Prolactinomas in children and adolescents.

Prolactinomas are the most common pituitary adenomas in children and adolescents followed by adrenocorticotropic hormone-secreting and growth hormone-secreting adenomas. Females are slightly more affected than males (who have macroadenomas more frequently). Compared with the adult setting, in children macroadenomas are more frequent than microadenomas. Diagnosis is generally based on clinical symptoms of primary or secondary gonadal failure, growth delay and/or tumor compressive symptoms. Treatment is based on medical therapy with dopamine agonists, to control prolactin levels and reduce tumor size. Surgery is indicated in patients with tumors resistant to dopamine agonists as well as in those showing severe neurological symptoms at diagnosis. Radiotherapy should be limited to the cases with aggressive tumors, nonresponsive to dopamine agonists, because of the risk of neurological damage and hypopituitarism later in the lives of these patients.