Endocrine Abstracts

Introdution: Prolactinomas in men are rare and the majority are macroadenomas. Some studies suggest that these tumors in men have higher proliferative activity and aggressiveness indicating gender-specific differences in biological behavior. Dopamine agonists (DA) are considered first-line therapy.

Material/methods: Retrospective analysis of male patients diagnosed with prolactinoma between 2005 and 2016. Age at presentation, clinical, hormonal and image data were collected. Mode and responses to therapy were analysed.

Results: Twenty two patients with median age at diagnosis of 50.8 years were observed. Sexual dysfunction was the main complaint (59.1%), followed by headaches (50%) and visual disturbances (36.4%). Imagiology revealed macroadenoma in 95% of the cases (19% giant). At the time of diagnosis mean value of prolactin (PRL) was 3.662 ng/ml (min 177 ng/ml, max 23.200 ng/ml). Hypogonadism was present in 54.5%. Fourteen patients (63.6%) were treated with DA as the only therapy and eight patients (36.4%) with DA and neurosurgery. From the latter three presented pituitary apoplexy, four were misdiagnosed as non-functioning adenoma and onepresented cerebrospinal fluid rhinorrhea. None of these patients were cured after surgery and all received medical therapy. At the last visit normalization of PRL level were observed in 59.1% of the patients (71.4% treated with AD as only therapy) and 77.8% of the remaining presented a PRL level less than 2X upper limit of normal. Reversal of hypogonadism occurred in 66.7%. Previous and after therapy MRI findings were available in 12 patients. A reduction ≥50% in tumor maximum diameter was achieved in 8 patients. The mean follow-up was 5.4 years.

Commments: Our data confirms that prolactinomas in men are usually symptomatic macroadenomas. Although DA were efficient in reducing tumor size and normalizing PRL, surgery was performed as first-line therapy in four patients due to misdiagnosis and possibly late referral to our department. The correct diagnosis is crucial for successful treatment and avoidance of unnecessary surgery.