Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
November 2015
Next Case of the Month coming December 1 …
Prolactin-Secreting Pituitary Macroadenoma, with PCA Territory Infarction
- In recent case series of pediatric adenomas1–3
- Percentage of females ranges from 40.5%1 to 80%3
- Most are functioning (range: 85%3 to 95%1,2)
- Percentage of tumors that were prolactin-secreting varied (47.6%,1 55%,2 70%3)
- Percentage that were > 1 cm varied (63%,2 80%1)
- Patients most frequently presented with endocrinopathy and/or visual symptoms. Headache was also common.
- Treatments varied among centers, but usually included dopamine agonists for small prolactin-secreting tumors, surgery (most often transsphenoidal in recent papers) for large tumors causing mass effect or visual symptoms, and radiotherapy for tumors with growing residual following surgical resection.1–3
- In adolescent girls be aware that the normal, physiologically enlarged gland, or the hypertrophied gland in the setting of hypothyroidism, can be mistaken for a pituitary adenoma or macroadenoma. In these cases, the gland will enhance homogeneously, and patient presentation with visual symptoms is very uncommon. Correlation with pituitary function testing usually aids in distinguishing these possibilities.4
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