15-YEAR-OLD BOY WITH OCULAR PALSY AND HEADACHE

The diagnosis of prolactinoma was made on basis of high plasma levels of prolactin (459 ng/ml); FT3 and FT4, as well as other pituitary horm ones and testosterone, were under the normal range resulting in a comp lete hypopituitarism. As a first line of treatment, the patient was st arted on bromocriptine 2.5 mg twice daily together with levothyroxin ( 50 mu g daily) and cortisone acetate (25 mg daily). Four days later an improvement in ocular disturbance was noted and progressed towards co mplete resolution of ocular palsy within 15 days. This was accompanied by an important reduction of prolactin levels at 32 ng/ml. Three mont hs later, endocrinological evaluation showed normal values of plasma p rolactin thyroid hormones and testosterone levels and hormone replacem ent therapy was withdrawn. At the same time, MRI showed an important r eduction of the pituitary tumour mass, especially of its suprasellar a nd left cavernous sinus extension. After 9 months of bromocriptine the rapy, clinical evaluation showed a normal progression of puberty and t he patient's height was increased by 3 cm (161 cm); prolactin and othe r pituitary hormone levels resulted normal. MRT indicated a complete d isappearance of the pituitary tumour (Fig. 2).