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Moyamoya disease is a rare chronic progressive cerebrovascular disease. The etiology of moyamoya disease has not been established yet. If an underlying cause is detected, moyamoya disease is called moyamoya syndrome. A 27-year-old right-handed male was admitted to an external medical center with recurrent severe headaches, vomiting, and seizures. He was diagnosed with prolactinoma as a result of cranial magnetic resonance imaging and blood tests. After three months, he presented again with headache and left-sided weakness affecting both his arm and leg. Head and neck computed tomography angiography showed critical stenosis in the right distal internal carotid artery (ICA), in the right supraclinoid ICA, in the left supraclinoid ICA, and occlusion in the right ICA and middle cerebral artery. Digital subtraction angiography was performed following a preliminary diagnosis of Behçet’s disease due to HLA B51 positivity. However, the results did not support a diagnosis of neuro-Behçet’s but were instead indicative of moyamoya disease. This is the third case in which prolactinoma and moyamoya disease occur together. Moyamoya disease is a very rare chronic disease that mostly affects the cranial vessels. Patients can apply with very different complaints that may mimic other diseases.

ABSTRACT Hyperprolactinemia is a frequent cause of menstrual irregularity, galactorrhea, hypogonadism, and infertility. The most common etiologies of hyperprolactinemia can be classified as physiological, pharmacological, and pathological. Among pathological conditions, it is essential to distinguish prolactinomas from other tumors and pituitary lesions presenting with hyperprolactinemia due to pituitary stalk disconnection. Proper investigation considering clinical data, laboratory tests, and, if necessary, imaging evaluation, is important to identify the correct cause of hyperprolactinemia and manage the patient properly. This position statement by the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Society of Endocrinology and Metabolism (SBEM) addresses the recommendations for measurement of serum prolactin levels and the investigations of symptomatic and asymptomatic hyperprolactinemia and medication-induced hyperprolactinemia in women.

ABSTRACT Dopamine agonists are the first line of treatment for patients with symptomatic hyperprolactinemia due to prolactinomas and in those with idiopathic hyperprolactinemia. Treatment with these agents is effective in 80%-90% of the cases. Infertility treatment of patients with hyperprolactinemia is also carried out with dopamine agonists, aiming for the normalization of prolactin levels. The risk of symptomatic growth of prolactinomas during pregnancy is dependent on the tumor's size, duration of previous treatments, and prolactin levels. Notably, the corresponding risk is relatively low in cases of microprolactinomas (

Pituitary prolactinoma is a neuroendocrine disease caused by excessive pituitary prolactin-cell adenoma synthesis and prolactin secretion. The standardized diagnosis and treatment of pituitary prolactinoma in of great significance for recovering and maintaining pituitary function and improving life quality of the patients. In January 2022, the International Chapter of Clinical Endocrinology (ICCE) and the Italian Association of Clinical Endocrinologists (AME) published a position statement on pituitary prolactinoma in the European Journal of Endocrinology: 2022 ICCE/AME Position Statement for Clinical Practice in Pituitary Prolactinoma (abbreviated as 2022 ICCE/AME position statement) . Based on the latest medical evidence, 2022 ICCE/AME position statement conducts a systematic review, analysis and recommendations on the clinical diagnosis and treatment of pituitary prolactinoma. This article provides an update on the diagnosis and treatment of pituitary prolactinoma, special populations, dopamine agonist resistance, and invasive prolactinoma in the 2022 ICCE/AME position statement, which is hoped to be helpful to the awareness of pituitary prolactinoma among general practitioners and endocrinologists, and provide a reference for the clinical practice of standardized diagnosis and treatment.

