Endocrine Abstracts (2003) 6 P36

Macroprolactinomas in men: long-term efficacy of bromocriptine treatment

A Chattopadhyay, A Bhansali & RJ Dash

Department of Endocrinology, Postgraduate Institute of MedicalEducation and Research (PGIMER), Chandigarh, India.

Gender-specific differences in tumor size at clinical presentation and possible differences in tumor biology make it important to determine treatment outcomes of male patients with bromocriptine [BRC]. We retrospectively analysed treatment response to bromocriptine in 29 male patients with macroprolactinoma (15) and giant macroprolactinoma (14). The duration of treatment was 6-96 months (mean 22.7). Clinical features at presentation included headache (21, 72.4%), visual field defects (20, 69%), libido-potency failure (18, 62.1%), pituitary apoplexy (5, 17 %), primary infertility (5, 17%), gynaecomastia / galactorrhoea (4, 12%). Pretreatment serum prolactin (PRL) ranged between 124 and 29,200 nanogram per mililitre and tumour volume, between 5.4 and 252 cm3.

In 26 patients, PRL decreased 96% of the pretreatment value; PRL was normalised (<16 nanogram per mililitre) in 12 patients (41%). Tumour shrinkage at final follow-up was > 50% in 22 patients (74.8%); with near complete disappearance in 5, > 95% in 7, and >50% in 10 patients. Tumour volume reduction in both giant prolactinoma (P= 0.005) and macroprolactinoma (P= 0.02) was significant.An improvement of field defect was noted in 8 out of 20 patients (40%). Nine patients with secondary hypoadrenalism, 7 with secondary hypothyroidism and 7 with hypogonadism needed substitutive therapy. Trans-sphenoidal surgery was performed in 9 patients (CSF leakage related to BRC in 2, increasing prolactin despite BRC in 3, pituitary apoplexy in 1 and unable to afford the cost of long term BRC in 3). Among the five patients presenting with primary infertility, 2 had normalised PRL, improvement in sperm count and had a child.

These data suggest that, in male macro-and giant prolactinomas, bromocriptine represents a first-line therapy effective in reducing PRL, determining tumour shrinkage, preserving/ restoring vision and pituitary function.

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