Macroprolactinoma in an adolescent female with primary amenorrhoea.

Summary: Paediatric pituitary adenomas are rare in children and adolescents and differ from adults in both clinical presentation and management. We present the case of a 14-year-old female with primary amenorrhoea secondary to a macroprolactinoma, showing a modest radiological and biochemical response to dopamine agonist (DA) therapy. Despite a 10-month duration of increasing DA therapy, initial symptoms of primary amenorrhoea and hyperprolactinaemia persisted, with new symptoms of weight gain, lethargy and low mood. A transsphenoidal resection of the macroprolactinoma was successfully performed, followed by the initiation of additional hormonal therapy. This case explores the unique challenges of treating a macroprolactinoma refractory to medical management in adolescence.

Learning points: Management of macroprolactinomas in childhood and adolescence can bring unique challenges, including a delay in sexual development, often presenting with primary or secondary amenorrhoea in girls.DA therapy is typically the first-line therapy in treating macroprolactinomas; however, resistance in paediatric and adolescent patients is associated with tumour size and initial prolactin levels.Surgical resection should be considered as a second-line therapy for adolescents unable to tolerate high-dose DA therapy or have inadequate response to DA therapy.There are a range of potential surgical complications, including permanent or transient diabetes insipidus, meningitis, cerebrospinal fluid leakage and hypopituitarism.Timely management of macroprolactinomas is important for secondary sex characteristics, bone development and psychological well-being.