The priority treatment approach for prolactinomas is therapy with dopamine agonists, which allows for elimination of clinical symptoms, normalization of prolactin levels, reduction of the adenoma size and prevention of metabolic abnormalities in the majority of patients. Nevertheless, 10 to 20% of patients are resistant to dopamine agonists. The aim of this review is to analyze literature data on the source mechanisms and potential ways to overcome the resistance of prolactinomas to dopamine agonists. The criteria of a prolactinoma's resistance to dopamine agonists are as follows: 1) no normalization of serum prolactin levels and/or 2) no reduction of the adenoma volume by at least 50% after treatment of bromocriptine at a dose of ≤ 15 mg/day or cabergoline at a dose of ≤ 3 mg/week for at least 6 months. Full resistance is characterized by both no biochemical and no anti-tumor effects, whereas in partial resistance, prolactin levels can be decreased but not normalized, or the adenoma size can be reduced by less than 50% of the initial. The clinical and morphological predictors of prolactinoma resistance to dopamine agonists are male gender, young age, big size of the adenoma and its invasion into the sinus cavernosus, hypointensive and/or heterogeneous MRI signal on Т2 weighed images, and cystic components within the tumor. The main molecular genetic markers are: decreased expression of dopamine and estrogen receptors, higher proliferation index Ki-67 ≤ 3%, as well as the MENIN, AIP, SF3B1, PRDM2 gene mutations. In case of resistance to bromocriptine, it is recommended to switch the patient to cabergoline. In partial resistance to standard doses of cabergoline, it is possible to increase the dose up to a maximally tolerated. Neurosurgery and/or radiation surgery is recommended in cases of full resistance to dopamine agonists or an aggressive tumor. For very aggressive/malignant tumors, or in the event of their extended growth after surgery, temozolomide is recommended as adjuvant therapy.

Key Clinical Message We report a rare clinical case of a malignant prolactinoma in which the exponential increase of prolactin levels with minimal tumor growth and no response to treatment led to diagnosis of abdominal, thoracic, and vertebral metastases.

Prolactinoma is frequently found not only in females but also in males with abnormal reproductive and/or sexual function. Patients typically complain about amenorrhea and infertility because of anovulation. Approximately 15% to 20% of cases of secondary amenorrhea are caused by prolactinemia. Galactorrhea may occur simultaneously, before or after menstrual disorders, and sometimes it may not be clinically obvious, or only detected by breast examination. We reported a case of a 14-year-old girl who presented primary amenorrhea accompanied by frequent headaches and blurred vision. Hormonal tests showed severe hyperprolactinemia (prolactin [PRL] concentration: 1,570 ng/ml). Further tests confirmed a mass in the pituitary with an extension to the left parasellar and suprasellar regions. Some parts of the sella turcica tumor were removed by transcranial surgery. During the follow-up, the clinicopathological examinations revealed the patient had hyperprolactinemia. Clinicians should be aware of the diagnostic and therapeutic problems regarding the management of hyperprolactinemia.

Objectives: To estimate the incidence of pituitary adenomas (PA) in adult Omani patients and describe its epidemiological, clinical, and radiological characteristics. Methods: In this longitudinal, descriptive study, we reviewed the records of all PA patients from January 2015 to January 2020 who presented at the endocrinology facilities at Sultan Qaboos University Hospital, Muscat. Results: The participants comprised of 112 Omani patients with PA. The incidence of PA among all adult patients at Sultan Qaboos University Hospital (inpatient and outpatient) over five years (2015–2020) was 0.23%. The cohort had a mean age of 41.0±15.0 years. Of the 112 patients included in this study, 79 (70.5%) were women. Nearly half (51; 45.5%) of adenomas were prolactinomas while 46 (41.1%) were non-functioning adenomas, and seven (6.3%) were growth hormone-secreting adenomas while six (5.4%) were adrenocorticotropic hormone secreting adenomas. Headache was present in 67 (59.8%) patients, followed by visual field defects (40; 35.7%), galactorrhea (26; 23.2%), and fatigue (19; 17.0%). The majority of women (45/79; 57.0%) presented with menstrual cycle abnormalities. Radiological appearances were nearly equally distributed between micro- and macroadenomas. Most cases (58/112; 52.0%) of PA were treated medically by cabergoline, octreotide, and replacement therapies such as hydrocortisone and thyroxin, 38 (33.9%) were treated surgically (mainly by trans-sphenoidal pituitary resection), and the remaining 10 (8.9%) cases were subjected to radiotherapy. Medical treatment combined with surgery was employed for 15 (13.4%) patients. Conclusions: In our investigation, PA was primarily prevalent among Omani female patients, and the most common subtype of pituitary tumors was prolactinomas. The most common presentation symptom was headaches; most female patients had menstrual irregularities. Medical treatment was the primary approach for the applicable types of PAs, while surgery and radiotherapy were found to be secondary and tertiary treatment options, respectively.

