Endocrine Abstracts

Background: Incidental pituitary haemorrhage, not associated with pituitary apoplexy, is a common clinical and radiological finding. Little information exists on the clinical behaviour of incidental haemorrhage with most reports describing surgically treated macroprolactinoma and non-functioning adenoma, and there are few data in a clinic prolactinoma population.

Aims: To characterise the prevalence, natural history and risk factors associated with pituitary haemorrhage in a large clinic prolactinoma population.

Method: A retrospective case-note analysis of 368 patients with prolactinoma presenting to Guy’s and St Thomas’ Hospitals between 2000 and 2008. Presence of haemorrhage was noted on magnetic resonance imaging (MRI).

Results: Pituitary haemorrhage was found in 25 patients, giving an overall prevalence of 6.8%, and was significantly higher in macroprolactinoma (20.3%) than in microprolactinoma (3.1%) (P<0.0001). Three patients had classical pituitary apoplexy. The majority of patients in the haemorrhage group had macroprolactinomas (16/25 (64%)) and the majority were female (22/25 (88%)). The proportion of females with macroprolactinoma was also higher in the haemorrhage group (14/16 macroprolactinomas (87.5%)) than in the non-haemorrhage group (36/63 macroprolactinomas (57.1%)P=0.02).The majority of patients were treated conservatively (92%) with 87% of patients having complete resolution of their haemorrhage within 26.6±5.2 (mean±S.E.M.) months. Anticoagulant therapy, diabetes, hypertension and different types of dopamine agonist therapy were not associated with pituitary haemorrhage. After adjustment for confounders, the presence of macroprolactinoma (odds ratio 9.00 95% CI 3.79–23.88 P<0.001) and being female (odds ratio 8.03 (95% CI 1.22–52.95) were independently associated with haemorrhage.

Conclusion: These data suggest that haemorrhage is common in macroprolactinoma where one in five develop haemorrhage, but is also present in microprolactinoma. The vast majority resolved spontaneously with medical treatment. We also present novel data showing a strong female preponderance, suggesting that women, particularly with macroprolactinoma, were more likely to develop haemorrhage.