Pituitary apoplexy due to prolactinoma in a Taiwanese boy: patient report and review of the literature.
We report a Taiwanese boy who presented with apoplexy of a prolactinoma. A 12 9/12 year-old boy presented to our clinic with headache and visual deficit of bitemporal hemianopsia. Skull X-ray showed an enlarged sella. Magnetic resonance imaging (MRI) of the sella turcica showed a 4 x 2.5 x 2.5 cm mass, located at the sella turcica and extending upward to compress the optic chiasm. Preoperative laboratory data showed hyperprolactinemia, hypothyroidism and hypocortisonism. After a stress dose of i.v. hydrocortisone was given, he underwent transsphenoid surgery to remove the tumor. Immunohistochemical stains were positive for PRL in the tumor cells. After surgery, he suffered from neurogenic diabetes insipidus, hypopituitarism and hyperprolactinemia, with serum PRL level of 491 ng/ml. Visual field examination was normal 4 months later. In conclusion, pituitary apoplexy is rare in children but should be considered if a patient suffers from headache, vomiting, and visual deficit. Brain MRI is preferred for diagnosis. Dopaminergic agonists should be given if residual tumor or recurrence of prolactinoma is found after transsphenoidal surgery.
Yang
Min-Hui
MH
Division of Endocrinology, Chang Gung Children 's Hospital, Taoyuan, Taiwan.
Chuang
Huoli
H
Jung
Shih-Ming
SM
Van
Yang-Hau
YH
Lo
Fu-Sung
FS
D002648:Child; D003348:Cortisone / Q000172:deficiency; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D006423:Hemianopsia / Q000175:diagnosis; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D006966:Hyperprolactinemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007037:Hypothyroidism / Q000175:diagnosis; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009897:Optic Chiasm / Q000473:pathology; D010899:Pituitary Apoplexy / Q000175:diagnosis* / Q000209:etiology*; D010907:Pituitary Hormones / Q000097:blood; D011388:Prolactin / Q000097:blood / Q000378:metabolism; D015175:Prolactinoma / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D011859:Radiography; D012658:Sella Turcica / Q000002:abnormalities / Q000000981:diagnostic imaging; D013624:Taiwan; D013739:Testosterone / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D014794:Visual Fields / Q000502:physiology
D010907:Pituitary Hormones; D013739:Testosterone; D011388:Prolactin; D003348:Cortisone; D006854:Hydrocortisone