Prolactinoma in 53 men: clinical characteristics and modes of treatment (male prolactinoma)

Abstract

The data of 53 men treated for hyperprolactinemia were reviewed retrospectively to determine the efficacy of the medical and surgical treatment. The clinical assessment, radiological and neuro-ophthalmological investigations and hormonal measurements were performed before treatment as well as during the follow-up period. Imaging evaluation included computed tomography and/or nuclear magnetic resonance of the pituitary. The hormonal profile examined was PRL, FSH, LH and testosterone, as well as TSH, T4, T3 and cortisol. Thirty patients were treated solely by dopamine agonists (DA), twenty-two men had pituitary surgery in addition to DA treatment, and one patient was operated with no need for medical treatment. Decreased sexual function was the most frequent presenting symptom (85% of the men). Most of the patients had large invasive macroadenomas, with suprasellar extension. More than 40% had visual field defects. Baseline PRL (mean +/- SE) was 51,842 +/- 9,292 mU/L and decreased to a level below 575 mU/L in 70% of the patients after DA therapy. Mean testosterone, FSH, and LH levels increased slightly but significantly from the low baseline values. Complete clinical response to DA was achieved in 49% of the men and the tumor mass disappeared entirely in 21%, and incompletely in 42%. The surgical success rate (transsphenoidal or trans-cranial operation) was low--only one of the 23 patients operated recovered completely, and most of the patients were left with hormonal deficits and hyperprolactinemia. These findings indicate that continuous medical treatment with DA should be the preferred mode of treatment for male prolactinomas. Removal of these large tumors is recommended only when the tumors are life-threatening or if drug resistance or severe adverse reactions to DA develop.