Male prolactinomas are rare and considered as bad responders to medical treatment compared to female cases. Our aim was to evaluate response of pituitary macrolesions secreting prolactin (PRL) to dopamine agonists. Our population was composed of 34 men (mean age =36.6 years) with a diagnosis of macroprolactinomas: mean tumor size =35.5 mm (12 118) and mean PRL =2505 ng/ml (132 19996). Bromocriptine was used with a mean dose of 22.94 mg/day (3.75 80) and a mean duration of =48.5 months (1 240). After medical treatment our patients underwent a reevaluation of clinical symptoms, hormonal exploration, ophtalmological exam, CT scan and / or MRI.
Our results are: treatment was considered as irregular in 57%. Side effects were present in 45% (hypotension and / or gastro intestinal troubles). Headaches disappeared totally in 88% and sexual complaints improved in 34%. Mean PRL after Bromocriptine was significantly reduced =268 ng/ml vs 2505, P<0.01; lactotropic hormone was totally normalized in 58.8% and Bromocriptine was inefficient on PRL secretion in 5.9%. Tumor size was significantly reduced: 17.9 mm vs 35.5, P<0.001. For individual responses: pituitary process disappeared totally in 22%, was reduced in 59.5%; tumor size was not modified in 14.8% and increased in 3.7%. Testosterone was normalized in 50% and others anterior pituitary deficits were improved in some subjects. Post pituitary function was normalized in one from two subjects with diabetes insipidus. Ophtalmological disorders disappeared in 55%.
Conclusion: In spite of irregular treatment and side effects response to Bromocriptine in male macroprolactinomas seems good because PRL was normalized or has decreased in 94% and tumor size decreased or disappeared in more than 80%.
01 - 05 Apr 2006
European Society of Endocrinology