Fideleff H L, Boquete H R, Suárez M G, Azaretzky M
Endocrinology Unit, Department of Medicine, Hospital T. Alvarez, Buenos Aires, Argentina.
Horm Res. 2009;72(4):197-205. doi: 10.1159/000236081. Epub 2009 Sep 29.
The evolution of prolactinomas in children and adolescents continues to be controversial. Girls have more prevalence of microprolactinomas and their signs and symptoms are related to hyperprolactinemia and the resulting hypogonadotrophic hypogonadism. In males, the greater incidence of macroadenomas results in the presence of neuro-ophthalmologic signs. The larger prevalence of macroadenomas in males is consistent with findings in adults and would not be related to a later diagnosis. In patients with asymptomatic hyperprolactinemia, the presence of altered proportions of PRL isoforms should be evaluated. The diagnosis of prolactinoma requires both radiographic evidence of pituitary adenoma and laboratory analysis documenting the presence of sustained hyperprolactinemia. Because of their effectiveness and tolerance, dopaminergic agonists are the initial therapy of choice in pediatric age patients. Finally, molecular biology and genetic studies have brought new insights into the pathogenesis, clinical behavior and different therapeutic responses.
儿童和青少年催乳素瘤的演变仍存在争议。女孩微催乳素瘤的患病率更高，其体征和症状与高催乳素血症以及由此导致的低促性腺激素性性腺功能减退有关。在男性中，大腺瘤的发病率较高，会出现神经眼科体征。男性大腺瘤的患病率较高与成人的研究结果一致，且与诊断较晚无关。对于无症状高催乳素血症患者，应评估催乳素异构体比例的变化。催乳素瘤的诊断需要垂体腺瘤的影像学证据以及记录持续性高催乳素血症存在的实验室分析。由于其有效性和耐受性，多巴胺能激动剂是儿童患者的首选初始治疗方法。最后，分子生物学和遗传学研究为发病机制、临床行为及不同的治疗反应带来了新的见解。
