Prolactinoma Presenting with Secondary Amenorrhoea in a Young Girl
Prolactinoma in a Young Woman
Abstract
Prolactinoma is the most common secreting pituitary adenoma. It has different clinical presentation in men and women which varies with age. Young women present with menstrual problems, infertility and galactorrhoea, whilst older women and men may present with loss of libido, visual disturbances and in late cases, with osteoporosis. In approaching a young woman with secondary amenorrhoea, other causes such as pregnancy, functional hypothalamic amenorrhea, pituitary adenoma, Polycystic Ovarian Syndrome (PCOS) or primary ovarian insufficiency should be ruled out. Prolactinoma can be confirmed in the presence of high serum prolactin level and adenoma on pituitary gland magnetic resonance imaging (MRI). Dopaminergic agonist, cabergoline is efficacious in restoring gonadal and sexual functions by normalising prolactin levels. We presented a case report on an 18-year-old girl who presented with secondary amenorrhoea for six months. On further evaluation she was noted to have galactorrhoea with substantially high prolactin level of 466.9 ng/mL (normal range: 4.0- 23) and the MRI showed a pituitary tumour measuring 1.2 x 1.1 x 1.4 cm. A diagnosis of macroprolactinoma was made and she was managed with cabergoline with gradual dose increment. At 6 months of treatment, her menstrual cycle and serum prolactin had normalised. A repeat MRI pituitary one year later showed reduction in tumour size.
Keywords :
Amenorrhoea,
galactorrhoea,
pituitary adenoma,
prolactinoma,
Abstrak
Prolaktinoma merupakan adenoma pituitari yang paling lazim dijumpai. Presentasi klinikal pada lelaki dan wanita adalah berbeza mengikut umur. Wanita muda lazimnya mengalami masalah kitaran haid, ketidaksuburan dan "galactorrhoea" manakala lelaki dan wanita warga emas lazimnya mengalami kekurangan libido, gangguan penglihatan dan sekiranya lambat dikesan, mungkin mengalami komplikasi seperti osteoporosis. Punca putus haid melebihi tempoh tiga bulan di kalangan wanita yang sebelumnya mempunyai kitaran haid yang normal perlu disiasat kerana ia mungkin disebabkan oleh kehamilan, masalah hypothalamus, masalah kelenjar pituitary atau Sindrom Polycystic Ovarian (PCOS). Prolaktinoma dapat disahkan apabila tahap prolaktin dalam darah adalah tinggi dan adenoma dikesan pada pengimejan resonans magnetik (MRI) kelenjar pituitari. Ubat dopaminergik agonis seperti cabergoline amat berkesan untuk menurunkan tahap prolaktin kembali ke paras normal dan membolehkan fungsi gonad dan seksual pesakit kembali seperti sediakala. Kami membentangkan laporan kes mengenai seorang gadis berusia 18 tahun yang mengalami masalah kitaran haid yang tidak teratur. Tahap prolaktin yang tinggi, 466.9 ng/mL (tahap normal: 4.0- 23) serta MRI pituitari yang menunjukkan tumor berukuran 1.2 x 1.1 x 1.4 cm, mengesahkan bahawa pesakit mengalami masalah makroprolaktinoma. Selepas enam bulan rawatan dengan ubat cabergoline, kitaran haid dan tahap prolaktin pesakit telah kembali normal. MRI pituitari pula menunjukkan pengurangan saiz ketumbuhan selepas setahun menerima rawatan.
Kata Kunci :
Adenoma pituitari,
amenoria,
galaktoria,
prolaktinoma,
Correspondance Address
Assoc. Prof. Dr. Leelavathi Muthupalaniappen. Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 9475 Email: drleelaraj@gmail.com
