Experience with PRL-secreting macroadenomas in the pediatric and adolescent population is limited. Although use of synthetic GH
after treatment of
central nervous system tumors in children without active disease is accepted practice, reports of GH use in patients with
central nervous system tumors in situ are rare. Furthermore, the effect of GH on
tumor growth is not known. We report GH treatment (10 and 11.5 months), concomitant with
bromocriptine (BC;
dopamine agonist)
therapy in two children, a 15.5-yr-old male and a 15.5-yr-old female, with PRL-secreting macroadenomas in situ. Surgical resection was deemed undesirable because of the risk of major morbidity due to the large size of the
tumors and the close proximity to major vessels. Both patients were GH deficient and had heights below the fifth percentile coupled with arrested pubertal progress. During BC
therapy, a decrease in
tumor size and a reduction in serum PRL levels occurred in both patients, which continued after the addition of GH treatment. Neither patient experienced changes in visual acuity during combined treatment, and both experienced marked improvement in growth velocity. We conclude that in children with PRL-secreting
tumors and GH deficiency in whom surgery is not advised, combined treatment with BC and GH appears to be safe and efficacious. To our knowledge, these patients represent the first report of the combined
therapeutic use of BC and GH as the primary mode of treatment in children with
prolactinoma in situ with documented GH deficiency.