Endocrine Abstracts (2004) 7 P117

Managing prolactinomas: our experience at Preston

M Banerjee1, M Myers2 & PA Vice1

1Endocrine Unit, Department of Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK; 2Department of Clinical Biochemistry, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK.

Patients who have Sr. Prolactin level >3000 mU/l (n=24) were selected from the Biochemistry laboratory record & patients with confirmed diagnosis of prolactinoma (n=33) identified and / followed up at Endocrine Clinic between December 1999 and October 2001 were studied. The mean age of the patients were 45.03+ 14.09 years and 72% were women. Of the patients diagnosed to have prolactinoma, 16 had microprolactinoma. 16 had macroprolactinoma and 1 had stalk disconnection. Of 24 who had incidental elevated prolactin, 10 were reported to have normal level, 7 elevated level (all were on psychotropic drugs) on repeat check and in the other 7 no further checks were done. Initial IST, TRH and LRH tests were done in 87% of macroprolactinomas, while they were done in 60% of microprolactinomas.14 patients with macroprolactinoma had extrasellar extension initially, which persisted in 2 patients during follow up. Visual fields were tested in 94% of macroprolactinoma patients and were found to be normal in 47% of them.

50% of macroprolactinoma patients were managed by dopamine agonists only, 37.5% by hypophysectomy and 12.5% by hypophysectomy and radiotherapy. 94% of microprolctinoma patients were managed with dopamine agonists only but 1 patient required hypophysectomy who subsequently has iatrogenic hypopituitarism.

After therapy, the visual field abnormalities resolved in 75% of patients, while the rest had persistent but no worsening of symptoms. 50% of macroprolactinoma patients are not on any hormone replacement at the follow up phase. 85.96% of patients achieved biochemical cure and 37.5% of patients achieved radiological resolution. Only 28.13% of all patients developed iatrogenic hypopituitarism. 15 living patients with macroprolactinoma and 13 patients with microprolactinoma are still being actively followed up at Preston.

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