Macroprolactinoma aos 6 anos de idade dificuldades diagnósticas: difficulties in diagnosis

Oliveira, Miriam Da Costa; Abech, Denise Dotta; Barbosa-Coutinho, Lígia M.; Ferreira, Nelson Pires

doi:10.1590/S0004-282X1992000300024

Resumos

Prolactinoma é raro na infância e adolescência. O diagnóstico mais precoce conhecido na literatura ocorreu aos 8 anos de idade. Aqui é relatado o achado de tumor selar em menina com 6 anos, embora só fosse procurado auxílio médico tardiamente, quando a paciente já apresentava atrofia parcial de papila. Nessa ocasião, foi constatada reserva diminuída de hormônio do crescimento e de cortisol, bem como hiperprolactinemia. Devido à rápida deterioração visual, a paciente foi submetida a craniotomia fronto-temporal com a hipótese diagnóstica de craniofaringioma. O exame imuno-histoquímico do tecido tumoral foi positivo para prolactina. Conclui-se que o prolactinoma deve ser considerado no diagnóstico diferencial de tumores selares na infância, por possibilitar terapêutica menos agressiva.

prolactinoma na infância; tumores selares; diagnóstico

Prolactinoma is rare in cihldhood and adolescence. The earliest known diagnosis was reported in a patient at 8 years of age. We report the case of a sellar tumor found in a 6 years old girl. After a long symptomatic period she was brought for treatment. At this time she had partial papillar atrophy, hyperprolactinemia, and diminished reserve of growth hormone and Cortisol. Due to rapid visual deterioration, she was submitted to a frontotem-poral craniotomy for suspected craniopharyngioma. The tumor tissue immunohistochemistry was positive for prolactin. It is concluded that prolactinoma must be considered in differential diagnosis of sellar tumors in childhood since it benefits from a less aggressive therapy.

prolactinoma in childhood; sellar tumors; diagnosis

Miriam Da Costa Oliveira^I; Denise Dotta Abech^I; Lígia M. Barbosa-Coutinho^II; Nelson Pires Ferreira^III

^IDisciplina de Endocrinologia, FFFCMPA. Trabalho realizado na Disciplina de Endocrinologia da Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA)

^IIDisciplina de Patologia. Trabalho realizado na Disciplina de Endocrinologia da Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA)

^IIIDisciplina de Neurocirurgia, FFFCMPA. Trabalho realizado na Disciplina de Endocrinologia da Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA)

RESUMO

Prolactinoma é raro na infância e adolescência. O diagnóstico mais precoce conhecido na literatura ocorreu aos 8 anos de idade. Aqui é relatado o achado de tumor selar em menina com 6 anos, embora só fosse procurado auxílio médico tardiamente, quando a paciente já apresentava atrofia parcial de papila. Nessa ocasião, foi constatada reserva diminuída de hormônio do crescimento e de cortisol, bem como hiperprolactinemia. Devido à rápida deterioração visual, a paciente foi submetida a craniotomia fronto-temporal com a hipótese diagnóstica de craniofaringioma. O exame imuno-histoquímico do tecido tumoral foi positivo para prolactina. Conclui-se que o prolactinoma deve ser considerado no diagnóstico diferencial de tumores selares na infância, por possibilitar terapêutica menos agressiva.

Palavras-chave: prolactinoma na infância, tumores selares, diagnóstico.

SUMMARY

Prolactinoma is rare in cihldhood and adolescence. The earliest known diagnosis was reported in a patient at 8 years of age. We report the case of a sellar tumor found in a 6 years old girl. After a long symptomatic period she was brought for treatment. At this time she had partial papillar atrophy, hyperprolactinemia, and diminished reserve of growth hormone and Cortisol. Due to rapid visual deterioration, she was submitted to a frontotem-poral craniotomy for suspected craniopharyngioma. The tumor tissue immunohistochemistry was positive for prolactin. It is concluded that prolactinoma must be considered in differential diagnosis of sellar tumors in childhood since it benefits from a less aggressive therapy.

Key words: prolactinoma in childhood, sellar tumors, diagnosis.

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Full text available only in PDF format.

Dra. Miriam da Costa Oliveira Rua Dona Mimi Moro 40 - 90430 Porto Alegre RS - Brasil.

