Introduction: Prolactin (PRL) -secreting adenomas are about 40% of all pituitary adenomas. Their clinical symptoms are mainly related to development of secondary hypogonadism and/or tumor mass effects. Dopamine agonists (DA) are first-line drugs for prolactinoma patients due to their effectiveness in normalizing PRL levels and shrinking tumour mass. Surgery is an option for DA failure or tumour mass effects.
Objective: To assess clinical characteristics and treatment outcomes of patients with prolactinomas.
Methods: Retrospective review of the clinical records of 72 patients (22 men and 50 women) with prolactinoma diagnosed from 1984 to 2012 and followed up in our outpatient clinic.
Results: The mean follow-up time was 103.82±80 months(range 7338). Men was older at diagnosis (40±16 vs 28.72±10.33 years) (P<0.001).The most common clinical symptoms in men were erectile dysfunction (59.1%) and headache (45.5%), whereas in women were oligo-amenorrhea (88%) and galactorrhea (58%). Incidental diagnosis was done in 10 patients (nine men and one woman). Symptoms related to tumour mass effect were more frequent in men (P<0.01). Within the 72 patients, 39 (54.2%) had microadenomas and 33 (45.8%) had macroadenomas. Macroprolactinomas showed higher mean basal serum PRL levels (P<0.001) and were more frequent in men (P<0.001). Sixty-five patients (90.2%) received long-term DA therapy alone and seven patients were treated by pituitary surgery followed by long-term DA therapy. Frequency of surgical removal was higher in men (P<0.05). At the end of follow-up, complete or partial remission (no visible or reduced tumour in CT or MRI and normal PRL levels on/off current DA medication) were achieved in 77.7% of patients. Prevalence of adverse drug effects were lower in cabergoline treated subjects (P<0.05). Seventeen out of 26 patients (65.4%) recurred after DA withdrawal. Recurrence was more frequent in patients with macroadenomas (P<0.05).
Conclusions: In our study, prolactinomas showed different and more aggressive clinical characteristics in men. DA therapy normalized prolactin and reduced tumour size, alone or associated with surgery, in the majority of patients.
27 Apr - 01 May 2013
European Society of Endocrinology