Emeksiz Hamdi Cihan
Department of Pediatric Endocrinology, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye.
North Clin Istanb. 2024 Mar 29;12(3):269-276. doi: 10.14744/nci.2024.65049. eCollection 2025.
Prolactinoma is the most common hormone-secreting pituitary tumor in the pediatric population. Although it is less common in children and adolescents than in adults, it accounts for 50% of childhood pituitary adenomas. Data on prolactinomas in the pediatric population are still limited. In this study, the symptoms, laboratory data, radiological findings, and therapeutic outcomes of prolactinomas in children and adolescents were assessed.
This retrospective study included pediatric patients diagnosed with prolactinomas before 18 years of age, who presented at Istanbul Medeniyet University, Professor Doctor Suleyman Yalcin City Hospital during an 8-year period (August 2015 to November 2023).
Seventeen patients (13 female; 76.4%) with prolactinoma were included. Median age at diagnosis was 14.7 years (12.2-16.1 years) in girls, 11.8 years (6.8-16.2) years) in boys. All boys and most girls (62%) had macroadenomas (≥1 cm). The most common presenting symptom was amenorrhea/oligomenorrhea in girls and, mass effects and gynecomastia in boys. The median prolactin (PRL) level was significantly higher in the macroprolactinoma group than in the microprolactinoma group (262.5 vs. 178 ng/mL; p=0.035). Cabergoline was introduced to all patients as first-line treatment and normal PRL level was achieved in 88.3% of them after a two-year treatment. One male and one female patient were unresponsive to 2 mg/week cabergoline treatment and therefore underwent transsphenoidal surgery. PRL elevation recurred in six of seven patients (86%) after the withdrawal of cabergoline treatment.
A macroprolactinoma is more common in children and adolescents than a microprolactinoma in adults. Increased PRL levels, male gender and the presence of mass effects at the time of diagnosis are associated with macroprolactinomas diagnosed during childhood and adolescence. Cabergoline was highly effective in the treatment of pediatric prolactinomas. However, due to the high recurrence rate of hyperprolactinemia after withdrawal of a 2-year treatment, use of cabergoline for a longer duration (≥3 years) before the first withdrawal attempt might be beneficial to reduce the risk of recurrence in selected pediatric cases with macroprolactinoma.
泌乳素瘤是儿童人群中最常见的分泌激素的垂体肿瘤。尽管其在儿童和青少年中比在成人中少见，但它占儿童垂体腺瘤的50%。关于儿童人群泌乳素瘤的数据仍然有限。在本研究中，评估了儿童和青少年泌乳素瘤的症状、实验室数据、影像学表现及治疗结果。
这项回顾性研究纳入了18岁之前被诊断为泌乳素瘤的儿科患者，这些患者于8年期间（2015年8月至2023年11月）在伊斯坦布尔梅德尼耶特大学苏莱曼·亚尔钦教授市立医院就诊。
纳入了17例泌乳素瘤患者（13例女性；76.4%）。女孩诊断时的中位年龄为14.7岁（12.2 - 16.1岁），男孩为11.8岁（6.8 - 16.2岁）。所有男孩和大多数女孩（62%）患有大腺瘤（≥1 cm）。女孩最常见的首发症状是闭经/月经过少，男孩是占位效应和乳腺增生。大泌乳素瘤组的泌乳素（PRL）中位水平显著高于微泌乳素瘤组（262.5对178 ng/mL；p = 0.035）。所有患者均将卡麦角林作为一线治疗药物，两年治疗后88.3%的患者PRL水平恢复正常。一名男性和一名女性患者对每周2 mg卡麦角林治疗无反应，因此接受了经蝶窦手术。卡麦角林治疗停药后，7例患者中有6例（86%）泌乳素升高复发。
与成人的微泌乳素瘤相比，大泌乳素瘤在儿童和青少年中更常见。诊断时泌乳素水平升高、男性以及存在占位效应与儿童和青少年时期诊断的大泌乳素瘤相关。卡麦角林在治疗儿童泌乳素瘤方面非常有效。然而，由于两年治疗停药后高泌乳素血症的复发率较高，在首次停药尝试前使用卡麦角林更长时间（≥3年）可能有利于降低部分患有大泌乳素瘤的儿科病例的复发风险。
