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.