Clinical, hormonal and radiological features, and treatment outcomes of prolactinomas in a pediatric population

Abstract

OBJECTIVE: Prolactinoma is the most common hormone-secreting pituitary tumor in the pediatric population. Although it is less common in children and adolescents than in adults, it accounts for 50% of childhood pituitary adenomas. Data on prolactinomas in the pediatric population are still limited. In this study, the symptoms, laboratory data, radiological findings, and therapeutic outcomes of prolactinomas in children and adolescents were assessed. METHODS: This retrospective study included pediatric patients diagnosed with prolactinomas before 18 years of age, who presented at Istanbul Medeniyet University, Professor Doctor Suleyman Yalcin City Hospital during an 8-year period (August 2015 to November 2023). RESULTS: Seventeen patients (13 female; 76.4%) with prolactinoma were included. Median age at diagnosis was 14.7 years (12.2-16.1 years) in girls, 11.8 years (6.8-16.2) years) in boys. All boys and most girls (62%) had macroadenomas (>= 1 cm). The most common presenting symptom was amenorrhea/oligomenorrhea in girls and, mass effects and gynecomastia in boys. The median prolactin (PRL) level was significantly higher in the macroprolactinoma group than in the microprolactinoma group (262.5 vs. 178 ng/mL; p=0.035). Cabergoline was introduced to all patients as first-line treatment and normal PRL level was achieved in 88.3% of them after a two-year treatment. One male and one female patient were unresponsive to 2 mg/week cabergoline treatment and therefore underwent transsphenoidal surgery. PRL elevation recurred in six of seven patients (86%) after the withdrawal of cabergoline treatment. CONCLUSION: A macroprolactinoma is more common in children and adolescents than a microprolactinoma in adults. Increased PRL levels, male gender and the presence of mass effects at the time of diagnosis are associated with macroprolactinomas diagnosed during childhood and adolescence. Cabergoline was highly effective in the treatment of pediatric prolactinomas. However, due to the high recurrence rate of hyperprolactinemia after withdrawal of a 2-year treatment, use of cabergoline for a longer duration (>= 3 years) before the first withdrawal attempt might be beneficial to reduce the risk of recurrence in selected pediatric cases with macroprolactinoma.