Endocrine Abstracts

Introduction: Prolactinomas in men are rare but are characterised by their giant and invasive nature. They present with signs of hypogonadism and mass effect. The aim of this study is to clarify the clinical, biological, radiological and therapeutic features of Prolactinomas in men.

Patients and methods: Retrospective descriptive study including 27 adult males with a prolactin pituitary adenoma hospitalized in the endocrinology department of the Hedi Chaker Sfax university hospital over the period from 1998 to 2020.

Results: The average age of diagnosis was 38.6 years with two peaks of incidence: between 20 and 39 years (59.52%) and between 40 and 59 years (25.9%). The most frequent revealing symptom was mass effect (48.1%) Dcreased libido and erectile dysfunction were found in 85.1% and 81.4% of cases respectively. Gynecomastia was found in 8 patients and galactorrhea in only 2 patients. Prolactin levels above 250 ng/ml were present in 24 patients, 7 of whom had prolactin levels above 10 000. The prevalence of pituitary insufficiency was 85.1%. Gonadotropic deficiency was the most frequent (85.1%, n=23) followed by corticotropic and thyroid deficiency (37% and 25.92% respectively). The mean tumour size was 46 mm [9–90 mm]. Giant prolactinomas and macroprolactinomas were the most frequent (48.1% and 40.7% respectively). Only 3 patients had a microprolactinoma. Suprasellar extension was found in 85.2% of cases. Invasion of the cavernous sinus was found in 48.1% of cases and invasion of the sphenoidal sinus in 40.7% of cases. A cystic component was found in giant prolactinomas (30.7%, n=4). Radiological apoplexy was found in 29.5% of cases. The first-line treatment was medical in almost all patients. Surgical treatment was performed in 5 patients in the case of resistance to medical treatment in 4 patients and as first-line treatment in the case of chiasmatic compression with visual prognosis in one patient. Complete disappearance of the adenoma was observed in only 5 patients and 63.1% of prolactinomas were resistant to treatment.

Conclusion;: Compared to other types of adenoma. Treatment resistance defined as persistence of the adenoma and/or hyperprolactinemia is common in macroadenoma and invasive tumours. Other factors are very young age, male gender, cystic, haemorrhagic and/or necrotic components on initial imaging. This leaves room for new therapeutic alternatives such as pasireotide and temozolomide.