Prolactinoma in childrens and adolescents: a retrospective study of presentation, management, and outcomes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 88-129-Acromegaly & Prolactinoma
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-129
Thais de Paula Sickler1, Andrea Glezer2, Cristina Formiga3, Valter Angelo Sperling Cescato4, Nina Musolino5, Malebranche Cunha Neto6 and Marcello D Bronstein*7
1Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao Paulo Medical School., Sao Paulo, Brazil, 2Univ of Sao Paulo, 001 Sao Paulo, Brazil, 3Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao Paulo Medical School., Brazil, 4Hosp das Clin Faculd Med USP, Sao Paulo, Brazil, 5Institute of Psychiatry, Hospital das Clínicas, University of Sao Paulo Medical School., São Paulo, Brazil, 6Functional Neurosurgery , Institute of Psychiatry, Hospital das Clínicas, University of Sao Paulo Medical School., 7University of São Paulo Medical School, São Paulo, Brazil
Introduction: Prolactinomas diagnosed before 18 yrs-old are very rare, with an incidence of 0.1 per million,  and represent half of all pituitary adenomas. Prolactinomas in children and teenagers usually are more aggressive and macroadenomas (MAC) are more likely to occur.(1)

We conducted a retrospective study including children and adolescents harboring prolactinomas followed at our Neuroendocrine Unit.

Methods: A retrospective study to evaluate hyperprolactinemia in patients up to 20 yrs-old with symptoms related to increase prolactin levels was performed. Hospital records as clinical features at presentation, prolactinoma size, medical treatment outcomes and surgical results were analyzed.

Results: Thirty nine patients were included in the study, and except for 3 patients with macroprolactinemia, all others presented prolactinomas: 77.8% were females. They included 28 (77.8%) macroprolactinomas (MAC), 8 (22.2%) microprolactinomas (MIC) and 3 cases of MEN1 amongst patients with MAC (2 women). Surgery was performed in 16 (44.4%) patients (2 MIC and 14 MAC, 12 women and 4 men) due to dopamine agonist resistance in 9 patients, dopamine agonist intolerance in 5 patients, and apoplexy in 2 patients (one of them during pregnancy). Four cases presented tumor remission after surgery and five cases needed two surgeries. Panhypopituitarism was already present in 20% at the diagnosis and in additional 12.5% of patients after surgery. In two cases, hormonal deficiencies were reverted during dopamine agonist treatment.

Twenty eight patients were treated with bromocriptine (46.4% intolerant), and thirty three patients were treated with cabergoline (9.1% intolerant). Five % of cases presented intolerance to both dopaminergic agonists. In five patients (13.9%) normoprolactinemia was maintained after dopamine agonist withdrawal.

Conclusions: In this study, we confirmed literature data about prolactinoma aggressiveness in children and teenagers. The high rate of surgical treatment was due to a high percentage of dopamine agonist resistance/intolerance in this group of patients

(1)     Catli G, Abaci A, Bober E, Büyükgebiz A. Clinical and diagnostic characteristics of hyperprolactinemia in childhood and adolescence. J PediatrEndocrinolMetab.2012.

Nothing to Disclose: TDPS, AG, CF, VASC, NM, MC, MDB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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