Scientific Letter
Prolactinomas in a paediatric population
Prolactinomas en la población pediátrica
Alejandra Mora Mendoza
, Beatriz García Cuartero, Yoko Oyakawa, Raquel Barrio Castellanos
Corresponding author
Unidad de Endocrinología y Diabetes Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
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"doi" => "10.1016/j.anpedi.2015.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315005378?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916300928?idApp=UINPBA00005H" "url" => "/23412879/0000008500000003/v1_201608250218/S2341287916300928/v1_201608250218/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Prolactinomas in a paediatric population" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "158" "paginaFinal" => "159" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandra Mora Mendoza, Beatriz García Cuartero, Yoko Oyakawa, Raquel Barrio Castellanos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alejandra" "apellidos" => "Mora Mendoza" "email" => array:1 [ 0 => "arnaleja@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Beatriz" "apellidos" => "García Cuartero" ] 2 => array:2 [ "nombre" => "Yoko" "apellidos" => "Oyakawa" ] 3 => array:2 [ "nombre" => "Raquel" "apellidos" => "Barrio Castellanos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Endocrinología y Diabetes Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prolactinomas en la población pediátrica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 844 "Ancho" => 903 "Tamanyo" => 74942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follow-up MRI scan one month after initiation of treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>: female patient aged 15 years that sought care at her assigned health care centre for irregular menstruation. There was no personal or family history of interest, and the patient was not taking any medication. Her age of menarche was 11.5 years.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was referred to the paediatric endocrinology unit after testing revealed an elevated prolactin level (198<span class="elsevierStyleHsp" style=""></span>ng/mL; normal value range, 8.5–26.5<span class="elsevierStyleHsp" style=""></span>ng/mL). During the structured interview, the patient reported one year of intermittent blurry vision and frontal headache of three months’ duration accompanied by light unilateral galactorrhoea. The findings of the physical examination were: height, 169.5<span class="elsevierStyleHsp" style=""></span>cm (standard deviation [SD], +1.1); weight, 53.3<span class="elsevierStyleHsp" style=""></span>kg; body mass index (BMI), 19.29<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (SD, −0.79). The patient was at Tanner stage V of pubertal development with proportionate features. There was no galactorrhoea, hirsutism or acne. The complete blood count and blood chemistry panel were normal, with the most salient finding being the serum prolactin level (205.6<span class="elsevierStyleHsp" style=""></span>ng/mL). Magnetic resonance imaging (MRI) revealed an enlarged pituitary gland with a superior border that was convex towards the midline and signal hyperintensity suggestive of subacute haemorrhage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The pituitary gland extended into and obliterated the suprasellar cistern, exerting a mass effect on the optic chiasm. The ophthalmological examination evinced mild hyperopia, and the visual field test and eye fundus examination were normal. The patient was given a diagnosis of prolactinoma with subclinical apoplexy based on these findings, and started treatment with cabergoline at a dose of 0.25<span class="elsevierStyleHsp" style=""></span>mg the first week, followed by a maintenance dose of 0.50<span class="elsevierStyleHsp" style=""></span>mg a week. One month after treatment initiation, the follow-up MRI scan showed an adenoma measuring 10<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), values that may have been overestimated due to haemorrhagic features, and the serum prolactin level was 12.6<span class="elsevierStyleHsp" style=""></span>ng/mL. At present, the patient has regular menstrual periods, normal vision without headache and no galactorrhoea.