Key Clinical Message Ectopic pituitary adenoma is a rare neoplasm located in the clivus and could mimic other clival tumors. Diagnosis and treatment could be challenging. It should be considered in the differential diagnosis of clival tumors. Abstract Ectopic pituitary adenomas (EPAs) are isolated adenomas that can be located in variable locations outside the sella turcica and have a normal‐appearing pituitary gland. These tumors are rare and are thought to often arise from embryological remnants along the route of Rathke's pouch migration. EPAs are associated with a wide range of clinical manifestations depending on hormonal activity and involvement of adjacent structures, which can represent a challenge in making the diagnosis and deciding on the most appropriate management. In this case study, we report a 47‐year‐old male who presented with visual disturbances, a headache, and generalized weakness. Magnetic resonance imaging showed a 2 cm mass located in the clivus invading the sphenoid sinus with an intact pituitary gland. The patient underwent endoscopic transsphenoidal surgery to eradicate the mass while maintaining the integrity of the pituitary gland, which was successful and uneventful. Pathological studies were consistent with prolactinoma, with no cytological malignant features. Post‐surgery, symptoms notably improved, and serum prolactin levels significantly dropped, The patient's condition was satisfactory on follow‐up with no long‐term complications reported. This paper contributes to the existing literature by sharing the clinical management of a challenging and uncommon case.

Pituitary adenomas usually cause damage to the gonadal axis, leading to a decrease in fertility in female patients. As pituitary gland enlarges during pregnancy, the hormone secretion of the gonadal axis changes accordingly. Therefore, it is particularly important to standardizedly manage pregnant women with pituitary adenomas. To this end, the European Society of Endocrinology (ESE) published Clinical Practice Guideline on Functioning and Non-functioning Pituitary Adenomas in Pregnancy in August 2021, which details the timing and methods selection of diagnosis and treatment of pituitary adenomas from preconception to postpartum in terms of size, location, and endocrine function of adenomas. We interpreted this guideline and summarized its main points, with a view to providing practical guidance for Chinese clinicians to manage such patients based on relevant clinical evidence and patient characteristics in China.

Objectives:To compare dry eye parameters in prolactinoma patients and healthy controls and evaluate their correlation with prolactin (PRL) levels and the duration of hyperprolactinemia.Materials and Methods:Consecutive patients with prolactinoma and healthy controls were included in the study. Schirmer, tear break-up time (TBUT), tear osmolarity values, and ocular surface disease index (OSDI) scores were evaluated for each patient. Follow-up time and total duration of hyperprolactinemia were recorded for prolactinoma patients.Results:The study included 39 eyes of 39 patients with prolactinoma and 39 eyes of 39 age- and gender-matched healthy controls. Prolactinoma patients showed lower Schirmer (14.1±8.4 vs. 24.8±8.9 mm; p

The prevalence of hyperprolactinemia in postmenopausal women is unknown and has been estimated as infrequent by many studies. Prolactinomas found after menopause are usually macroadenomas and remain unrecognized for a long time due to atypical clinical signs or their absence. The growth potential of prolactinomas persists after menopause, most of them are invasive and accompanied by high prolactin levels. Treatment with dopamine agonists is usually long-term, the goals of which are to reduce tumor size, normalize prolactin levels and the negative effects of hyperprolactinemia. Treatment with cabergoline makes it possible to achieve remission of the disease in the first years after discontinuation, however, the proportion of relapses in postmenopausal women increases 5 years after discontinuation of the drug. Remission of prolactinomas is not evident in postmenopausal women. The modern management of patients with prolactinoma and/or hyperprolactinemia does not have clear positions in the postmenopausal period. Controversial issues remain: an ambiguous relationship between prolactin levels and breast cancer, there are no convincing conclusions on the improvement of bone mineral density and/or a decrease in the risk of fractures with normalization of prolactin levels, there are no data on metabolic parameters after the end of treatment with dopamine agonists, conflicting information about the relationship of prolactin levels and the severity of the manifold manifestations of the climacteric syndrome. The use of estrogen-progestin drugs in women with hyperprolactinemia/prolactinomas is also not well understood. Thus, the problem of hyperprolactinemia in the perimenopausal and postmenopausal period is underestimated and requires additional research, as well as the development of diagnostic and therapeutic strategies for potential benefits in terms of weight loss, improving insulin sensitivity, reducing the risk of fractures, maintaining sexuality and psycho-emotional well-being.

