Hyperprolactinemia in children during the peripubertal period--personal observations.

There can be many reasons for functional hyperprolactinemia, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and hypoglycemia. Prolactinoma is also a frequent cause. This study included 12 patients (10 girls and 2 boys) aged 14-17 years with hyperprolactinemia. Six patients were treated for PCOS, two for type 1 diabetes mellitus, and one patient suffered from Prader-Willi syndrome. In all patients, TSH, fT3, fT4, FSH, LH, testosterone, and E2 levels were measured. MRI of the pituitary was performed. Prolactin was measured with the metoclopramid dynamic test (MTC). IRI, C-peptide, oral glucose test, and minor pelvis ultrasound examination were performed in patients with PCOS. Pituitary adenoma was diagnosed in four out of 12 patients. In the remaining eight patients, functional hyperprolactinemia was found. All of these patients remain under pharmacological treatment with positive clinical results.

CONCLUSIONS

1. It is necessary to determine prolactin in each girl with unexplained amenorrhea irrespective of galactorrhea. 2. In some patients with prolactinoma the basal prolactin levels may be in the normal range, but they are increased in the MTC test. 3. In girls with various disorders of the menstrual cycle it is necessary to determine the level of prolactin with a provocative test.