MACROPROLACTINOMA IN ADOLESCENTS: THREE CASES TREATED WITH BROMOCRIPTINE

Macroprolsctinomas (M) seem to be infrequent in individuals below 18 years of ace. In adults Bromocriptine (BC) therapy has been, successful, but few data have been resorted in adolescents. We report the clinical course and hormonal response to SC m three adolescents witn M. [Case 1] A 14-year-old girl with secondary amenorrhea, galactorrhea and headache. Height p25 weight p25 NCHS, and Tanner stage IV. PRL 175 ng/ml (N≤20); TSH 2.9μU/ml (normal:0.5-5); T4 6.2ug/dl (N: 7.1-12.5); FSH 14.9 mU/ml (N:1-20); CT scan : intrasellar mass with sphenoidal sinus invasion, 20 mm in diameter; Goldmann's perimetry (GP) normal. She received 7.5 mg of EC per cay. and after 4 months PRL, and menses were normal. After two years of follow-up, she is normoprolactmemic with 5 ma daily of BC and complete resolution of tumor [Case 2] A 17.6-year-ola cirl witn primary amenorrhea, headache and visual loss. Height P 10 NCHS, Tanner stage III. PRL 799 ng/ml; TSH 2.3 pU/ml; T4 9.8 μg/dl; FSH 3.9 mUI/ml; LH 4.5 mUI/ml; E2 49 pg/ml; CT: solid-cystic supra/intrasellar mass, 13 mm in diameter; GP: bilateral temporal field deficit. One year after BC 22.5 mg daily, PRL decreased to 193 ng/ml, but the amenorrhea has persisted, she experienced tumor shrinKage (60%) and normalization of visual fields. [Case 3] An 18-year-old boy with delay in growth and puberty. Height Bone age/chronological age=15.25/18; CT: solid-cystic supra/intrasellar BC, PRL and GH were normal, and there was complete resolution of the tumor. After 1.5 years he presented catch-up-orowth, proaression of puberty and be remains normoprolactinemic with 7.5 mg daily of BC. [Conclusions] In our experience BC was effective in the treatment of M, even with visual field deficits or hypopituitarism. Tumor shrinkaoe improves surgical approach, even if normoprolactmemia is not achieved. We observed dissociation between tumor size reduction and suppression of PRL as described in the literature. In our patients BC was well tolerated.