Peripubertal prolactinomas: Clinical presentation and long-term outcome with different therapeutic approaches

The evolution of prolactinomas in children and adolescents continues to be controversial. We report on the long-term evolution (2-20 yr) of prolactino mas in 40 patients (29 F, 11 M), In females, the age for the onset of sympt oms ranged between 8 and 16 yr and the age at which diagnosis was made rang ed from 15 to 19 yr; in males, ages ranged from 8 to 17 yr and from 13.8 to 19 yr, respectively. In females, there was predominance of microprolactino mas (22/29) and the symptomatology resulted from functional disorders, wher eas in males there was predominance of macroprolactinomas (8/11) and sympto ms were caused by tumor mass disorders. Surgery was used as primary therapy in nine patients and as supplemental therapy in six patients. Twenty-four patients were treated primarily with bromocriptine and seven with cabergoli ne, Of the nine patients treated primarily with surgery, only one achieved gonadotropic axis restoration; in 25/31 patients receiving drug therapy gon adotropic function was restored to normal. Fifteen patients showed complete resolution or substantial shrinkage of tumor. Conclusion: In pediatric and adolescent age, there seem to be age- and sex- dependent differences in the clinical presentation of prolactinomas that ca nnot be accounted for only in terms of time of evolution. Drug therapy can control the disease, normalize prolactin levels and achieve gonadotropic ax is restoration in most patients.