Endocrine Abstracts

Introduction: Prolactinomas are frequent in women and between 20 and 40 years but rarely seen in men especially as macroadenoma. Both in microadenomas and macroadenomes unless there is not any indication for an emergent surgery, first line treatment is always medical with dopamine agonists. In this report, we presented a patient with macroprolactinoma that disappears in a short time with dopamine agonist treatment.

Case: A 20-year-old boy admitted to endocrinology policlinic with complaints of headache for 9 months, short statue and delayed secondary sex characters. In initial physical examination his height, weight and BMI were 161 cm, 61.9 kg and 23.9 kg/m²respectively. His axillary and pubic hair were tanner stage1, left and right testicle volume were 8 ml and enlarged penis length was 6.5 cm. Laboratory values revealed hyperprolactinemia (>200 ng/ml), hypogonadotropic hypogonadism and secondary hypothyroidism. Pituitary MR detected a 40×26×23 mm mass located in hypophysis that invades optic chiasma, sphenoid sinus and cavernous sinus. Eye examination showed a nasal visual field defect. Cabergoline 0.5 mg/per week and levothyroxine 100 μg/day were started and 2 weeks later cabergoline dose was increased to 2 mg/week. At 3th month patient’s testosterone levels and prolactin levels were improved, hipophysis MR revealed that pituitary mass decreased to 21×15×22 mm. At 9th month of cabergoline treatment patient’s right and left testicle volume were both 18 ml, enlarged penis length was 12 cm, axillary and pubic hair were tanner stage 2, laboratory values were all normal, pituitary mass was totally disappeared in MR and no visual defect was detected.

Conclusion: Macroprolactinomas are seen especially in males. In macroprolactinomas first line treatment is medical with dopamine agonists. Clinical presentation of prolactinomas in males are frequently hypogonadism and erectile dysfunction and these symptoms improves with treatment. In our case medical treatment with dopamine agonists was preferred and in a short time prolactinoma was totally disappeared, prolactine levels and hypogonadism were improved. We suggest medical treatment as first line treatment for macroprolactinoma unless there is a urgent surgery indication.