Galactorrhea in an Adolescent Girl

Patricia Ryan-Krause, MS, MSN, RN, CPNP

Disclosures

J Pediatr Health Care. 2009;23(1):54-58. 

In This Article

Follow Up

DK continued to have her prolactin levels checked periodically. After a brief return to twice weekly treatment with cabergoline, DK's prolactin levels normalized again and she resumed a weekly medication regimen. She has since maintained prolactin levels within the normal range on a weekly dose of 0.25 mg of cabergoline. Repeat MRIs showed a continued decrease in the size of the adenoma. Her most recent scan revealed only a small residual microadenoma (3 mm) on the right side of the pituitary gland.

DK recently returned for her WCC visit almost 3 years after the diagnosis. She is a delightful young lady now entering the 11th grade. She is an honor student and an avid soccer and tennis player with college in her future plans. Her height and weight have stabilized with a body mass index of 24 and blood pressure of 110/68 mm Hg. Her prolactin levels have remained in the normal range on a single weekly dose (0.25 mg) of cabergoline. She experiences no adverse effects from the medication and is compliant with the weekly schedule. There have been no new concerns about the safety of this medication in low doses. DK reports occasional frontal headaches (fewer than two per month) that resolve with a single dose of ibuprofen. Menses continue to be regular with a fairly short cycle of 20 days and moderate dysmenorrhea that does not effect school attendance or sports participation. A repeat MRI is scheduled, and the endocrinologist plans to continue having DK take cabergoline until the tumor is no longer visible on imaging. DK may be given a trial off medication with close monitoring of her prolactin levels and tumor size 5 years from the initiation of medication even if the tumor is still noted on MRI at that time. Some literature suggests that normal prolactin levels are maintained for several years following discontinuation of medication (Cannavo et al., 2003), while other research suggests that continuous lifelong medical management may be needed in this condition (Bronstein, 2006).

DK and her mother understand clearly the importance of medication compliance and careful follow-up with the specialists and with the primary care provider. It is anticipated that DK will continue to do very well with medical management and close follow-up. Pituitary adenoma is a differential diagnosis to consider in children and adolescents who present with unusual symptoms including galactorrhea, amenorrhea, growth and pubertal issues, vision problems, and neurologic symptoms.

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