Case Report
Cystic giant prolactinoma in childhood

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Abstract

In childhood and adolescence, pituitary adenomas are rare and half are prolactinomas. However, cystic giant prolactinoma in prepuberty is extremely rare. In this report, we present a 10-year-old boy with a cystic giant prolactinoma who was treated with two-stage surgery as the tumor was dumbbell shaped. To our knowledge, this is the second reported case of a cystic giant prolactinoma in a prepubertal child.

Introduction

Prolactinomas are the most common pituitary tumors, occuring frequently in females 20–50 years of age.1 However, they are uncommon in childhood and adolescence. There are only a few reported series or cases of prolactinoma in childhood treated either surgically or medically with dopaminergic drugs.[1], [2], [3], [4], [5] Therefore information regarding prolactinoma in childhood is limited and controversial. Cystic and also giant prolactinoma in childhood is extremely rare. In this report, we present a 10-year-old right-handed boy with a cystic giant prolactinoma treated with transcranial and transsphenoidal surgery. There is only one similar case of a cystic giant prolactinoma in a child reported previously in the literature.6

Section snippets

Case report

A 10-year-old right-handed boy was admitted to our department with a suprasellar mass. Six months prior to admission, he was examined by an ophthalmologist due to visual disturbance. However, several ophthalmological examinations failed to reveal the cause. About 2 weeks before admission, the boy was examined by a neuro-ophthalmologist and decreased visual acuity was detected. Subsequently cranial MRI revealed a suprasellar mass. Thus he was referred to our department.

His physical and

Discussion

The incidence of prolactinoma in childhood and adolescence range from 0.6% to 6.2% of pituitary adenomas in all age groups, and from 19.7% to 72.2% of pituitary adenomas in pediatric patients.[1], [4], [5], [7], [8], [9], [10], [11] In the two largest series, reported by Mindermann et al.5 and Dyer et al.,7 adrenocorticotropic hormone (ACTH)-releasing adenomas were the most common lesions in childhood followed by prolactinoma. Mindermann et al.5 noted that prepubertal children were most likely

Conclusion

Giant cystic prolactinomas in childhood are extremely rare. They should be considered in the differential diagnosis of suprasellar lesions, because they can occur in children and may have a component of cystic hemorrhage on presentation. This differentiation is especially important with cystic craniopharyngioma which is mostly seen in the suprasellar region in this age group, as a transsphenoidal approach is indicated for prolactinoma, whereas a transcranial approach is required for a

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      This series includes 50 CP and the remission rates for CP in their series was 80%. Dinc et al.,13 and Scott et al.,14 have reported isolated cases of cystic macroprolactinomas treated surgically with normal serum prolactin at last follow-up. We opted for medical therapy in our patients, as they refused surgery for varying reasons and preferred medical treatment.

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