Introduction: Male patients with prolactinoma commonly present with macroadenoma and a history of long-standing hypogonadism. Data regarding the effect of hypogonadism on bone health in these patients is scarce. The present study compared the long-term results of male patients with prolactinomas treated primarily either surgically or medically.
Methods: This retrospective study evaluated the records of 44 male patients with proven prolactinoma. Clinical and biochemical characteristics, as well as tumor size, were assessed at baseline, first-, and last-follow-up.
Results: The mean age at diagnosis was 47 ± 15 years. Mean body-mass-index (BMI) at diagnosis was 28.7 ± 4.5 kg/m2. Median prolactin levels were 1979 µg/L [interquartile range (IQR) 768.4 – 5368], and MRI scan showed macro- or microadenoma in 82% and 18%, respectively. Pathological bone density was revealed in 25% of the patients. Therapeutic strategy included primary operation in 34% and dopamine agonists in 66% of these patients.
The average long-term follow-up was 81.4 ± 62.6 months. Mean BMI tended to decrease, from 28.7 ± 4.5 to 28.0 ± 4.4 kg/m2 (p=0.36). Median prolactin concentration decreased significantly, to 13.8 µg/L [6.2 –29.4] (IQR; p<0.0001) and was within normal range in 73% of the patients. Hyperprolactinaemia was controlled in 66% in the medically treated group versus 93% in the surgically treated group (p=0.07). Control of hyperprolactinaemia required dopamine agonist therapy in 47% of patients with primary surgical therapy, compared to 90% of patients with primary medical therapy (p=0.003). Fifty-five percent of all patients required testosterone therapy. Biphosphonate and/or vitamin D and calcium were prescribed in 29% of all patients, with no significant difference according to the therapeutic strategy (i.e. primary surgery vs. primary medical therapy; p=0.16).
Conclusions: Based on our results, bone densitometry in male patients with prolactinoma can be recommended.
The present data support the discussion about the need for pituitary surgery as primary treatment in selected male patients aside from the classical indication (i.e. intolerance of dopamine agonists and non-responder).
Patient Care: The present data support the discussion about the need for pituitary surgery as primary treatment in selected male patients and may help in clinical decision making.
Learning Objectives: By the conclusion of this session, participants should be aware that:
1) Osteopenia is a common co-morbidity in male patients suffering from prolactinoma
2) Surgery can be recommended as primary treatment in male patients with macroprolactinoma