Abstract Refractory aggressive prolactinomas are detected after the unresponsiveness to conventional therapies. We report two cases that underwent temozolomide treatment and have been in near‐complete remission ever since. We suggest the pathology techniques for earlier detection and, subsequently, treatment with temozolomide to reduce morbidities and better respond to therapy.

La hiperprolactinemia es un diagnóstico frecuente en la consulta de endocrinología y de los adenomas hipofisarios los prolactinomas son el subtipo más frecuente causantes de hiperprolactinemia. Se revisó pacientes con hiperprolactinemia idiopática y prolactinomas evaluados en el servicio de endocrinología del Centro Médico Docente La Trinidad. Se realizó un estudio descriptivo, retrospectivo, de carácter observacional en el que se explorararon posibles relaciones estadísticamente significativas, entre la presencia de hiperprolactinemia idiopática versus tumores hipofisiario (prolactinoma) e hiperprolactinemia y características demográficas o de presentación y presentació clínica. Se encontró: predominio de hiperprolactinemia en el sexo femenino, con una proporción de 4:2, pacientes con prolactinomas la proporción fue 3 mujeres por cada hombre afectado, el promedio de edad al momento del diagnóstico en las mujeres resultó 37 años y 45 años en los hombres. Los prolactinomas eran responsables de la hiperprolactinemia en un 67.44 %, siendo los microadenomas los tumores más frecuentes con un 68,9 %. Los macroadenomas se presentaron en 9 pacientes (31,03 %) de los cuales 8 fueron tratados con neurocirugía. Las manifestaciones clínicas y comorbilidades en los 43 pacientes con hiperprolactinemia principales fueron trastornos menstruales, dislipidemia y sobrepeso. La concentración media de prolactina estuvo directamente relacionada con las dimensiones de los tumores. Por último, se observó que la totalidad de los pacientes recibió tratamiento con cabergolina y 8 ameritaron neurocirugía, presentando déficits secuelares más inherentes al tumor que a la cirugía.

Los tumores de hipófisis representan la forma más frecuente de tumor intracraneal en un 14.7%. Las prolactinomas son adenomas secretores de prolactina representando un 40% de tumores hipofisarios. Su frecuencia hospitalaria varia con la edad y el sexo, ocurriendo frecuentemente en sexo femenino 10:1 y en un rango de edad entre 20-50 años, con manifestaciones clínicas dadas por el efecto de masa y niveles altos de prolactina. Estudio previo realizado por Al-Dahmani et al, en 2015 en Canadá, arrojo un conglomerado de 1005 pacientes de los cuales 345 correspondían a las prolactinomas. En concordancia, los centros asistenciales que deseen avanzar en el manejo de estos pacientes deben emplear estrategias que garanticen el registro, a fin de comprender a profundidad esta entidad. Por lo ante expuesto se realiza este estudio con el fin de elaborar un sistema de registro epidemiológico en el Servicio de Endocrinología y Otorrinolaringología del Centro Médico Docente La Trinidad 2012-2020. Se realizó un estudio descriptivo y retrospectivo con las historias medicas de pacientes con diagnóstico de prolactinoma, registrando97 pacientes en total. La distribución por sexo evidencia mayor incidencia en el sexo femenino constituyendo el 79%, evidenciándose que la galactorrea es el principal signo en sexo femenino, seguido de los trastornos visuales. El abordaje diagnóstico y terapéutico, se ampara de los estudios de imagen de la región sellar con la cuantificación de niveles de prolactina, ambos sumados a las características del paciente permiten tomar decisión sobre el método terapéutico adecuado, debatiéndose entre el manejo médico y quirúrgico.

