık görülmektedir (% 60-70) (5,7) . Tümörler çoğun-lukla benigndir, ancak büyüme gelişme ve puberteye olan etkileri, sık ve ciddi baş ağrısı nedeniyle çocuğun yaşam kalitesinde ciddi etkiye yol açabilir (2) .…”

“…Olgumuzda da tiroid antikorları yüksek bulunarak Hashimoto tiroiditi tanısı kondu. Dopamin agonistleri yan etkileri nedeniyle kullanıla-madığında ya da tümör çapında yeterli küçülme sağla-namadığında cerrahi tedavi uygulanmalıdır (5) . Mikroskopik veya endoskopik transsfenoidal adenomektomi makroprolaktinomaların çoğunda kullanılan tedavi yöntemdir (15) .…”