Prolactinoma in children and adolescents

Area of Science:

• Pediatric Endocrinology
• Neuro-oncology
• Genetics

Background:

• Prolactinomas in children and adolescents present complex diagnostic and therapeutic challenges.
• Understanding sex-specific differences in tumor size and clinical presentation is crucial.

Purpose of the Study:

• To elucidate the controversial aspects of prolactinoma evolution in pediatric populations.
• To highlight sex-based disparities in prolactinoma subtypes and associated symptoms.
• To review diagnostic criteria and current therapeutic strategies.

Main Methods:

• Review of existing literature on pediatric prolactinomas.
• Analysis of clinical presentation based on sex and tumor size (microadenoma vs. macroadenoma).
• Discussion of diagnostic modalities including imaging and hormone level analysis.
• Evaluation of treatment outcomes with dopaminergic agonists and emerging molecular insights.

Main Results:

• Girls predominantly develop microprolactinomas, leading to hyperprolactinemia and hypogonadotropic hypogonadism.
• Boys exhibit a higher incidence of macroadenomas, often presenting with neuro-ophthalmologic signs.
• Macroadenoma prevalence in males aligns with adult findings and is not indicative of delayed diagnosis.
• Asymptomatic hyperprolactinemia warrants evaluation of prolactin (PRL) isoforms.

Conclusions:

• Diagnosis requires radiographic confirmation of a pituitary adenoma and sustained hyperprolactinemia.
• Dopaminergic agonists are the first-line therapy due to efficacy and tolerability in pediatric patients.
• Molecular and genetic studies are advancing understanding of prolactinoma pathogenesis and treatment variability.