Endocrine Abstracts

Introduction: Pituitary adenoma has been exceptionally reported in Down’s syndrome (DS). We report the case of a 23 year-old patient diagnosed with Down’s syndrome, who was admitted to the Endocrinology Department for a macroprolactinoma.

Case report: A 23 year-old woman, diagnosed with DS, presented with acute headaches and diplopia. She had no history of trauma, and physical examination showed signs of damaged third and sixth cranial nerves, along with provoked galactorrhea. Hormonal workup showed elevated levels of prolactin at 104 ng/ml with low levels of gonadotropin, and the MRI showed a pituitary lesion measuring 14mm, with a necrotic center recalling a pituitary adenoma in apoplexy. The posterior pituitary hypersignal was absent. The patient was then put on 30 mg of hydrocortisone per day, with 1 mg of cabergoline per week. The follow-up showed decreasing levels of prolactin two months after her admission, the cabergoline was then discontinued

Discussion: Down’s syndrome is associated with increased risk of malignancies, most of which, however, are haematological. Pituitary functions in Down’s syndrome have been studied and showed no significant difference while compared to other patients. Some cases of pituitary hyperplasia in patients with Down’s syndrome presenting with primary hypothyroidism have been reported.

Conclusion: We report a macroprolactinoma in 23 year-old Down’s syndrome in apoplexy. It remains to confirm if an ethio-pathological link exists between Down’s syndrome and pituitary neoplasia.