Elsevier

Pediatric Neurology

Volume 42, Issue 1, January 2010, Pages 72-74
Pediatric Neurology

Case Report
Giant, Solid, Invasive Prolactinoma in a Prepubescent Boy With Gynecomastia

https://doi.org/10.1016/j.pediatrneurol.2009.08.005Get rights and content

Pituitary adenomas are extremely rare in prepubescent children. Most of these tumors are functioning adenomas, but can also present with vision disturbances and changes in body morphology. We discuss the presentation, management, and outcome of a giant, solid, invasive prolactinoma in a 7-year-old boy who presented with visual disturbances and gynecomastia. The child demonstrated significant improvement in vision and a reduction in size of the tumor after subtotal tumor decompression and treatment with oral bromocriptine for 4 months. Tumor decompression and oral dopamine agonist therapy comprise the accepted treatment for pediatric prolactinomas. To our knowledge, only two previous reports described a giant prolactinoma in a prepubescent child. The relevant literature on pediatric pituitary tumours and prolactinoma is reviewed.

Introduction

Pituitary adenomas account for approximately 2.7% of all supratentorial tumors in childhood, with an estimated annual incidence of 0.1/million [1], [2]. Prolactinomas most commonly occur in women in the age group of 20-50 years [2]. There is sufficient evidence that prolactinomas are more aggressive and proliferative in males than in females, and are also more aggressive and proliferative in the pediatric age group [2], [3], [4]. Their presentation and optimal treatment differ from those of adults [3]. Only a few series of prolactinoma in childhood, treated either surgically or medically with dopaminergic drugs, have been reported [3], [5], [6].

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Case Report

A 7-year-old boy presented with painless progressive vision loss, insidious in onset, and bitemporal headache of 1.5 year duration. On general examination, he exhibited bilateral gynecomastia. His optic discs were pale, and he had a visual acuity of 6/18 in the right eye and 6/36 in the left eye according to Snellen's chart examination, with a temporal field cut in the left eye. Other central nervous system findings were unremarkable.

A magnetic resonance imaging scan revealed a sellar tumor of

Discussion

Prolactin microadenomas were previously reported in boys [3]. Their most common presenting signs are primary amenorrhea in females, and gynecomastia and hypogonadism in males [7]. Prolactinomas in children are frequently associated with delayed puberty, because high prolactin levels affect hypothalamic-gonadotropic activity.

In a series of 42 patients with pediatric pituitary adenomas, Pandey et al. reported on 20 (47.6%) prolactinomas [1]. Kunwar and Wilson reported on five cases of

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