Abstract In a difficult case of macroadenoma with progressive change during pregnancy, timely cesarean delivery, avoidance of breastfeeding, and intensive conservative treatment after birth could have satisfactory results, in terms of fetal outcomes, regression of tumor, and resumption of visual activity.

Abstract Background Prolactinomas are tumors of the pituitary gland that usually respond very well to treatment with cabergoline. Resistance to cabergoline is very rare, but when it occurs, it is a difficult problem to resolve if the tumor is inoperable. Case presentation A 62-year-old white man was treated for a giant macroprolactinoma detected during investigation of a subacute subdural hematoma of the left frontal lobe. The patient was treated with cabergoline for 17 years with a dose ranging from 1.0 mg to 3.5 mg per week. We were not able to normalize his prolactin level, which initially was 14,992 ng/ml and ultimately 1754 ng/ml. The tumor significantly shrank during the follow-up period but persisted. The patient had cardiac valvulopathies that did not worsen. He had an ischemic stroke and developed a psychotic condition that was successfully treated by lowering the cabergoline and administering quetiapine and mirtazapine together. This regimen led to a small increase in the patient’s prolactin that returned to previous levels and remained as such until the last medical evaluation. The tumor continued to shrink and had a cystic degeneration in the last evaluation. Conclusions Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in our patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors.

Abstract Background Giant prolactinomas are very rare pituitary tumors that may exhibit an aggressive behavior and present with a life-threatening condition. Case presentation A 25-year-old white woman was admitted to our hospital with a headache, psychomotor retardation, reduced vision, and loss of autonomy in daily activities. Her past medical history was significant for having oligomenorrhea and a depressive syndrome since her mother’s death. She also had a breast cancer gene 1 (BRCA1) mutation and a family history of breast cancer. She had marked hyperprolactinemia (7615 ng/dL), central hypocortisolism, growth hormone deficiency, and a giant pituitary tumor (52 × 30 × 33 mm) which was shown in magnetic resonance imaging with obstructive hydrocephalus, requiring emergency surgery. Treatment with cabergoline led to a 99.8% reduction in serum prolactin levels and significant tumor shrinkage. Her depressive symptoms progressively improved and psychiatric drugs were withdrawn after 3 months of cabergoline treatment. Currently, she is being followed in Endocrinology, Neurosurgery, and Neurophthalmology out-patient clinics and in a breast cancer unit. Careful monitoring, support, and follow-up will be essential throughout this patient’s life. Conclusions This case is a rare presentation of a giant prolactinoma in a young woman, who presented a life-threatening event. She also had an unexpected association between diseases or symptoms that may have contributed to the delay in diagnosis. Given the concomitant presence of a giant prolactinoma, a BRCA1 mutation, and depressive symptoms, a possible association was hypothesized. The breast cancer risk in a BRCA1 mutation carrier and the possible interference of hyperprolactinemia and life events were also discussed. However this hypothesis requires further investigation.

Aim: In the present study, the treatment results and treatment methods of the patients who had aggressive-progressing prolactinoma in our clinic were evaluated retrospectively. The purpose was to identify the most appropriate follow-up and treatment strategies in similar cases.Patients and Methods: In this study of ours, the data recorded in our endocrinology clinic between 2004 and 2013 out of the patients, who were followed-up in our clinic with a multidisciplinary approach in Hypophysis Council, were examined retrospectively. The patients were classified as Remission with Medical Treatment, Remission with Surgery, Remission with Medical Treatment After Surgery, Drug Resistance, and Surgery and “Second Surgery after Tumor Progression after Medical Treatment.Results: A total of 65 patients were included in the study. A total of 61.5% (n=40) of the patients were female; and 38.4% (n=25) were male. All of the cases were divided into two as 60% with microadenomas and 40% with macroadenomas. 37 cases received medical treatment, 7 patients received surgery, and 17 patients received medical treatment after surgery. A total of 69.4% of the patients, who were followed up due to microadenoma, had remission with medical treatment; 8.3% had remission with surgical treatment; and 8.3% had remission with medical treatment after surgery. It was determined that 20% of the 25 patients, who were followed-up due to macroadenoma, had remission with medical treatment; 16% had remission with surgical treatment; and 48% had remission with medical treatment after surgery. The average resistance in the cases was 11.4%. Conclusion: Despite its benign nature, prolactinoma is a hypophysis tumor with difficult treatment. Although the medical treatment responses in our study were compatible with existing literature, the prevalence of the surgical operation in our study was found to be more when compared to existing literature. This situation may be explained with the fact that the patients with aggressive progression were included in the present study of ours.

