Introduction: Prolactinoma is the most common secretory pituitary adenomas. It has clinical and biological characteristics that depend on age, gender and tumor size. Prolactinoma of the old subject is a rare clinical form that was not sufficiently treated in the literature.
Materiels and methods: It is a retrospective study including 77 cases of prolactinoma among which 3 cases aged over than 65 years. The collection of data was made between 2000 and 2017.
Results: The average age was 70 years [6675 years]. They were all male. The diagnostic latency was on average 10.33 months (1-24 months). For two patients, the finding was with headache and bilateral visual acuity decrease. For the other case, the discovery was fortuitous by a brain scan in front of the suspicion of cerebral thrombophlebitis. Hyperprolactinemia syndrome (erectile dysfunction and a decrease in libido) and anterior pituitary insufficiency were noted in all 3 cases. A narrowing of the visual field was objectified in 2 patients. Initial prolactinemia averaged 827 ng/ml (4701306 ng/ml). Radiologically, there were 2 cases of macroprolactinoma and 1 case of giant prolactinoma with an average size of 39.66 mm (3051 mm). First-line surgical treatment was indicated for a patient in front of pituitary apoplexy. No postoperative complication was noted. The evolution in this patient was marked by the installation of a remission without recourse to medical treatment. For the other 2 patients, treatment with bromocriptine was indicated. But normalization of prolactinemia and tumor size decrease (>50%) were noted in one of them after 24 months.
Conclusion: It seams that prolactinoma of the elderly was characterized by a fortuitous discovery or on the occasion of decreased visual acuity (66.6% of cases) which explained the initial diagnostic delay, because of non-specific clinical signs.
18 - 21 May 2019
European Society of Endocrinology