HYPERPROLACTINEMIA IN ADOLESCENCE

Abstract

Hyperprolactinemia is recognized commonly as a cause of menstrual dysfunction and hypogonadism in adults but is often assumed to be rare in adolescents. The clinical features of this in adolescence have not been well characterized. We have studied 20 patients with adolescent onset of hyperprolactinemia. Initial results on 16 (13 females and 3 males) are as follows: The cause of hyperprolactinemia was microadenoma in 6, macroadenoma in 7, pituitary cyst in 1 and tumor hydrocephalus in 2. Onset was between 9 and 19 years with a mean of 14.6 years but the diagnosis was delayed almost 5 years to a mean age of 19.3 years. Prolacting levels varied from 33 to 3450 ng/ml. Presenting complaints in females were: Amenorrhea in 64%, galactorrhea in 18%, cystic acne in 9%. Galactorrhea was present in 73% but only 1/3 of these were aware of it. Headaches were present in 82%. 6 of 8 patients had withdrawal bleeding after Provera.3 patterns of pubertal progression were seen: 1)primary amenorrhea 18%, 2)normal menarche with only a few periods 36%, 3) normal menarche, irregular menses for several years and amenorrhea in 46%. 4 of 5 patients with macroadenomas have had surgery, radiotherapy or both and 3 of these have residual hyperprolactinemia and other residua. Although hyperprolactinemia is a common cause of menstrual or pubertal disturbance in adolescence, diagnosis is usually delayed. Because outcome is often suboptimal, an effort toward timely diagnosis is indicated.