Endocrine Abstracts

JOINT2384

Introduction: The management of prolactin-secreting pituitary adenomas in men presents unique challenges due to their frequent late diagnosis and aggressive presentation, especially in cases of macroprolactinomas or giant prolactinomas. This study aimed to evaluate therapeutic approaches and their outcomes in male patients with prolactinomas.

Methods: We conducted a retrospective, descriptive, and analytical study of 36 men treated for prolactin-secreting adenomas at the Endocrinology and Diabetology Department of Hedi Chaker University Hospital, Sfax. Treatment modalities included dopamine agonists, surgery, and radiotherapy, with assessments of their clinical, biological, and radiological responses.

Results: From a therapeutic perspective, 20 patients (62.5%) were treated with dopamine agonists alone, 12 patients (37.5%) underwent surgical excision combined with dopamine agonists, and 4 patients (11.1%) had undergone surgical excision at the time of diagnosis without any association with medical treatment, either before or after the surgical procedure. However, radiotherapy was not indicated for any patient in our study cohort. Regarding disease progression, 17 patients (47.22%) had regular follow-up with good therapeutic adherence, with an average follow-up duration of 49.27 ± 59.17 months, ranging from 1 to 180 months. Among them, 11 patients (30.56%) achieved remission, and 6 patients (16.67%) had a favorable outcome. Of those who achieved remission, 3 patients (27.27%) experienced a late relapse. However, no patient had an early recurrence. Treatment resistance was only observed in 3 patients. We investigated the effectiveness of dopamine agonists (DA) in reducing prolactin levels and controlling tumor volume. We demonstrated that, regardless of tumor size, Cabergoline is more effective in achieving normal prolactin levels at lower to medium doses when compared to Bromocriptine. However, we could not identify any statistically significant correlation between the different therapeutic approaches and their effect on tumor volume (P = 0.440). For patients who achieved clinical remission, they had a significantly smaller average tumor volume (P = 0.008) and a lower initial prolactin level (P = 0.031) compared to those with a favorable progression or post-treatment resistance.

Conclusion: The management of prolactin-secreting adenomas in men remains challenging due to frequent resistance to medical therapy, tumor aggressiveness, and treatment-related complications. While dopamine agonists are highly effective in most cases, surgery is indispensable for resistant or complicated tumors. Long-term follow-up is crucial to monitor recurrence and manage persistent complications.