Catli Gonul, Abaci Ayhan, Bober Ece, Büyükgebiz Atilla
Department of Pediatric Endocrinology, DokuzEylul University, Izmir, Turkey.
J Pediatr Endocrinol Metab. 2013;26(1-2):1-11. doi: 10.1515/jpem-2012-0327.
Pituitary adenoma is the most common cause of hyperprolactinemia, which is a rare endocrine disorder encountered in pediatric patient care. Epidemiological and clinical information about hyperprolactinemia in childhood and adolescence is limited. Clinical signs of hyperprolactinemia are very heterogeneous. In girls, disturbances in menstrual function and galactorrhea may be seen, whereas in boys, headache, visual disturbances, delayed pubertal development and hypogonadism are often present. Owing to the ease of ordering a serum prolactin measurement, an evidence-based, cost-effective approach to the management of this endocrine disorder is required. Before a diagnosis of hyperprolactinemia is made, drug use, renal insufficiency, hypothyroidism, and parasellar tumors should be excluded. The main objectives of treatment are normalization of prolactin level, adenoma shrinkage, and recovery from clinical signs related to hyperprolactinemia. In patients with microadenoma, invasive or non-invasive macroadenoma, and even in patients with visual field defects, dopamine agonists are the first-line treatment. Surgical treatment is indicated in patients who are unresponsive or intolerant to medical treatment or who have persistent neurological signs. Radiotherapy should be considered as a supportive treatment for patients in whom surgery fails or medical response is not achieved.
垂体腺瘤是高催乳素血症最常见的病因，高催乳素血症是儿科患者护理中罕见的内分泌疾病。关于儿童和青少年高催乳素血症的流行病学和临床信息有限。高催乳素血症的临床症状非常多样。在女孩中，可能会出现月经功能紊乱和溢乳，而在男孩中，常出现头痛、视觉障碍、青春期发育延迟和性腺功能减退。由于血清催乳素检测操作简便，因此需要一种基于证据、具有成本效益的方法来管理这种内分泌疾病。在诊断高催乳素血症之前，应排除药物使用、肾功能不全、甲状腺功能减退和鞍旁肿瘤。治疗的主要目标是使催乳素水平正常化、腺瘤缩小以及从与高催乳素血症相关的临床症状中恢复。对于微腺瘤、侵袭性或非侵袭性大腺瘤患者，甚至对于有视野缺损的患者，多巴胺激动剂是一线治疗方法。对于对药物治疗无反应或不耐受或有持续性神经症状的患者，应考虑手术治疗。对于手术失败或未达到药物治疗效果的患者，放射治疗应作为一种支持性治疗方法。