Multiple endocrine neoplasia syndrome type 1 (MEN1, Wermer's syndrome) is a group of heterogeneous inherited diseases, with its pathogenesis related to hyperplasia or neoplasms of several endocrine glands. This syndrome is characterized by autosomal dominant mode of inheritance, high penetrance and similar prevalence among males and females. Prevalence of MEN1 is estimated to be 1:100,000 of the population. An interesting feature of the presented clinical case is a relapse and transformation of pituitary tumor from a prolactin-secreting into the mixed one, with distinct compartments of ACTH- and prolactin-secreting, in a female patient with a family MEN1 syndrome, with involvement of the pancreas, parathyroid and pituitary glands. Her brother had a synchronous manifestation of the same types of tumors, except corticotropinoma. The presented clinical case highlights the necessity of a comprehensive and life-long follow-up of MEN1 patients for a timely detection of neoplasms and appropriate treatment.

Hipotalamus-hipofiz aksının en sık rastlanan endokrin bozukluğu hiperprolaktinemidir. Prolaktinoma çocukluk çağı ve adolesan dönemde hipofizer adenomlarının en sık görülen tipidir. Çocukluk çağında ve adolesanda görülen hipofizer tümörlerin yaklaşık %40’ını prolaktinoma oluşturmaktadır. Klinik bulguları amenore, anovulasyon, infertilite, hipogonadizm, galaktore ve adet düzensizliğidir. Tedavide ilk seçenek dopamin agonistleridir (bromokriptin, kabergolin). Biz amenore ve galaktore şikayetleri ile başvuran, prolaktinomalı 15 yaşında kız hastayı sunmayı amaçladık.

Background: Pituitary adenoma is not as infrequent as thought previously. The prevalence of macroadenomas in general population is up to 0.16–0.2%. Magnetic resonance imaging (MRI) is a method of choice in diagnosis of pituitary adenomas. Until now, specifics of imaging of pituitary adenomas with various hormonal activities have not been discussed.Aim: To analyze comparatively the size, volumes and growth direction in pituitary macroadenomas with various hormonal activities.Materials and methods: We analyzed MRI images of 305 patients with hypophyseal adenomas of more than 10 mm diameter, among them with non-functioning adenomas (n=109), prolactinomas (n=58), and somatotropinomas (n=138).Results: Depending on their hormonal activity, hypophyseal adenomas had different volumes (р0.05). Non-functioning hypophyseal adenomas and prolactinomas demonstrated mostly suprasellar growth (in 83.5 and 79.3% of cases, respectively), whereas somatotropinomas were growing mostly in infrasellar direction (66.1%).Conclusion: These characteristic features of hypophyseal macroadenomas with various hormonal activities could be used for differential diagnosis, which may help to optimize patient assessment during the diagnostic work-up.

Osteoporosis in the younger age group is an important cause of morbidity. Prolactinoma is an uncommon but reversible cause of osteoporosis. The main mechanisms of osteoporosis in prolactinoma are reduced osteoblast activity and hypogonadism. A high index of suspicion is the key in diagnosis and management of this treatable entity.

The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.

Objectives: To clinically characterize women with hyperprolactinemia at InSer Pereira (Colombia) and to determine the prevalence of prolactinoma. Methods: Retrospective description of 45 patients with hyperprolactinemia, and contrasted pituitary magnetic resonance (MR), between January 2008 and July 2013. Clinical manifestations, etiology, serum prolactin level, and MR findings were included. Results: The most frequent clinical manifestations were: infertility, galactorrhea, oligomenorrhea. There were 26 cases of prolactinoma (57.8 %), and 12 of idiopathic hyperprolactinemia (26.6 %). Out of the 26 prolactinomas, 23 were microadenomas (average size 5.1 mm; SD ± 3.2 mm). Average serum prolactin level was 74.05 ng/mL (SD ± 13.33 ng/mL). 78 % of patients with prolactinoma had serum prolactin level under 70.0 ng/mL. No significant association was found between serum prolactin level and the presence of prolactinoma. Conclusion: Prolactinomas are the main cause of hyperprolactinemia and they are found mostly with slight rise of serum prolactin. Pituitary MRI is recommended in patients with hyperprolactinemia, regardless of their prolactin level.