1. Beck W, Stubbe P, Lüdecke IX Frolactin-producing pituitary adenoma in a 9 year old boy. Eur J Pediatr 1979, 130:193-198.
2. Bevan JS, Burke CW, Esiri MM, Adams CBT. Misinterpretation of prolactin levels leading to management errors in patients with sellar enlargement. Am J Med 1987, 82:29-32.
3. Blackwell RE, Younger JB. Long-term medical therapy and follow-up of pediatric-ado-lescent patients with prolactin-secreting macroadenomas. Fertil Steril 1986, 45:713-716.
4. Cheyne KL, Ligntner ES, Comerci GD. Bromocriptin-unresponsive prolactin macroadeno-ma in prepubertal female. J Adolesc Health Care 1988, 9:331-334.
5. Cohen ME, Duffner PK. Tumors of the brain and spinal cord including leukemic involvement. In Swaiman KF (ed) : Pediatric Neurology. St. Louis: CV Mosby, 1989, p 661-675.
6. Coulam CB, Laws ER, Abboud CF, Randall RV. Primary amenorrhea and pituitary adenomas. Fertil Steril 1981, 35:615-619.
7. Coutinho LMB. Adenomas da hipófise: estudo imuno-histoquímico. Tese de Doutorado, Universidade Federal do Rio Grande do Sul. Porto Alegre, 1988.
8. Cusimano MB, Kovacs K, Bilbao JM, Tucker WS, Singer W. Supraselar craniopharyngioma associated with hyperprolactinemia, pituitary lactotrophic hyperplasia, and micro-prolactinoma: case report. J Neurosurg 1988, 69:620-623.
9. Dalzell WG, Atkinson BA, Carson JD, Sheridan B. Normal growth and puberal development during bromocriptine treatment for a prolactin-secreting pituitary macroadenoma. Clin Endocrinol 1987, 28:169-172.
10. Dandona P, Mohiuddin J, Lindsay KW. Galactorrhea following hypophysectomy in a boy with a prolactinoma. Postgrad Med J 1984, 60:540-541.
11. Daughaday WH. The adenohyphophysis. In Williams RH (ed): Textbook of Endocrinology. Tokyo: Igak Shoin-Saunders, 1981, p 73-114.
12. Fenichel GM. Clinical Pediatric Neurology : a Sign and Symptoms Approach. Philadelphia: WB Saunders, 1988.
13. Grisoli F. Guibout M, Jaquet P., Michotey P, Mouly A, Lucas C. Les adénomes à prolactine péripubertaires : 8 observations. Nouv Presse Med 1978, 21 : 1819-1825.
14. Howlett TA, Wass JAH, Grossman A, Plowman PN, Charlesworth M, Touzel R, Rees LH, Savage MO, Besser GM. Prolactinomas presenting as primary amenorrhea and delayed or arrested puberty : response to medical therapy. Clin Endocrinol 1989 30:131-140.
15. Huseman CA, Rizk G, Hahn F. Long-term bromocriptine treatment for prolactin-secret-ing macroadenoma. Am J Dis Child 1986, 140:1216-1217.
16. Jenkins JS, Gilbert CJ, Ang V. Hypothalamic-pituitary function in patients with craniopharyngiomas. J Clin Endocrinol Metab 1976, 43:394-399.
17. Kapcala LP, Molitch ME, Post KD, Biller BJ, Prager RJ, Jackson IMD, Reichlin S. Galactorrhea, oligo/amenorrhea, and hyperprolactinemia in patients with craniopharyngiomas. J Clin Endocrinol Metab 1980, 51:798-800.
18. Lundberg PO, Osterman PO, Wide L. Serum prolactin in patients with hypothalamus and pituitary disorders. J Neurosurg 1981, 55:194-199.
19. Martinez-Campos A, Cornejo J, Garza-Flores J, Velasco F. Dysfunction of dopaminergic regulation of prolactin in patients with functioning and non functioning pituitary adenomas and craniofaryngiomas. Fertil Steril 1985, 44:471-477.
20. Mukai K. Pituitary adenomas: immunocythoehemieal study of 150 tumors with clínico-pathologic correlation. Cancer 1983, 52:648-653.
21. Pertzelan A, Bauman B, Gurewitz R, Matz S, Silbergeld A, Laron Z. Prolactin secreting pituitary adenoma in childhood and adolescence. In Dandolf AM, Heitz PU, Zapf J, Girard J, Del Pozo E (eds.) Advances in Pituitary Adenoma Research. Oxford: Perga-mon, 1988, p 303-306.
22. Randall RV, Scheithauer BW, Laws ER, Abboud CF, Ebersold MJ, Kao PC. Pituitary adenomas associated with hyperprolactinemia: a clinical and immunohistochemical study of 97 patients operated on transsphenoidally. Mayo Clin Proc 1985, 60:753-762.
23. Rilliet B, Mohr G, Robert F, Hardy J. Calcifications in pituitary adenomas. Surg Neurol 1981, 15:249-255.
24. Ross RJM, Grossman A, Bouloux P, Rees LH, Doniach I, Besser GM. The relationship between serum prolactin and immunocytochemical staining for prolactin in patients with pituitary macroadenomas. Clin Endocrinol 1985, 23 :227-235.
25. Ross RJ, McEniery JM, Grossman A, Doniach I, Besser GM, Savage MO. Massive prolactinoma with galactorrhoea in a prepubertal boy. Postgrad Med J 1989, 65:403-406.
26. Sauer R. Radiation therapy of brain tumors. In Jellinger K (ed): Therapy of Malignant Brain Tumors. New York: Springer-Verlag, 1987 p 232-237.
27. Schroffner WG. Prolactin-secreting pituitary tumor in early adolescence: hormonal and electron microscopical studies. Arch Intern Med 1976, 136:1164-1168.
28. Slonim AE, Glick Ad, Island DP, Kasselberg AG. Hyperprolactinemia associated with advanced puberty in a male. J Pediatr 1982, 101:236-239.
29. Turkington RW. Secretion of prolactin by patients with pituitary and hypothalamic tumors. J Clin Endocrinol Metab 1972, 34:159-164.
30. Wheatley T, Clark JDA, Stewart S. Craniopharyngioma with hyperprolactinemia due to a prolactinoma. J Neurol Neurosurg Psychiatry 1986, 49 : 1305-1307.

