ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 49 EP1051 | DOI: 10.1530/endoabs.49.EP1051

Prolactinomas diagnosed after menopause: presentation and outcomes from a large specialist centre

Sandhya Santharam1,2, Metaxia Tampourlou1,2, Wiebke Arlt1,2, John Ayuk2, Neil Gittoes1,2, Andrew Toogood2, Rachel Webster3 & Niki Karavitaki1,2

1Institute of Metabolism and Systems Research,College of Medical and Dental Sciences University of Birmingham, Birmingham, UK, 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK, 3Department of Clinical Biochemistry, Queen Elizabeth Hospital Birmingham, Birmingham, UK.

Introduction: Most prolactinomas in females are diagnosed during the years of reproductive age and the majority are microadenomas. Prolactinomas diagnosed after menopause are very rare with limited published data on their presentation and outcomes.

Aim: The aim of our study was to assess the presenting clinical, biochemical and imaging findings, as well as the outcomes of women diagnosed with a prolactinoma in the post-menopausal period.

Methods: All women of this group diagnosed between 1996 and 2016 and followed-up in a large specialist centre were included in the study.

Results: We identified 17 women with diagnosis of prolactinoma after menopause (median age at diagnosis 62 years, range 52–70). Headaches and/or visual deterioration were the most commonly reported presenting signs (47%). Acute pituitary apoplexy was diagnosed at presentation or during follow-up in 18%. Two prolactinomas were detected incidentally (12%). The median serum prolactin was 18 553 mU/L (range 4153–238479). In all cases, IGF-I values were not consistent with GH hypersecretion. Macroprolactinomas comprised 94% of the tumors and 88% of them had parasellar extension. All patients with macroprolactinoma were offered dopamine agonist therapy; the median duration of their follow-up, determined by the date of starting dopamine agonist until last serum prolactin measurement, was 91 (5–186) months. Normal prolactin was achieved in 94% and adenoma shrinkage was observed in all women. Improvement or resolution of the visual disturbances documented at presentation was observed in 86% of cases.

Conclusions: The clinical phenotype of prolactinomas diagnosed after menopause differs from that of premenopausal women, possibly due to the lack of clinical signs and symptoms of hyperprolactinemia in non-menstruating patients. Most tumours were macroadenomas, with frequent parasellar extension and a relative high rate of pituitary apoplexy. In this very rare group of tumours, response to dopamine agonists is good.

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