Endocrine Abstracts

Objective: Hyperprolactinemia is a rare endocrine disorder in childhood, which may be due to various etiological factors and may present with different signs and symptoms. We aimed to evaluate the etiologic reasons, clinical features and outcome in hyperprolactinemia patients retrospectively.

Method: Data from 25 patients who were followed up with hyperprolactinemia between years 2009 and 2017 were evaluated.

Results: A total of 25 patients [23 female (92%) and 2 male (8%)], with a mean referral age of 15.6±1.2 years were enrolled in the study. The mean duration of follow up was 21.1±11.5 (6-46) months. In 2 patients who presented with pubertal gynecomastia and acne vulgaris, macroprolactinemia (prolactine levels; 47.4 and 47.3 ng/ml) was detected. The most frequent symptoms were menstrual disorders (15 of 23), galactorrhea (7 of 23). Visual field defect was only seen in patients with macroadenoma. All patients were at pubertal stage. The mean prolactin level of the patients (n=23), female group (n=22) and male group (n=1) were 138.6±106.2 (31.5-479), 123.2±79.4 (31.5-315), 479 ng/ml, respectively. Eleven patients had microadenoma, six had macroadenoma, five were diagnosed with idiopathic hyperprolactinemia and Rathke’s cleft cyst was found in one. Cabergoline (0.25-0.5 mg/week in one /two doses) were given to all as initial therapy. Treatment was switched to bromocriptine in one because of treatment intolerance. All but one of the patients were responsive to medical treatment, gonadal and neurological functions were normalized. The patient who was unresponsive to medical treatment was male and had macroadenoma (35×20 mm) secreting PRL and growth hormone. Tumor was invasive to cavernous sinus and causing visual field defect. Surgery was performed as twice and gama knife was also performed for residual tumor and medical treatment(cabergoline and sandostatine) was continued after surgery. Hypothyroidism and hypocortisolemia were developed after treatment. No pituitary hormone abnormality was observed in others. Two patients with macroadenoma, one with microadenoma left follow up. Tumor sizes were not changed significantly in the majority of patients, only in two, tumor regressed totally. Treatment was completed in five, mean treatment duration was 23 (12-36) months.

Conclusion: Hyperprolactinemia should be considered in the differential diagnosis of cases with amenorrhea (primary/secondary), oligomenorrhea, galactorrhea. Medical treatment should be the first-line treatment option in both microadenoma and macroadenoma cases. Surgery should be employed in cases that have cavernous sinüs invasion or signs of nerve compression.