Macroprolactinoma aos 6 anos de idade dificuldades diagnósticas

Macroprolactinoma at 6 years of age: difficulties in diagnosis

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Set 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beck W, Stubbe P, Lüdecke IX Frolactin-producing pituitary adenoma in a 9 year old boy. Eur J Pediatr 1979, 130:193-198.

[2] 2. Bevan JS, Burke CW, Esiri MM, Adams CBT. Misinterpretation of prolactin levels leading to management errors in patients with sellar enlargement. Am J Med 1987, 82:29-32.

[3] 3. Blackwell RE, Younger JB. Long-term medical therapy and follow-up of pediatric-ado-lescent patients with prolactin-secreting macroadenomas. Fertil Steril 1986, 45:713-716.

[4] 4. Cheyne KL, Ligntner ES, Comerci GD. Bromocriptin-unresponsive prolactin macroadeno-ma in prepubertal female. J Adolesc Health Care 1988, 9:331-334.

[5] 5. Cohen ME, Duffner PK. Tumors of the brain and spinal cord including leukemic involvement. In Swaiman KF (ed) : Pediatric Neurology. St. Louis: CV Mosby, 1989, p 661-675.

[6] 6. Coulam CB, Laws ER, Abboud CF, Randall RV. Primary amenorrhea and pituitary adenomas. Fertil Steril 1981, 35:615-619.

[7] 7. Coutinho LMB. Adenomas da hipófise: estudo imuno-histoquímico. Tese de Doutorado, Universidade Federal do Rio Grande do Sul. Porto Alegre, 1988.

[8] 8. Cusimano MB, Kovacs K, Bilbao JM, Tucker WS, Singer W. Supraselar craniopharyngioma associated with hyperprolactinemia, pituitary lactotrophic hyperplasia, and micro-prolactinoma: case report. J Neurosurg 1988, 69:620-623.

[9] 9. Dalzell WG, Atkinson BA, Carson JD, Sheridan B. Normal growth and puberal development during bromocriptine treatment for a prolactin-secreting pituitary macroadenoma. Clin Endocrinol 1987, 28:169-172.

[10] 10. Dandona P, Mohiuddin J, Lindsay KW. Galactorrhea following hypophysectomy in a boy with a prolactinoma. Postgrad Med J 1984, 60:540-541.

[11] 11. Daughaday WH. The adenohyphophysis. In Williams RH (ed): Textbook of Endocrinology. Tokyo: Igak Shoin-Saunders, 1981, p 73-114.

