Growth hormone deficiency, secondary hypothyroidism, and empty sella following treatment of childhood macroprolactinoma
A 9-year-old girl presented with headache, nausea, vomiting, and decreased vision of 8 months duration. Automated perimetry revealed bitemporal hemianopia. Evaluation of anterior pituitary function revealed elevated serum prolactin (958 ng/ml), normal cortisol, thyroid function, and insulin-like growth factor 1 (IGF-1) []. Magnetic resonance imaging (MRI) brain (February 2009) showed 30 × 27 × 28 mm sellar mass with predominant suprasellar extension compressing the optic chiasma []. Cabergoline was initiated, initially at 0.5 mg/week increased to 1.5 mg/week over 6 months and continued. There was rapid improvement of symptoms with resolution of headache followed by resolution of nausea and vomiting by 2 months, vision became normal by 8 months of therapy. Revaluation after 10 months of initial diagnosis revealed normal serum prolactin with normal anterior pituitary function []. MRI brain that time (November 2009) showed a 91% reduction in tumor size, now measuring 11.5 × 13.6 × 12.7 mm.\nComplaints of lack of height gain, along with increased weight for 6 months, lead to revaluation in January 2012 (after 3 years of cabergoline therapy). Her height was 131 cm (<3rd percentile, height standard deviation score (SDS): –2.06; target height SDS: –1.4), height velocity 4 cm/year and body mass index (BMI) was 21.9 kg/m2 (85th percentile). Sexual maturity rating was prepubertal. Perimetry was normal this time. Hormonal evaluation revealed, low serum prolactin, secondary hypothyroidism, and growth hormone deficiency []. MRI brain showed complete resolution of pituitary adenoma with empty sella and absent posterior pituitary signal [].\nA diagnosis of complete regression of macroprolactinoma with growth hormone deficiency and secondary hypothyroidism with empty sella was made in an overweight adolescent girl who had received cabergoline for 3 years for macroprolactinoma. Cabergoline was stopped. Levothyroxine was initiated at 50 μg/day. She could not afford growth hormone replacement [Figures and ].