Microprolactinoma (Pituitary Adenoma) as a Cause of Secondary Headache in a Pediatric Patient With Pain and Restricted Mouth Opening: A Case Report

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Introduction: The aim of this paper is to report a case of a patient coming to the attention of the general dentist for TMD pain, limited mouth opening, and headache, for which the prescription of a blood test and an magnetic resonance imaging (MRI) led to the incidental diagnosis of a microadenoma of the pituitary gland. Case Presentation: A 15-year-old female came to a dental clinic with a chief complaint of pain at the level of the left temporomandibular joint (TMJ) and reduced mouth opening. The pain is ameliorated by nonsteroidal anti-inflammatory drugs (ibuprofen) and is aggravated during function (e.g., eating hard food and yawning). In general, the pain is worsened by any movement of the mandible. There was no pain in the other joints. The patient also reported headache in the frontotemporal region. If the intensity of the headache is increased, it is accompanied by episodes of vomiting. The MRI revealed the presence of disc displacement without reduction (DDwoR) in the left joint with limited opening and disc displacement with reduction (DDwR) in the right joint. The presence of myofascial pain was attributed to the presence of tendinitis. The blood sample test revealed an almost double level of prolactin (718.28 mU/mL) compared to the physiological one. The MRI also revealed the presence of a lesion with a 4 mm transversal diameter, 3 mm vertical, and 5 mm anteroposterior diameter compatible with a lateral pituitary microadenoma. Thus, the final diagnosis of microprolactinoma was formulated. Conclusion: This paper reported a case of an incidentally diagnosed microprolactinoma, which comes to the attention of dental practitioners due to the presence of TMD signs and symptoms. In the presence of uncommon symptoms, such as headache, practitioners should be incentivized to perform further diagnostic tests to rule out the presence of other conditions during the differential diagnosis phase.

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