PROLACTINOMA IN PEDIATRIC AGE: A LONGITUDINAL FOLLOW-UP

Abstract

Approximately 10-20% of the prolactinomas are recognized before age 20. However, there are few reports on their medium and long term follow-up. Thirteen patients (8♂, 9♀) aged 14,2 - 20 yr. (X̄ 16,5 yr) with prolactinoma were followed for 9 m-12 yr. Headaches, impairment of pubertal development, galactorrhea and visual field defects were the most common clinical findings. The responses of LH and FSH to LHRH among patients varied from normal, exaggerated or absent. THe TRH (TSH) test was normal in 8/9 cases and in 1 ♂ a primary concomitant hypothyroidism was reported. Serum PRL was elevated in all patients ranging 77-1150 ng/ml (X̄ 378±285). PRL response after TRH was inadequate (X̄ Δ MAX:25%). Radiologically, the patients were classified (Vezina and Sutton) in Gl: n=3 (♂); G2: n=5 (4♂, 1♀); G3: n=3 (1♂, 2♀) and G4: n=2 (♀). Eight patients (4♂, 4♀) were initially treated with surgery, 7 of them (3♂, 4♀) with a persistent hyperprolactinemia required Bromocriptine (BEC) after surgery. In 5 cases (4♂, 1♀) SEC constituted the primary treatment, but 1 ♂ with failure to BEC therapy needed transsphenoidal adenomectomy. Follow-up was possible in 11 patients. Among those who underwent surgery, 1 ♂ recovered gonadal function spontaneously and 5 cases (3 ♂, 2♀) required complementary medical treatment. Among those treated initially with BEC 1♂ recovered menses spontaneously, 1 ♂ needed progesterone therapy, 1 ♂ did not achieve normal PRL values after 9 m of treatment, the adolescent who required surgery had normal PRL levels without menses and the ♀ recovered gonadal function. In conclusion: - Basal PRL levels seem to be the most relevant element in hte diagnosis of prolactinomas.