Endocrine Abstracts

JOINT453

In women, prolactinomas are usually diagnosed between 20 and 40 years old, they are not frequently detected in postmenopausal women because they do not usually present symptoms of hyperprolactinemia as the ovarian function has stopped. There are scarce published data on their presentation and prognosis. The prevalent symptoms in this age are tumor mass effects. The exact incidence of prolactinomas in postmenopausal women is unknown.

Objective: Assess the clinical symptoms, biochemical and imaging findings at presentation, follow-up and the outcome in a cohort of postmenopausal women with prolactinomas.

Material and Methods: Retrospective, multicenter study in Argentina between 2014-2024. Nine patients with prolactinomas diagnosed in menopause were evaluated. The following patients’ data were recorded: age at last menstruation, age at prolactinoma diagnosis, adenoma size (mm), visual field, treatments performed, and biochemical determinations. For the statistical analysis, Infostat software was used. The results are expressed according to data distribution as median (Q1-Q3).

Results: The median age at diagnosis was 62 (60-68). The median age of the last menstruation was 47 (35-48); in 4 cases was reported before 40, 56% of patients had pregnancies before prolactinoma diagnosis. The most commonly symptoms at diagnosis were: headaches (2/9), and visual field defects (VFD) (5/9): 2 patients had bilateral hemianopsia, 1 had unilateral hemianopsia and 2 bilateral quadrantopsia; galactorrhea was present in 33%; 5/9 were incidental findings. Median serum prolactin was 1325 ng/ml (1000-2695), all patients had secondary hypogonadism (low levels LH, FSH and estradiol), 44% of the patients had other pituitary axes affected, the most frequent were thyroid and adrenal. Macroadenomas and cavernous sinus invasion macroadenomas were diagnosed in 56% and 44%, respectively. All the patients were treated with cabergoline, with doses between 1-4 mg/week, median treatment period was 60 (24-63) months. In the follow-up, 8/9 normalized prolactin levels, 7/9 women had reduction of the tumor size in more than 50 %, and tumor disappeared in the other 2. Most of these women (75%) normalized VFD.

Conclusions: In our series of patients with prolactinomas diagnosed in the postmenopausal period, the incidental finding at diagnosis of prolactinoma was more frequent compared to other publications. Almost half of the patients had the last menses in their fertile age, we can hypothesize that prolactinomas were present in that period but the diagnosis was made after menopause. All women treated with cabergoline had an excellent response in size reduction of adenomas, improved VFD and normalize prolactin levels.