Medical Mx of a Prolactinoma in a 15-Year-Old Girl
The present case has been published in the Journal of Pediatrics. A 15-year-old girl presented for evaluation of recurrent headaches with occasional blurry vision, periodic white discharge from the left nipple, and primary amenorrhea. Family history was notable for maternal breast cancer. On physical examination, patient was Tanner stage 5 for both pubic hair and breast development and all cranial nerves were grossly intact.

Initial laboratory results were as follows: prolactin 1070.0 ng/mL (reference, 3.2-20.0 ng/mL), testosterone 31 ng/dL (reference, < 40 ng/dL), thyroid-stimulating hormone 1.16 mIU/L (reference, 0.50-4.30 mIU/L), and free thyroxine 0.79 ng/mL (reference, 0.9-1.4 ng/mL). Initial MRI revealed an expansile, heterogeneously enhancing mass occupying the sella, most compatible with a pituitary macroadenoma (>10 cm.

The patient was initially started on cabergoline, a D2 dopamine receptor agonist, 0.25 mg twice weekly and gradually titrated up to 1.5 mg twice weekly. Ten months later, MRI was repeated and revealed that the macroadenoma had significantly decreased in size.

Given the clinical presentation and laboratory results, the patient was diagnosed with mild central hypothyroidism and hypogonadotropic hypogonadism secondary to a prolactinoma. The patient was started on levothyroxine 112 µg/day, while also continuing cabergoline. The most recent prolactin level was 75.4 ng/mL.

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