PROLACTINOMAS IN CHILDREN AND ADOLESCENTS - CLINICAL PRESENTATION ANDLONG-TERM FOLLOW-UP

In this study, we report the clinical presentation, response to medica l 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 ra diotherapy after surgery. In 7 prepubertal males and 6 females with ma croprolactinoma, headache and/or visual defects were the first symptom s. All females presented with primary or secondary amenorrhea. Growth arrest was observed in a male patient with microadenoma, whereas all t he remaining patients had normal heights, and pubertal development was appropriate for their age. Spontaneous or provocative galactorrhea wa s 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 mu g/L in patients with macroadenoma and 155 +/- 38 mu g/L in patients with microadenoma. In 10 patients, BRC normalized P RL levels and caused variable, but significant, tumor shrinkage. CV no rmalized PRL concentrations and reduced tumor size in 5 patients. Cabe rgoline 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 dia gnosis in 7 patients, 5 of whom underwent surgery. Four patients becam e GH deficient in adult age. In conclusion, the medical treatment with dopaminergic compounds is effective and safe in patients with prolact inoma with onset in childhood, allowing preservation of the anterior p ituitary function.