ABSTRACT Objective Prolactin is a multifunctional pituitary hormone. The effect of prolactin on platelet activation is not well understood. Prolactinomas are the most common type of pituitary adenomas, and they are medically responsive to dopamine agonists. Mean platelet volume (MPV) is a marker of platelet function and activation. The aim of this study was to evaluate MPV values before and 6 months of cabergoline treatment when normoprolactinemia was achieved. Subjects and methods A total of 101 newly diagnosed prolactinoma patients and 102 healthy control subjects were included in the study. Patients with hematological disorders that affect MPV and those on medications were excluded. Prolactin, platelet count and MPV levels were recorded before and 6 months after the initiation of cabergoline treatment (0.5 to 1 mg, two times a week). Results There was no significant difference in platelet count and MPV before and after 6 months of treatment with cabergoline in patients with prolactinoma compared with the control group (p > 0.05). Conclusion Our results showed that MPV, a marker of platelet function, was unchanged in patients with prolactinoma.

Prolactinoma is a rare tumor of childhood. Clinical presentations of prolactinoma include amenorrhea, delayed puberty, and galactorrhea. For the first time, in this case, elevated prolactin levels were associated with unexpected premature pubarche. We describe an 8-year, 7-month-old boy with acne and gradual appearance of pubic hair, corresponding to tanner stage 2. Hormonal tests showed severe hyperprolactinemia (prolactin = 246.8 μg/L and pooled prolactin = 175 μg/L and macroprolactin = 5 μg/L) and mildly elevated level of dehdroepiandrostenedion sulfate (DHEAS) and testosterone. Magnetic resonance imaging (MRI) findings confirmed the presence of a pituitary macroprolactinoma, measuring 14 mm × 12 mm × 8 mm on the right side of the pituitary gland. Cabergoline therapy was commenced (0.5 mg/week) and after 3 months, no evidence of pubarche progression was observed. Prolactin level and tumor size markedly reduced. At the 9-month follow-up visit, a normal MRI was reported. This case highlights that even when facing premature pubarche, careful examination is mandatory, and if no obvious etiology is found for premature pubarche, clinicians should consider prolactinoma.

It has been suggested that hyperprolactinemia may be associated with obesity and dyslipidemia. However it is not fully understood that dyslipidemia is occurs independently or due to obesity. The study was aimed to investigate lipid abnormalities and androgen hormone levels before and after cabergolin (CAB) treatment in non- obese premenauposal patients with prolactinoma. This study was a single-centre, prospective, casecontrol study, consisted of 53 patients with symptomatic prolactinoma (group 1) and 57 healty women (group 3). All subjects underwent a physical examination, anthropometric measurement and a 12 hour fasting blood sample for fasting blood glucose and lipid levels. 49 patients with prolactinoma were reevaluated for metabolic parameters after one year of cabergolin treatment (group 2). The median age was 34 (24-38) in group 1, and 33 (27-41) in group 3 (p=0.522). The initially higher body mass index (BMI) in patients with prolactinoma became similar after one year of treatment those with control group (p=0.475). While LDL-C was significanly higher in group 1 than in controls, HDL was significanly lower in group 1. Also post- treatment values of LDL-C (p=0.440) and HDL-C (p=0.612) were not different from the control group. No correlation was found between baseline prolactin levels and FSH, LH, LDL-C, HDL-C (p=0.129, p=0.658, p=0.817, p=0.760 respectively). In conclusion, beneficial metabolic changes were seen in patients with prolactinoma after treatment with cabergoline. Thus considering the metabolic profile and an appropriate treatment goal is important in the clinical management of patients with prolactinoma. [Med-Science 2015; 4(1.000): 1985-92]