Prolactin-secreting macroadenomas in adolescents. Response to bromocriptine therapy
D. Tyson, D. Reggiardo, C. Sklar and R. David
Department of Pediatrics, New York University Medical Center, New York 10016.
OBJECTIVE--To report five cases of prolactin (PRL)-secreting macroadenomas
in adolescents, including their presentations and responses to
bromocriptine mesylate treatment. PATIENTS--Five adolescents (three females
and two males) aged between 12.5 and 17 years were diagnosed as having
PRL-secreting macroadenomas at the pediatric endocrine service at New York
University Medical Center between 1987 and 1989. Presenting complaints
included visual field deficits, gynecomastia, and amenorrhea, both primary
and secondary. All patients demonstrated some feature of hypogonadism or
pubertal arrest. Diagnostic criteria included an elevated serum PRL level
(mean, 1670 micrograms/L; range, 610 to 3700 micrograms/L) and
visualization of a pituitary tumor that measured greater than 1 cm by
either a computed tomographic scan or magnetic resonance imaging (mean
size, 2.7 cm; range, 1.4 to 4 cm). INTERVENTIONS--Each patient was treated
with bromocriptine mesylate at an oral dose of 7.5 mg/d. The patients
continued with that treatment for the duration of the study period.
MEASUREMENTS AND RESULTS--Anterior pituitary function was evaluated in four
of five patients before treatment. All four were growth hormone deficient.
Three patients were also gonadotropin deficient. Thyrotropin
(thyroid-stimulating hormone) and corticotropin (adrenocorticotropic
hormone) deficiencies were demonstrated in three patients who had multiple
pituitary deficits. Follow-up testing included serial PRL measurements and
radiographic imaging of tumor size. All patients demonstrated a marked
decrease in PRL levels, as well as in tumor size (mean shrinkage, 70%). The
three patients who initially had visual field deficits showed significant
improvement of vision with bromocriptine therapy. Follow-up study of
anterior pituitary function showed significant improvement with
bromocriptine treatment in three patients. CONCLUSIONS--Bromocriptine was
quite effective in the shrinkage of PRL-secreting macroadenomas in all our
patients. It is a noninvasive treatment that can preserve and restore
vision, as well as pituitary function, which is integral to continued
growth and sexual maturation of the adolescent. Bromocriptine is preferable
to surgery or radiation in the treatment of PRL-secreting macroadenomas in
the adolescent.
