Endocrine Abstracts

Case: We report the case of a 22-year-old lady with pubertal arrest from a prolactinoma. She was diagnosed with a prolactinoma elsewhere at age 16 years when she presented with headaches, visual field defects and primary amenorrhea. She attained pubarche and telarche at ages 11 and 14 respectively. Pituitary MRI showed a 22 mm pituitary mass. Initial tests 6 years ago showed high prolactin, secondary hypothyroidism, low IGF-1 and gonadotropins. Cabergoline and levothyroxine were prescribed which she used for a year then stopped when headaches resolved. She did not go for follow-up because of financial constraints. She presented at our facility with recurrence of headaches and persistent primary amenorrhea. She had no visual field defects or galactorrhea. Normal female secondary sexual characteristics were present. Hormonal profile showed marked hyperprolactinemia and persistent pan-hypopituitarism. Growth hormone assay and repeat pituitary MRI were not done due to financial constraints. Pelvic sonography showed hypoplastic uterus and ovaries. She was re-commenced on cabergoline, hydrocortisone and levothyroxine. Repeat hormonal profile after 6 months showed normalization of prolactin and thyroid function. Estrogen however remained low despite normal progesterone and gonadotropins. She remained amenorrheic as at 8 months after recommencing treatment.

Discussion: The prolonged under-stimulation of the ovaries by the gonadotrophins and the persistent hyperprolactinemia likely contributed to the underdevelopment of the ovaries and uterus. It is uncertain if she will attain menstruation and fertility, considering the prolonged course through the critical adolescence period. It is important to promptly evaluate, educate and treat persons with hypoprolactinemia-related pubertal disorders to prevent persistent dysfunction of the pituitary-gonadal axis.