IMPE Abstracts

Background: Prolactinomas, the commonest pituitary adenomas are rare in children and adolescents. We aimed to study the clinical presentation, treatment response and long-term follow-up of young patients with prolactinomas.

Methods: Single-centre retrospective cohort study of young (age <20 years) prolactinoma patients treated between July 2006 and July 2022. Relevant data was collected from hospital records and analysed.

Results: Study included 30 patients (60% females); 25 (83.3%) with macroprolactinomas (MaP, 68% males). Median age at diagnosis was 17 (10-20) years and median follow-up period was four (0.5-10.5) years. The duration of symptoms varied between males (8 months) and females (21 months) (P= .043). Commonest symptoms were headache (70%) in males and menstrual abnormalities (91.6%) in females. Three patients had central hypothyroidism (10%), four had secondary adrenal insufficiency (AI) (13.3%) and two had both (6%). Five (20.8 %) had short stature. At diagnosis, median serum prolactin (PRL) was 2124.4 µg/L, maximum tumour diameter was 3.3 cm. Initial serum PRL and tumour size were positively correlated (r 0.71; P< .001). Males had higher PRL (P= .0024) and larger tumours (P= .0019). Ten patients (33.3 %) underwent surgery (100% males with MaP) and received cabergoline (CBG) postoperatively. Four were misdiagnosed and operated before referral. In 26 patients, CBG was initiated as the first line of treatment at 1 mg/week. Four of these (15.4 %) needed surgery for neurosurgical emergencies. Of the 22, 17 (77.3%) showed decline in PRL levels (1657 µg/L to 16 µg/L) within 3 months (P< .001) and tumour size (1.95 cm to 1.0 cm) over 21 months (n=12, P= .001). All five patients with MiP (100%) and 12/17 (70.5 %) with MaP responded to CBG (maximal dose: 3 mg/week) (P< .001). CBG dose was escalated in 3/5 poor responders and 2/5 underwent surgery. Patients who underwent surgery had higher initial PRL (P= .017). In surgically treated cases 5/10 (50 %) had incomplete resection. Postoperative complications included diabetes insipidus (DI, n=3, 30%), multiple pituitary hormone deficiency (MPHD, n=4, 40 %), secondary AI (n=1, 10%) and hypogonadism (n=1, 10%). Tumour recurred in two operated patients on CBG; managed with re-surgery in one and radiotherapy (RT) in other. RT given to patient with residual lesion.

Conclusion: PRL must be checked in cases of suprasellar masses. CBG is safe and effective for children and adolescents with prolactinomas, including macroadenomas. Children require surgery more often. Long-term complications like panhypopituitarism developed following surgery