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2</span>: male patient aged 14 years that was being followed up for obesity and tall height with advanced bone age. The assessment of the patient's headaches included performance of an MRI scan that revealed a 10<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm nodule in the left region of the pituitary gland, with remodelling of the angle of the sella turcica with no extension to the cavernous sinus compatible with adenoma (at the threshold between microadenoma and macroadenoma). The patient did not present with vision changes or galactorrhoea. The findings of the physical examination were: height, 173.6<span class="elsevierStyleHsp" style=""></span>cm (SD, +1.16); weight, 85.6<span class="elsevierStyleHsp" style=""></span>kg; BMI, 28.4<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (SD, +3.3). The patient had predominantly abdominal obesity with adipomastia. The only abnormal finding in laboratory tests was an elevated prolactin level of 118<span class="elsevierStyleHsp" style=""></span>ng/mL. Treatment with dopamine agonists was initiated at 0.50<span class="elsevierStyleHsp" style=""></span>mg a week, given in 2 doses, to which the patient responded favourably (prolactin, 11.5<span class="elsevierStyleHsp" style=""></span>mg/mL).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hyperprolactinaemia secondary to a pituitary adenoma is a rare finding in the paediatric population. The prevalence of prolactinoma is 100 per one million inhabitants, accounting for fewer than two percent of all intracranial tumours.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> There is a wide variability in its main clinical features, which vary based on sex, tumour size and age of onset.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> We have presented two cases of prolactinoma in patients of both sexes with a similar age of onset and clinical features that are nearly opposite. In case 1, the patient presented with headache and vision changes and imaging findings compatible with haemorrhagic adenoma. Subclinical pituitary apoplexy in children and adolescents is rarely mentioned in the literature, and most of the evidence consists in the description of isolated cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Patients may remain asymptomatic or have very mild symptoms compared to those of pituitary apoplexy. There is no correlation between prolactin levels and the duration or severity of symptoms. There is also no evidence of a relationship between tumour size and the presence of haemorrhagic processes.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In children, development of subclinical pituitary apoplexy is more frequent due to the decreased susceptibility to infarction of the tumour and a greater resistance to haemorrhage than adults, and is probably underdiagnosed.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As for treatment, cases of subclinical apoplexy, especially prolactin-producing adenomas, can be managed conservatively. Treatment with dopamine agonists can control prolactin levels and reduce tumour size significantly.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In cases of hyperprolactinaemia secondary to prolactinoma, medication is recommended as the first-line treatment for both microadenomas and macroadenomas regardless of age.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> The primary goal of dopamine agonist therapy is to improve sex-gland and neurologic functioning. The followup requires close monitoring of the patient's clinical manifestations and blood chemistry, and treatment may be discontinued after two years if prolactin levels are no longer elevated and there is no visible tumour remnant on MRI.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,6</span></a> If treatment is discontinued, serum prolactin should be measured every three months in the first year and annually thereafter, and MRI performed if serum prolactin levels increased past the normal range.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mora Mendoza A, García-Cuartero B, Oyakawa Y, Castellanos RB. Prolactinomas en la población pediátrica. An Pediatr (Barc). 2016;85:158–159.