Endocrine Abstracts

Prolactinomas are the most common hormone-active pituitary tumors, most common in young women, whose main reason for going to the doctor is menstrual irregularity. At the onset of the disease before puberty in children, there is a delay in sexual development, in girls primary amenorrhea.

A 27-year old woman has been observed since 15 years, when hyperprolactinemia was first detected, level of PRL was 10 900 IU/l, and according to MRI pituitary endosellar microadenoma. Cabergoline therapy was prescribed, which the patient received irregularly. The dose of cabergoline is gradually increased to 3.5 mg per week. However, no decrease in prolactin levels was observed. Adenoma growth was noted. After 7 years of observation, an increase in the size of adenomas with supra-parasellar growth (16 × 18 × 26 mm), prolactin levels ranged from 11 230 –16 800 IU/l. In connection with the patient’s refusal from surgery, the dose of cabergoline was increased to 4.5 mg per week. However, against this background, no positive dynamics were observed. During the entire observation period, the patient has primary amenorrhea, decreased libido, and obesity (BMI 35). On examination: the mammary glands are not sufficiently developed. At the age of 32, the patient began to notice headaches. When examining PRL was 16800 mU/l, the negative dynamics of the size of the adenoma: dimensions 21 × 22 × 18 mm with parainfrasurpasellar growth, the distance to the chiasm 2.5 mm. The patient is again offered an operation, to which she agreed. The patient underwent transnasal transphenoid adenomectomy. The histological examination and immunohistochemistry of surgical sample confirmed PRL-secreting pituitary adenoma, Ki-67–7.4%, positive p53. In hormonal blood tests in the postoperative period, the prolactin level is 498–742 IU/l. There were no signs of diabetes insipidus, adrenal insufficiency, or secondary hypothyroidism. 2 months after surgery, menstruation first came. In terms of monitoring and, if necessary, the appointment of hormone replacement therapy with sex hormones This clinical case demonstrates the delay in sexual development in a girl of 15 years with hyperprolactinemia, as well as the success of transnasal adenomectomy with resistance to cabergoline.