Case report and literature review of pituitary apoplexy in a 14-year-old girl with prolactinoma

Pituitary adenomas are rare in pediatric populations, with prolactinomas representing 20–39% of childhood cases. Pituitary apoplexy-hemorrhage or infarction of a pituitary adenoma-occurs in only 2–12% of tumors and is exceedingly uncommon in children, posing unique diagnostic challenges due to atypical presentations that are frequently misattributed to normal pubertal variation or common ocular conditions. A 14-year-old female presented with six months of progressive vision loss. She exhibited Tanner stage 4 breast development and stage 3 pubic hair without menarche. Laboratory studies demonstrated profound hyperprolactinemia and central hypothyroidism. Brain magnetic resonance imaging (MRI) revealed an 18×25×17 mm sellar mass consistent with a giant prolactinoma with apoplexy. She underwent emergent endoscopic transsphenoidal resection. Pathology confirmed a pituitary neuroendocrine tumor (PitNET) with a Ki-67 index of 6%. At one-month follow-up, visual acuity recovered, with prolactin decreased. She remains on bromocriptine and levothyroxine. This case highlights the diagnostic difficulty of pediatric pituitary apoplexy, where delayed menarche and visual impairment may be misinterpreted during adolescence. Early recognition requires heightened clinical suspicion for pituitary pathology in adolescents with visual decline and endocrine abnormalities. Prompt surgical intervention combined with long-term hormonal management yields favorable outcomes in this rare but serious condition.