Clinical profile and long term follow up of children and adolescents with prolactinomas Shrikrishna V. Acharya Æ Raju A. Gopal Æ Tushar R. Bandgar Æ Shashank R. Joshi Æ Padma S. Menon Æ Nalini S. Shah Published online: 23 October 2008 Ó Springer Science+Business Media, LLC 2008 Abstract We report clinical presentation, response to medical treatment, and long-term follow-up of 39 children and adolescents with prolactinoma (F:M; 30:9) (30 macro and 9 microadenoma) diagnosed at the age of 9–20 years. Mean duration of follow up was 56 months. All patients were treated with bromocriptine (BC) at doses ranging from 2.5 to 20 mg/day or by cabergoline at doses ranging from 0.5 to 2 mg/week orally. Two patients received external conventional radiotherapy after surgery. In patients with macroprolactinoma (F:M; 21:9), headache and/or visual defects were the first symptoms. All females had primary or secondary amenorrhea. Growth arrest was not observed in any patient and pubertal development was appropriate for their age. Spontaneous or provocative galactorrhea was observed in 23 patients (all females) and none of male patient had gynecomastia. Mean serum pro- lactin (PRL) concentration at the time of diagnosis was 322.50 ng/ml in patients with microadenoma, 522.38 ng/ ml in patients with macroadenoma and 2,294.86 ng/ml in patients with macroadenoma with suprasellar extension. In 25 patients, BC normalized PRL levels and caused vari- able, but significant, tumor shrinkage. Cabergoline normalized PRL concentrations in 14 patients. Pregnancy occurred in 6 patients while on treatment. Pregnancies were uncomplicated, and the patients delivered normal newborns at term. Impairment of other pituitary hormone secretion was documented at the time of diagnosis in only one patient. Postoperatively six patients had other pituitary hormone deficiencies. In conclusion, the medical treatment with dopaminergic compounds is effective and safe in patients with prolactinoma with onset in childhood, allowing preservation of the anterior pituitary function. Keywords Prolactinoma Á Cabergoline Á Bromocryptine Á Radiotherapy Á Amenorrhea Introduction Pituitary adenomas are less common in children than in adults, but they become increasingly more frequent during the adolescent years [1–3]. The average annual incidence of pituitary adenomas in childhood has been estimated to be 0.1 per million children [4]. Pituitary adenomas con- stitute less than 3% of supratentorial tumors in children and 2.3–6% of all intracranial tumors treated surgically [5–8]. However, most published series included patients with onset of symptoms before the age of 20 years as pediatric patients [6]. Pituitary carcinomas are rare in adults and extremely rare in children. There appears to be a greater invasiveness of prolactinomas in children compared with adults [9]. Macroadenomas at presentation are more likely in boys than in girls [7]. The clinical presentation, response to medical treatment, and long-term outcome of children and adolescents with prolactinoma have been reported in only few series [10–12]. Subjects and methods Retrospective analysis of records between 1986 and 2006 of children and adolescents less than 20 years at the onset S. V. Acharya (&) Á R. A. Gopal Á T. R. Bandgar Á S. R. Joshi Á P. S. Menon K E M Hospital, Parel, Mumbai 400012, Maharashtra, India e-mail: drshri25@rediffmail.com N. S. Shah Department of Endocrinology, K E M Hospital, Parel, Mumbai 400012, Maharashtra, India 123 Pituitary (2009) 12:186–189 DOI 10.1007/s11102-008-0149-8