ESPE Abstracts

Introduction: Pituitary adenomas, while rare in the pediatric population, pose significant challenges in terms of diagnosis and treatment despite their generally benign nature. The aimof this study was to elucidate the clinical features, hormonal profiles, and therapeutic interventions employed in the management of prolactinoma in a pediatric cohort.

Methods: This study included children <18 years diagnosed with prolactinoma between 2005-2024 at a single referral center. Demographic information, clinical presentations, tumor characteristics, initial serum prolactin levels, and treatment modalities were evaluated retrospectively.

Results: The cohort comprised 25 patients with prolactinoma, 18 (72%) of whom were female. The median (range) age at diagnosis was 16 (12-18) years (females) and 15.6 (9.5-18) years (males). The median follow-up duration was 44.5 (3-159) months. Among these patients, 4 (16%) had microadenomas and 21 (84%) had macroadenomas, with two exhibiting mixed somatotropinoma/prolactinoma characteristics. Three were classified as giant prolactinomas. Nine macroadenomas were invasive. Predominant symptoms included headache (n = 17), menstrual irregularity (n = 14), and visual disturbances (n = 10). The most frequent hormonal deficiency at diagnosis was central hypothyroidism (n = 8), followed by hypogonadotropic hypogonadism (n = 6), central adrenal insufficiency (n = 4), and growth hormone deficiency (n = 3). The median serum prolactin level was 1989 (101-16762) μg/L. Cabergoline was the first-line treatment in 56% of cases and 60% required surgical intervention. Surgical intervention was required for 1/3 giant prolactinomas. The remaining two were managed with cabergoline therapy. Surgical cases exhibited treatment non-response (n = 3), headache (n = 2), apoplexy (n = 1), invasion (n = 1), compression (n = 3), and combined invasion/compression (n = 5).

Conclusion: Prolactinomas are rare in childhood/adolescence and may present with nonspecific symptoms. These symptoms may be due to hyperprolactinemia, mass effects, or associated anterior pituitary hormone deficiencies. Bromocriptine and cabergoline are known first-line treatments for prolactinomas, with cabergoline particularly noted for its efficacy and tolerability in reducing clinical symptoms, serum prolactin levels, and tumor size. In our study, cabergoline was administered as the initial treatment for two patients with giant prolactinomas, in accordance with existing literature. Due to the substantial size of the tumor, one patient experienced rhinorrhea on cabergoline. Conversely, the other patient did not exhibit rhinorrhea when the dosage was increased gradually. Considering the potential for rhinorrhea as a side effect of high-dose cabergoline, we deem it prudent to begin cabergoline at lower doses. The high rate of surgical intervention in our cohort (60%) was likely due to referral to our tertiary pituitary center, particularly for cases exhibiting an aggressive clinical course.