Symptomatic hyperprolactinemia mimicking pituitary pathology in a child with Landau-Kleffner syndrome, autism spectrum disorder, and intellectual disability: a case report.

introductionSymptomatic hyperprolactinemia is rarely seen in children, particularly among those with complex neurodevelopmental disorders. While risperidone is known to raise prolactin levels, cases with clear clinical symptoms are uncommon. This report describes an unusual presentation of hyperprolactinemia in a 12-year-old girl with Landau-Kleffner syndrome, autism spectrum disorder, and intellectual disability, whose symptoms closely resembled pituitary pathology. CASE PRESENTATION: The 12-year-old Hispanic Peruvian female was under long-term behavioral control therapy of risperidone. With time, she got galactorrhea, visual impairments, and falls. Laboratory revealed high serum prolactin (40.2 ng/mL) and normal thyroid and negative beta-hCG level. No pituitary lesion was seen on neuroimaging. Behavioral symptoms increased following the discontinuation of risperidone, after which the substitution of the latter with olanzapine led to complete restoration. Three months later galactorrhea disappeared, vision improved, and prolactin level was restored (2.2 ng/mL). The mother of the patient was relieved to find out that it was a medication-related issue, but not a tumor and indicated a significant enhancement in the overall behavior and quality of life of her child.

conclusionsThe case shows the significance of following prolactin levels in children who are on risperidone therapy particularly those who are non-verbal or those who cannot communicate any discomfort. Clinicians are to remember that risperidone leads to hyperprolactinemia which can simulate pituitary malfunctions. Early identification, educating caregivers, and substitution of prolactin-stimulating drugs with prolactin-sparing ones like olanzapine will allow avoiding unnecessary investigations and enhancing the clinical and family outcomes.