[12] 12. Fenichel GM. Clinical Pediatric Neurology : a Sign and Symptoms Approach. Philadelphia: WB Saunders, 1988.

[13] 13. Grisoli F. Guibout M, Jaquet P., Michotey P, Mouly A, Lucas C. Les adénomes à prolactine péripubertaires : 8 observations. Nouv Presse Med 1978, 21 : 1819-1825.

[14] 14. Howlett TA, Wass JAH, Grossman A, Plowman PN, Charlesworth M, Touzel R, Rees LH, Savage MO, Besser GM. Prolactinomas presenting as primary amenorrhea and delayed or arrested puberty : response to medical therapy. Clin Endocrinol 1989 30:131-140.

[15] 15. Huseman CA, Rizk G, Hahn F. Long-term bromocriptine treatment for prolactin-secret-ing macroadenoma. Am J Dis Child 1986, 140:1216-1217.

[16] 16. Jenkins JS, Gilbert CJ, Ang V. Hypothalamic-pituitary function in patients with craniopharyngiomas. J Clin Endocrinol Metab 1976, 43:394-399.

[17] 17. Kapcala LP, Molitch ME, Post KD, Biller BJ, Prager RJ, Jackson IMD, Reichlin S. Galactorrhea, oligo/amenorrhea, and hyperprolactinemia in patients with craniopharyngiomas. J Clin Endocrinol Metab 1980, 51:798-800.

[18] 18. Lundberg PO, Osterman PO, Wide L. Serum prolactin in patients with hypothalamus and pituitary disorders. J Neurosurg 1981, 55:194-199.

[19] 19. Martinez-Campos A, Cornejo J, Garza-Flores J, Velasco F. Dysfunction of dopaminergic regulation of prolactin in patients with functioning and non functioning pituitary adenomas and craniofaryngiomas. Fertil Steril 1985, 44:471-477.

[20] 20. Mukai K. Pituitary adenomas: immunocythoehemieal study of 150 tumors with clínico-pathologic correlation. Cancer 1983, 52:648-653.

[21] 21. Pertzelan A, Bauman B, Gurewitz R, Matz S, Silbergeld A, Laron Z. Prolactin secreting pituitary adenoma in childhood and adolescence. In Dandolf AM, Heitz PU, Zapf J, Girard J, Del Pozo E (eds.) Advances in Pituitary Adenoma Research. Oxford: Perga-mon, 1988, p 303-306.

[22] 22. Randall RV, Scheithauer BW, Laws ER, Abboud CF, Ebersold MJ, Kao PC. Pituitary adenomas associated with hyperprolactinemia: a clinical and immunohistochemical study of 97 patients operated on transsphenoidally. Mayo Clin Proc 1985, 60:753-762.

[23] 23. Rilliet B, Mohr G, Robert F, Hardy J. Calcifications in pituitary adenomas. Surg Neurol 1981, 15:249-255.

[24] 24. Ross RJM, Grossman A, Bouloux P, Rees LH, Doniach I, Besser GM. The relationship between serum prolactin and immunocytochemical staining for prolactin in patients with pituitary macroadenomas. Clin Endocrinol 1985, 23 :227-235.

[25] 25. Ross RJ, McEniery JM, Grossman A, Doniach I, Besser GM, Savage MO. Massive prolactinoma with galactorrhoea in a prepubertal boy. Postgrad Med J 1989, 65:403-406.

[26] 26. Sauer R. Radiation therapy of brain tumors. In Jellinger K (ed): Therapy of Malignant Brain Tumors. New York: Springer-Verlag, 1987 p 232-237.

[27] 27. Schroffner WG. Prolactin-secreting pituitary tumor in early adolescence: hormonal and electron microscopical studies. Arch Intern Med 1976, 136:1164-1168.

[28] 28. Slonim AE, Glick Ad, Island DP, Kasselberg AG. Hyperprolactinemia associated with advanced puberty in a male. J Pediatr 1982, 101:236-239.

[29] 29. Turkington RW. Secretion of prolactin by patients with pituitary and hypothalamic tumors. J Clin Endocrinol Metab 1972, 34:159-164.

[30] 30. Wheatley T, Clark JDA, Stewart S. Craniopharyngioma with hyperprolactinemia due to a prolactinoma. J Neurol Neurosurg Psychiatry 1986, 49 : 1305-1307.