From the Guidelines
Prolactinomas are the primary type of pituitary tumors that cause polycystic ovaries, as they produce excess prolactin, disrupting normal gonadotropin secretion and leading to estrogen deficiency. According to the most recent consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence, prolactinomas are the most common type of pituitary adenoma in children and young people, occurring in approximately 0.1 million children every year 1. These benign tumors can cause hormonal imbalances that prevent normal ovulation, leading to the development of multiple small follicular cysts in the ovaries.
Key Characteristics of Prolactinomas
- Occur in approximately 0.1 million children every year 1
- Most common type of pituitary adenoma in children and young people 1
- Produce excess prolactin, disrupting normal gonadotropin secretion and leading to estrogen deficiency
- Can cause hormonal imbalances that prevent normal ovulation, leading to the development of multiple small follicular cysts in the ovaries
Treatment and Management
Treatment typically involves dopamine agonists such as cabergoline or bromocriptine, which shrink the tumor and normalize prolactin levels, restoring normal ovarian function in most patients 1. Surgery is reserved for cases resistant to medication. Regular monitoring of prolactin levels and tumor size via MRI is essential during treatment. Other pituitary tumors like ACTH-secreting tumors (causing Cushing's disease) can indirectly affect ovarian function through cortisol excess, but prolactinomas are the most direct cause of polycystic ovarian morphology among pituitary tumors.
Important Considerations
- Prolactinomas can occur in children and young people, especially after puberty 1
- Genetic testing should be considered for patients with prolactinomas, especially if there is a family history of pituitary adenomas or other endocrine disorders 1
- Multidisciplinary collaboration between pediatric and adult pituitary specialists is essential for the optimal diagnosis and management of pituitary adenomas in children and young people 1
From the Research
Pituitary Tumors and Polycystic Ovaries
- Prolactinomas are the most common functional pituitary tumors, accounting for 40% of all pituitary adenomas 2
- Hyperprolactinemia, which can be caused by prolactinomas, is associated with polycystic ovaries
- The exact relationship between pituitary tumors and polycystic ovaries is complex and multifactorial
Types of Pituitary Tumors
- Prolactinomas are the most common type of primary pituitary tumors and can cause hyperprolactinemia, leading to polycystic ovaries 3
- Other types of pituitary tumors, such as lactotroph tumors, can also cause hyperprolactinemia and potentially lead to polycystic ovaries 4
Treatment and Management
- Dopamine agonists, such as cabergoline, are the primary treatment for prolactinomas and can help reduce hyperprolactinemia and alleviate symptoms of polycystic ovaries 2, 5
- Alternative medical treatments, such as somatostatin analogues and temozolomide, may be considered for dopamine agonist-resistant prolactinomas 4