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 861 "Ancho" => 903 "Tamanyo" => 88954 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagnostic MRI scan with diffuse hyperintensity on T1-weighted image.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 844 "Ancho" => 903 "Tamanyo" => 74942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follow-up MRI scan one month after initiation of treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of prolactinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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Schlechte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2010-1692" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2011" "volumen" => "96" "paginaInicial" => "273" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21296991" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008500000003/v1_201608250218/S2341287916300916/v1_201608250218/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008500000003/v1_201608250218/S2341287916300916/v1_201608250218/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916300916?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 8 | 23 |
| 2024 October | 123 | 44 | 167 |
| 2024 September | 142 | 30 | 172 |
| 2024 August | 135 | 67 | 202 |
| 2024 July | 194 | 36 | 230 |
| 2024 June | 144 | 31 | 175 |
| 2024 May | 144 | 50 | 194 |
| 2024 April | 130 | 30 | 160 |
| 2024 March | 91 | 28 | 119 |
| 2024 February | 95 | 31 | 126 |
| 2024 January | 84 | 28 | 112 |
| 2023 December | 149 | 18 | 167 |
| 2023 November | 104 | 28 | 132 |
| 2023 October | 78 | 25 | 103 |
| 2023 September | 61 | 25 | 86 |
| 2023 August | 72 | 16 | 88 |
| 2023 July | 109 | 28 | 137 |
| 2023 June | 108 | 28 | 136 |
| 2023 May | 91 | 22 | 113 |
| 2023 April | 52 | 23 | 75 |
| 2023 March | 70 | 29 | 99 |
| 2023 February | 73 | 23 | 96 |
| 2023 January | 74 | 31 | 105 |
| 2022 December | 78 | 24 | 102 |
| 2022 November | 94 | 37 | 131 |
| 2022 October | 110 | 43 | 153 |
| 2022 September | 86 | 24 | 110 |
| 2022 August | 94 | 86 | 180 |
| 2022 July | 100 | 72 | 172 |
| 2022 June | 58 | 35 | 93 |
| 2022 May | 99 | 33 | 132 |
| 2022 April | 58 | 32 | 90 |
| 2022 March | 88 | 40 | 128 |
| 2022 February | 103 | 29 | 132 |
| 2022 January | 98 | 40 | 138 |
| 2021 December | 90 | 46 | 136 |
| 2021 November | 58 | 38 | 96 |
| 2021 October | 73 | 57 | 130 |
| 2021 September | 61 | 44 | 105 |
| 2021 August | 48 | 43 | 91 |
| 2021 July | 47 | 21 | 68 |
| 2021 June | 65 | 58 | 123 |
| 2021 May | 65 | 44 | 109 |
| 2021 April | 147 | 97 | 244 |
| 2021 March | 84 | 33 | 117 |
| 2021 February | 64 | 17 | 81 |
| 2021 January | 71 | 32 | 103 |
| 2020 December | 51 | 28 | 79 |
| 2020 November | 54 | 21 | 75 |
| 2020 October | 55 | 19 | 74 |
| 2020 September | 109 | 22 | 131 |
| 2020 August | 86 | 15 | 101 |
| 2020 July | 67 | 15 | 82 |
| 2020 June | 29 | 13 | 42 |
| 2020 May | 41 | 27 | 68 |
| 2020 April | 29 | 15 | 44 |
| 2020 March | 27 | 19 | 46 |
| 2020 February | 39 | 20 | 59 |
| 2020 January | 35 | 22 | 57 |
| 2019 December | 59 | 11 | 70 |
| 2019 November | 29 | 12 | 41 |
| 2019 October | 20 | 12 | 32 |
| 2019 September | 31 | 13 | 44 |
| 2019 August | 43 | 22 | 65 |
| 2019 July | 37 | 22 | 59 |
| 2019 June | 40 | 22 | 62 |
| 2019 May | 50 | 39 | 89 |
| 2019 April | 93 | 38 | 131 |
| 2019 March | 37 | 20 | 57 |
| 2019 February | 57 | 21 | 78 |
| 2019 January | 27 | 20 | 47 |
| 2018 December | 50 | 22 | 72 |
| 2018 November | 56 | 31 | 87 |
| 2018 October | 73 | 23 | 96 |
| 2018 September | 32 | 14 | 46 |
| 2018 August | 5 | 0 | 5 |
| 2018 July | 5 | 0 | 5 |
| 2018 June | 6 | 0 | 6 |
| 2018 May | 23 | 0 | 23 |
| 2018 April | 26 | 0 | 26 |
| 2018 March | 26 | 0 | 26 |
| 2018 February | 20 | 0 | 20 |
| 2018 January | 20 | 0 | 20 |
| 2017 December | 28 | 0 | 28 |
| 2017 November | 20 | 0 | 20 |
| 2017 October | 23 | 1 | 24 |
| 2017 September | 24 | 0 | 24 |
| 2017 August | 28 | 0 | 28 |
| 2017 July | 18 | 1 | 19 |
| 2017 June | 26 | 8 | 34 |
| 2017 May | 17 | 9 | 26 |
| 2017 April | 21 | 6 | 27 |
| 2017 March | 20 | 5 | 25 |
| 2017 February | 12 | 8 | 20 |
| 2017 January | 21 | 4 | 25 |
| 2016 December | 21 | 7 | 28 |
| 2016 November | 18 | 18 | 36 |
| 2016 October | 22 | 15 | 37 |
| 2016 September | 42 | 25 | 67 |
| 2016 August | 21 | 2 | 23 |
| 2016 July | 2 | 1 | 3 |
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