ESPE Abstracts

Prolactinoma is the most common pituitary adenoma in children and adolescents originating from lactotrophic cells, autonomously secreting prolactin, usually diagnosed >12 years of age, more often in girls. We present the case of a 17-year-old girl, diagnosed in the Endocrinology Outpatient Clinic of the University Children's Clinical Hospital in Bialystok, due to excessive weight gain and secondary amenorrhoea. The girl was referred to the Department of Paediatrics, Endocrinology, Diabetology with the Cardiology Divisions for further diagnostics. There was a history of excessive weight gain for one and a half years. Moreover the patient reported irritability, daily headaches, nose bleedings and secondary amenorrhoea. There was obesity in the family history on the father's side. The physical examination revealed features of obesity, stretch marks on the abdomen, hips, breasts and in the popliteal fossae. Laboratory tests showed slight hypertransaminaemia and hyperuricaemia, suboptimal vitamin D3 concentration. There was normal TSH, fT4, ACTH, gonadocropins, oestradiol and androgens concentration. Daily profile of cortisol, glycaemia and insulinaemia as well as HOMA index remained within the reference range. CEA, AFP, beta-HCG markers were normal but prolactin concentration was above norm. In the metoclopramide test, no significant increase in prolactin secretion was observed. MRI showed a pituitary macroadenoma of size 10 × 8 × 9mm. The patient was consulted neurosurgically with no indications for surgery, gynaecologically - no abnormalities, ophthalmologically - peripheral visual field normal. Echocardiography and abdominal ultrasound were performed. The pharmacological treatment of hyperprolactinemia was recommended: cabergoline 0.5 mg - initially 1 × 1/2tabl 2 × per week for one month, then 1 × 1tabl, vitamin D3 - 1 × 3000jm. During the further care in the Endocrinology Outpatient Clinic, a slight decrease in prolactin concentration was observed, but the value was still significantly above normal. The dose of Cabergoline was increased to 1 × 1.5 tabl 2 × per week. At the next visit, the patient reported a worsening rash, which turned out to be an allergic reaction to cabergoline. Due to poor tolerance of cabergoline, treatment was changed to bromocriptine 2 × 2.5 mg. In the meantime at the visit in the Neurosurgical Outpatient Clinic, a date for hospitalisation for surgical treatment was established. On admission to the Department of Neurosurgery of the Military Institute of Medicine in Warsaw, laboratory tests revealed prolactin levels within normal ranges. The resection of the pituitary tumour through the cuneiform bone was performed. Recommendations for hydrocortisone supplementation were given and further follow-up was planned.