Brichta Corinna Melanie, Wurm Michael, Krebs Andreas, Schwab Karl Otfried, van der Werf-Grohmann Natascha
Department of General Paediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany.
Department of Paediatrics, St. Hedwigs Campus, University Children's Hospital Regensburg, Regensburg, Germany.
J Pediatr Endocrinol Metab. 2019 Sep 25;32(9):969-977. doi: 10.1515/jpem-2018-0475.
Background Prolactin-secreting pituitary adenomas in childhood and adolescence are rare. First-line therapy consists of dopamine agonists (DAs) like cabergoline. Experience in treating prolactinomas in paediatric and adolescent patients is limited. Methods This study was a retrospective analysis of clinical data, laboratory data, radiological findings and medical treatment of paediatric and adolescent patients with prolactinomas between 2009 and 2018. Results Our cohort of nine patients had a median age at diagnosis of 13 years (range 5-17). Main presenting symptoms were weight gain, disorders of the pituitary-gonadal axis and headache. Treatment with cabergoline resulted in a marked reduction in prolactin concentration in all nine patients. Tumour mass reduction was confirmed by magnetic resonance imaging (MRI) scan in seven patients. Noteworthy is that cabergoline therapy triggered frequent adverse effects in a total of eight patients - seven of whom suffered from mental disorders, five of whom had neurological symptoms and five of whom had gastrointestinal problems. The adverse effects occurred at a median dose of only 0.5 mg/week (range 0.25-2.0). Most symptoms were alleviated after the cabergoline dose was lowered. Therapy discontinuation was not necessary in any patient. Conclusions Cabergoline effectively lowers prolactin levels and may reduce tumour mass in paediatric and adolescent patients with prolactinomas. Potential adverse effects may include mental disorders and behavioural problems even at low cabergoline doses. Low starting doses and careful individual dose adjustments are required to enable therapy adherence.
背景 儿童和青少年分泌催乳素的垂体腺瘤较为罕见。一线治疗包括使用卡麦角林等多巴胺激动剂（DAs）。儿科和青少年患者催乳素瘤的治疗经验有限。方法 本研究对2009年至2018年间儿科和青少年催乳素瘤患者的临床数据、实验室数据、影像学检查结果及治疗情况进行回顾性分析。结果 我们的9例患者队列诊断时的中位年龄为13岁（范围5 - 17岁）。主要症状为体重增加、垂体 - 性腺轴紊乱和头痛。所有9例患者使用卡麦角林治疗后催乳素浓度均显著降低。7例患者经磁共振成像（MRI）扫描证实肿瘤体积减小。值得注意的是，卡麦角林治疗共引发8例患者出现频繁的不良反应，其中7例患有精神障碍，5例有神经症状，5例有胃肠道问题。不良反应发生时的中位剂量仅为0.5毫克/周（范围0.25 - 2.0）。降低卡麦角林剂量后，大多数症状得到缓解。所有患者均无需停药。结论 卡麦角林可有效降低儿科和青少年催乳素瘤患者的催乳素水平，并可能减小肿瘤体积。即使卡麦角林剂量较低，潜在的不良反应也可能包括精神障碍和行为问题。需要低起始剂量并仔细进行个体化剂量调整，以确保治疗的依从性。
