Atypical onset of prolactinoma in an adolescent girl

Abstract

rolactin is one of the main pituitary hormones secreted from the pituitary gland and plays an important role in reproductive functions. Hyperprolactinemia (HPRL), with a prevalence of 0.4% to 5%, is considered a frequent endocrinopathy, although rare in childhood. HPRL can be related to pathological conditions, such as tumors (adenoma) or systemic diseases. With respect to prolactinomas, clinical signs manifest with mass compression of the optic chiasm and/or anterior pituitary gland and PRL hypersecretion. Here we report a case of a15-year old girl who came to our observation due to severe episodes of headache(every 3 days) during the last year, accompanied by two incidents of amaurosis (lasting 5-10 minutes, with spontaneous resolution) and also lately spontaneous galactorrhoea (for 1 month). Brain MRI identified a “pituitary microadenoma (6 mm), with minimal blood component in context and sinking the floor of the sella turcica”. The patient underwent neurosurgical evaluation, which excluded pituitary apoplexy. She started medical treatment with cabergoline (0.25 mg twice a week), with progressive resolution of symptoms and normalization of prolactin levels. Although prolactinoma is a rare condition in pediatric patients, it must be considered as a possible diagnosis in presence of galactorrhoea and headache, even without irregularities of the menstrual cycle.