Hyperprolactinemia Prolactinomas

Patients with prolactin-secreting adenomas mostly have growth arrest, in the form of short stature, and pubertal arrest.6,9 Specifically, females are at risk for menstrual dysfunction and galac-torrea, whereas males have hypogonadism. All patients harboring prolactinomas in a Mayo Clinic study had a raised level of serum prolactin.6 Hyperprolactinemia may also occur as a result of the stalk section effect. If the pituitary stalk is compressed, so that the delivery of the prolactin inhibitor (dopamine) to the adenohypophysis is interfered with, then hyperprolactinemia may occur. Thus hyperprolactinemia occurring as a result of a prolactinoma versus the stalk section effect must be distinguished. The most common hormone deficiency associated with prolactinomas is GH.15

In children, prolactinomas are quite rare, but when present can grow to large size (Figure 94-1). In many instances, chil-

F IGURE 9 4-1 Coronal (A) and sagittal (B) magnetic resonance images after gadolinium administration to an 11-year-old girl with large macroadenoma of the pituitary. The patient experienced precocious puberty and galactorrhea. The serum prolactin level was markedly elevated. Unfortunately, this lesion was resistant to bromocriptine, cabergoline, and pergolide, and the patient required transsphenoidal resection of her tumor.

FIGURE 94-2 Coronal magnetic resonance scan in a

14-year-old boy with Cushing's disease. As is often the case with basophil adenomas of the pituitary, these lesions are small and can be difficult to detect on imaging studies. In this case, the adenoma is appreciated in the right inferior aspect of the gland.

dren will have visual impairment as a result of compression of the optic apparatus. The diagnosis may not be entertained, especially in young children when other conditions such as optic gliomas and craniopharyngiomas occur more commonly in this age group. A plea is therefore made for clinicians to perform a prolactin level test in all children with large pituitary lesions so that the diagnosis of a prolactinoma is not missed.

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