Hyperprolactinemia: Different Clinical Expression in Childhood

Abstract

Background: Hyperprolactinemia is the most common disturbance in pituitary gland secretion. Functional diversity of prolactin action is responsible for different initial clinical expressions of hyperprolactinemia. Patients and Methods: We investigated causes of hyperprolactinemia in 11 children and adolescents (6 females and 5 males), aged from 1.5 to 17.5 years. Children with primary hypothyroidism, iatrogenic hyperprolactinemia and adolescents with polycystic ovaries were excluded. Results: Four patients had short stature or growth deceleration, the same number were clinically obese, 2 adolescent girls had secondary amenorrhea, 1 girl had premature thelarche and gynecomastia, and hypogonadism was the indication for the endocrinologic examination of two adolescent boys. Delayed pubertal development was present in both sexes. Hyperprolactinemia was also found in the youngest girl with multiple ovarian cysts. A very high prolactin (PRL) level was documented in the PRL profile of all patients (mean 2,553.00 ± 1,020.97 mU/l). MRI of the pituitary was indicated and revealed 4 microprolactinomas, one congenital hypophyseal cyst and one tumor of the hypothalamus. Dopamine agonist treatment was efficacious in almost all the patients. Conclusion: Hyperprolactinemic children expressed a wide variety of initial clinical presentations. The most common were growth and puberty disorders and obesity. PRL determination should be included in investigation protocols of obese and short stature children.

Beneficial Effects of High Doses of Cabergoline in the Treatment of Giant Prolactinoma Resistant to Dopamine Agonists: A Case Report with a 21-Year Follow-Up

“…He then started GH replacement therapy, which was maintained until the age of 16 years. Growth deficiency has been reported in another study [11] in 24% of all patients with similar characteristics to those of our patient, in 4 patients in a group of 11 children [21], and in only 1 individual among a sample of 26 adolescents [12]; however, other authors found no growth deficiency in a study with 39 children [20]. …”

“…Other authors have also shown this effect in patients younger than 20 years [11-14, 20, 21]. However, despite the use of bromocriptine for 34 months and cabergoline for 252 months at high doses (4.5 mg per week), the tumor in our patient did not disappear, but rather it became cystic.…”

“…In girls, symptoms are more related to excessive prolactin, such as menstrual changes and galactorrhea [11, 14, 18, 19]. Galactorrhea and gynecomastia have also been described in men [12, 21] and in obese patients in a small sample [21], but these conditions were not observed in the patient described here.…”

“…In the study by Steele et al [8], for example, of the 29 prolactinoma patients reported, only 1 was a male patient. Saranac et al [21], however, reported that 5 out of the 11 patients in their study were male.…”

Complex Biological Pattern of Fertility Hormones in Children and Adolescents: A Study of Healthy Children from the CALIPER Cohort and Establishment of Pediatric Reference Intervals

“…Although more common in adulthood compared to childhood, suspected hyperprolactinemia is the main indication for prolactin measurement. In most cases, pituitary adenomas are responsible for the increased secretion of this hormone and, therefore, serum prolactin measurement should be included in all cases of suspected pituitary disease (21,22 ). The finding in the present study that sex partitioning is not required for prolactin reference intervals is in agreement with others (4,23 ).…”