Endocrine Abstracts

Background: Incidental pituitary haemorrhage in prolactinomas is a common radiological finding. The clinical significance, associations and outcome of this are largely unknown. Most reports describe 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 attending 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 more prevalent 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±standard error of mean) months. Anticoagulant therapy, diabetes, hypertension and type 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<0.0001) and being female (odds ratio 8.03 (95% CI 1.22–52.95, P=0.03) were independently associated with haemorrhage.

Conclusion: These data show that haemorrhage is relatively common in macroprolactinoma where one in five develop haemorrhage but is also present in microprolactinoma. The vast majority were clinically silent and resolved spontaneously with only dopamine agonist therapy. We present novel data showing that women, particularly with macroprolactinoma, were more likely to develop haemorrhage in comparison to men.