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Pituitary Disorders of Childhood pp 71–87Cite as

Prolactinomas

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Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Prolactinomas are the most common type of pituitary adenoma in adolescence. Microprolactinomas are more common in females, whereas males are more likely to present with macroprolactinomas. Micro- and macroprolactinomas may have distinct pathophysiology: microprolactinomas rarely progress, whereas macroprolactinomas may behave aggressively and infiltrate suprasellar structures. Ten to twenty percent of children with sporadic macroprolactinomas may harbor mutations in the aryl hydrocarbon receptor interacting protein (AIP) or multiple endocrine neoplasia 1 (MEN1) genes. Evaluation for prolactinoma requires consideration of the differential diagnosis of hyperprolactinemia and, in patients with confirmed hyperprolactinemia, magnetic resonance imaging. Elevations in prolactin are typically proportional to the size of the prolactinoma. A prolactin level ≥ 250 ng/mL and a pituitary adenoma on MRI are virtually diagnostic of prolactinoma, whereas numerous types of sellar and suprasellar lesions may cause milder elevations in prolactin due to pituitary stalk compression. Dopamine agonists are the first-line treatment in nearly all patients with prolactinomas. These normalize prolactin in approximately 90% of patients with microprolactinomas, and they achieve tumor shrinkage and prolactin normalization in approximately 75% of patients with macroprolactinoma. For patients whose prolactinomas are resistant to dopamine agonists, surgical treatment is the second-line therapy. Outcomes for patients with prolactinomas are generally quite good, with over 75% of patients achieving cure with dopamine agonists and, if required, surgery.

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  1. Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA

    Takara L. Stanley

  2. Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA

    Madhusmita Misra

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  1. Division of Pediatric Endocrinology, New York University, New York, NY, USA

    Brenda Kohn

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Stanley, T.L., Misra, M. (2019). Prolactinomas. In: Kohn, B. (eds) Pituitary Disorders of Childhood. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-030-11339-1_4

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