Prolactin-secreting macroadenoma in a prepubertal girl.
Prolactin-secreting adenoma, which usually presents with amenorrhea and galactorrhea syndrome, is quite rarely diagnosed in the prepubertal age group. We reported a rare case of a prepubertal prolactin-secreting adenoma and discuss its clinical, radiological and histological features. An 8-year-old girl presented with headache, progressive visual deterioration and precocious puberty. The serum prolactin level was 57.8 ng/ml. Computerized tomography and magnetic resonance imaging revealed an invasive suprasellar tumor. The tumor was partially resected through an interhemispheric approach in a first operation, and residual tumor was resected through the right pterional approach in a second operation. The histological diagnosis was a prolactin-secreting adenoma with high cellular pleomorphism. The Ki-67 labeling index was 5.7%, indicating aggressive biological behavior. Postoperatively, the patient was prescribed bromocriptine as maintenance therapy, and the serum prolactin level became normalized. There is a tendency for diagnosis of a prepubertal prolactin-secreting adenoma to be delayed because there are no endocrinological manifestations. Therefore, the tumor tends to become larger and invasive. Although it is rarely experienced, a prolactin-secreting adenoma should be considered in the differential diagnosis of a large, invasive parasellar lesion in the prepubertal age group.
Kashiwagi
S
S
Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan. kashi-ygc@umin.u-tokyo.ac.jp
Nishizaki
T
T
Harada
K
K
Ito
H
H
Setoguchi
M
M
Takahashi
M
M
Ishihara
T
T
D001971:Bromocriptine / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011627:Puberty; D014057:Tomography, X-Ray Computed
D006727:Hormone Antagonists; D001971:Bromocriptine; D011388:Prolactin