Introduction: Prolactinomas are rare in childhood and adolescence, representing a half of pituitary adenomas (1% of intracranial tumors); macroadenomas are more frequent than microadenomas. The signs and symptoms depend on age, sex, tumor size and prolactin level. Due to a higher frequency of macroadenomas in boys, they present more often neuro-ophthalmologic findings (impaired vision, headache)
Case report: We present a case of 25-year-old pacient diagnosed at age 13 with giant prolactinoma. He came to our observation after neurosurgery was performed for symptoms of tumor expansion. No pituitary insufficiency was observed after surgery. Dopamine-agonist therapy was required postoperatively due to persistent hyperprolactinemia (PRL>250 ng/ml n 0.717 ng/ml). The pacient developed normal puberty, reaching a final high=172 cm. After 7 years of prolactin level control and no IRM signs of recidive under medical therapy, we lost follow-up. At current evaluation (nov. 2011) PRL level was very high=3575 μIU/ml (n86324 μIU/ml); clinical and biological signs of pituitary insufficiency were absent. Visual field was normal. Pituitary X-ray revealed a raised intrasellar volume, undefined sellar walls and a deeply declined sellar floor in the sphenoidal sinus. IRM described a 2/1.3/2.5 cm tumor residue with extension in the right cavernous sinus. Cabergoline therapy was reinitiated.
Discussions: Surgery is reserved for pacients resistant to medical therapy and those with severe neurological symptoms at diagnosis. First-line treatment is represented by dopamine-agonists.
Conclusions: The pacient had severe symptoms at diagnosis. Neurosurgery was performed before endocrinological evaluation and was not curative. Dopamine-agonists were needed postoperatively. After 7 years of good evolution we lost follow-up. The absence of symptoms at current evaluation raised the suspicion of macroprolactinemia. Dopamine-agonist therapy was reinitiated and might be necessary life-long.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology