ESPE Abstracts

Background: Prolactinomas are rare in the prepubertal and adolescent age group. Therapeutic approaches are guided by experience from treating adults. Few series have been reported.

Objective: Retrospective analysis of presenting features, treatment and outcomes in young patients presenting to a Tertiary Endocrine Service (total referral population ~3.5 million) managed jointly between Paediatric and Adult Endocrine and Neurosurgical services.

Patients and Methods: Patients presenting to the Paediatric/Adolescent Endocrine & Neurosurgical services under 20 year age with Prolactinoma from 2005–2015. Clinical records reviewed and outcome to latest follow-up (2–10 years) is reported.

Results: 9 patients (5 Female) presented age 13–19 years. Symptoms were: Menstrual disturbance (4), Galactorrhoea (3 F), Headache 4 (3 macro-/1 micro-adenoma), Visual field loss (2), Gynaecomastia (1), Weight loss (1), Hirsutism/PCOS (1), Pubertal growth delay (1). MRI defined microadenoma (<10 mm intrasellar lesion) in 4 patients (basal Prolactin levels 2800 – 5200 mIU/l) and macroadenoma (3 haemorrhagic) in 5 patients (basal Prolactin levels 3800, 4850, 7600, 45000 & 130,000 mIU/l). 3 macroadenoma patients had co-existing pituitary hormone deficiencies (ACTH/TSH/GH) and one had GH hypersecretion. No patients had family history of Multiple Endocrine Neoplasia. All patients received initial dopaminergic agent treatment with Cabergoline under shared Paediatric/Adult Endocrine Services, with reduction in Prolactin, variable tumour shrinkage and no side effects. Microadeomas have come under stable control (1 patient off treatment). 4 patients with macroadenoma underwent trans-sphenoidal surgery, 3 for tumour debulking and 1 for persistent, severe headache despite tumour shrinkage to within the sella. One of the two patients with giant macrodenoma (both male) proceeded to chemotherapy (Temozolomide) and radiotherapy with successful outcome to date.

Conclusion: Paediatric and Young Adult patients with Prolactinomas benefit from being managed in shared/Transitional care with the Adult Endocrine and Neurosurgical Teams.