Endocrine Abstracts (2011) 26 P211

Gender-related differences in prolactinomas

A Ramos-Prol, R Cámara-Gómez, B León-de Zayas, A Beltrán, J A Simal, M Argente-Pla, M I del Olmo-García & J F Merino-Torres

Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Introduction: It has been previously described that prolactinomas may have a more aggressive behaviour in men than in women.

Methods: We performed a retrospective study in 59 patients diagnosed of prolactinoma (19 men). The variables collected were: age at diagnosis, clinical presentation, tumor size and stage (Hardy classification) and treatment response. The results were compared between both genders.

Results: Age at diagnosis was 41 (18.9) years in men and 32.7 (12.5) in women (P=0.051). At the moment of diagnosis men had higher basal prolactin (P<0.001) and a bigger adenoma size (P<0.05). Macroprolactinomas were more frequent in men (P<0.001) and had a greater invasiveness (P<0.05). The most common clinical onset in men was headache (73.7%) and erectile dysfunction (68.4%), whereas in women was menstrual disorders (74.2%), galactorrhea (39.4%) and headache (39.4%). 89.5% of men and 37.5% of women had some kind of hypophysary hormonal deficiency (P<0.001). Complications such as visual defects and haemorrhagic transformation were more prevalent in men (P<0.05). A delay of 29.8 (37.9) months in the diagnosis was observed in men whereas in women it was of 7.2 (10.7) months (P=0.001). There was a positive correlation between the delay at diagnosis and tumoral stage (P=0.001) but not with the tumor size (P=0.068). During the follow-up with medical treatment, imaging techniques showed: tumor resolution in 81.8% of women and 47.4% of men (P=0.01), reduction in 50% of women and 15.8% of men (P=0.02) and an increase 31.3% of men and 3% of women (P<0.01). Prolactin took more time to normalize in men (P=0.001). Surgery was required in 31.6% of men and only 3% of women (P<0.01).

Conclusions: Clinical behaviour of prolactinomas in men is more aggressive, this could be due to a delay in the diagnosis. Women presented a faster and better response to medical treatment.

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