ECE2011 Poster Presentations Pituitary (111 abstracts)
Macroprolactinomas in 38 children and adolescents: sex differences and long-term results of medical treatment
D A Ancelle 1 , G R Raverot 2 , B D Découdier 1 , S V Sulmont 1 , M N Nicolino 2 , P B Berlier 2 , F B C Borson-Chazot 2 & B D Delemer 1
1CHU Reims, Marne, France; 2CHU Lyon, Rhone, France.
Objectives: Long-term results of medical treatment of macroprolactinoma in children and adolescents (<20 years).
Patients and methods: Retrospective analysis of all the cases of macroprolactinoma occurring in children and adolescents, medically treated in two university centers.
Results: 38 patients, 25 girls 13 boys, age at diagnosis: 15.7±2.8 years (only two cases before 12 years). At diagnosis, 2/3 presented with headaches, 1/3 visual disturbances, 1/2 abnormal pubertal development, 1/4 growth failure, amenorrhea (primary or secondary) in 22/25 girls. Mean serum prolactin was 2700±6145 μg/l, maximum diameter of the adenoma was 22±12 mm. There were sex differences (boys/girls): age 14/16.6 years (P=0.0016), size of adenoma 28/18 mm (P=0.019), prolactin level 5176/1368 μg/l (P=0.016), growth failure 6 /3 (P=0.027; OR=3.6), pituitary deficiency 7/2 (P=0.003; OR=13.4). First line treatment was dopamin agonist in all cases: cabergoline (22), bromocriptine (14) quinagolide (2) leading to normalisation of prolactin in 74% of the patients, 50% decrease of the volume of the adenoma in 58%, gonadal function normalised in 78% (10/25 girls had normal pregnancy). The patients resistant to medical treatment had surgery (9), radiotherapy (3) or high and prolonged dose of dopamin agonists (6). At this time, only one is not controlled with tumoral expansion symptoms. After a median 8 years follow-up, 1/3 of the patients had sequelae (boys/girls 8/5, P=0.014), predictive factor was initial diameter of the adenoma (P=0.022), >20 mm.
Conclusion: This is the largest cohort of macroprolactinomas under 20 years. Sex differences are the same than in adult population with larger tumors in boys, leading to more frequent sequelae. This study confirms that development of prolactinomas is associated with puberty. Long term medical treatment in children and adolescents is effective and safe in 3/4 of the patients but must be completed by surgery or radiotherapy in a few resistant cases.
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Endocrine Abstracts
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