ESPE Abstracts

Introduction: Prolactinomas, constitute 50% of pediatric pituitary adenomas and 2% of all intracranial tumors. These tumors disrupt normal dopamine regulation, leading to hyperprolactinemia and mass effects that impair growth, puberty, and reproduction. Early detection is vital to prevent complications and preserve fertility. This case report outlines diagnostic challenges and management of a prolactinoma in a 15-year-old boy with visual disturbances, delayed puberty, and obesity.

Case Presentation: A 15-year-old boy, EH, presented with progressive blurry vision since around 2015, worsening over several years despite changing glasses. By March 2021, he experienced decreased vision in his right eye, peripheral vision loss, and persistent frontal headaches unresponsive to medication. He also reported breast enlargement over the past year without discharge and had not undergone typical pubertal changes. Physical examination revealed Tanner stage IV gynecomastia, short stature (151.5 cm, <3rd percentile), obesity (BMI 29, >95th percentile), and Tanner stage G2/P1 genital development. MRI on May 31, 2021, showed a large sellar and suprasellar mass (33.1 × 39.3 × 43.16 mm) compressing the optic chiasm, suggestive of a macroadenoma. Laboratory tests indicated elevated prolactin (initially 238 ng/mL, peaking at 2697 ng/mL). Bone age was consistent with 14 years. Bromocriptine was initiated at 2.5 mg twice daily, later increased to 2.5 mg three times daily. Subsequent prolactin levels decreased to 155.9 ng/mL by October 2021. Hormonal assays showed low LH, FSH, and testosterone, confirming delayed puberty. The patient continues pharmacotherapy and is under consideration for surgical intervention.

Conclusion: This case emphasizes the importance of early prolactinoma diagnosis in adolescents, despite its rarity. Early detection is critical to prevent severe complications, including vision loss and impaired growth. The rarity in this age group demands heightened clinical awareness and prompt multidisciplinary intervention. Timely management, including medical and surgical approaches, can significantly enhance patient outcomes and quality of life. Vigilance in evaluating atypical symptoms is paramount in pediatric patients.