Characteristics of prolactin macroadenomas:a cross-sectional analytical study of 40 cases

Farah Ayechi; Hanene Sayadi; sana abid; Raoua Naouar; Ghassen Belkahla; Nsir Atef Ben; Amor Bilel Ben; Ekram Hajji; Ines Bayar; Hela Marmouch; Ines Khochteli; Mahdi Darmoul; Tames Gema Martinez

doi:10.1530/endoabs.99.EP1238

Introduction: Macroprolactinoma is a rare pathology often considered benign. However, its singularity lies in its potential to become highly invasive, threatening both functional and vital prognosis by infiltrating surrounding structures.

Patients and methods: We conducted a monocentric, cross-sectional, analytical study of patients followed for confirmed prolactinoma at the endocrinology-internal medicine and neurosurgery departments of the Fattouma Bourguiba University Hospital, Monastir, from January2000 to March2022.

Results: Our study population comprised 24men and 16women (sex ratio (M/F)1.5) with a mean age at diagnosis of 41±15.3 years. Men were significantly older than women (P<0.001). The mean time to diagnosis was 1.9±0.68 years. The main circumstances of discovery were: headache (47.5%), visual disorders (65%), galactorrhea (22.5%), menstrual cycle disorders (50% of women) and erectile dysfunctio (41.66% of men). The clinical signs most frequently encountered in both sexes were headache (70%), reduced visual acuity (60%) and visual field impairment (65%). In women, galactorrhea-amenorrhea syndrome was the most frequent clinical sign: galactorrhea was noted in 75% of patients, and secondary amenorrhea was present in 56.25% of cases. In men, erectile dysfunction (58.33%) and decreased libido (33.33%) were the most common signs. Median prolactinemia was 399 ng/ml[291.4 - 1075] and mean tumor size was estimated at 28.25±11.85 mm. Extra-sellar extension was observed in 82.5% of cases, with invasion of the cavernous sinus in 62.5% of our patients. In our series, macroprolactinoma was complicated by pituitary deficiency in 85% of patients, involving the gonadotropic axis in 72.5% of cases. The metabolic impact showed the presence of: overweight or obesity (55%), prediabetes (15%), unrecognized diabetes (2.5%), hypertriglyceridemia (7.5%)and hypercholesterolemia (27.5%). Treatment with dopaminergic agonists resulted in tumor reduction and disappearance in 77.5% and 15% of cases respectively, and normalization of serum PRL levels in 65% of cases. Complete remission was achieved in 15% of our patients, more frequently in women than in men, with a statistically significant difference (P=0.01). At the end of our study, we noted a similar serum PRL concentration whatever the type of treatment received, and an absence of significant difference between the mean rate of tumor reduction in the case of surgical treatment compared with that of medical treatment (P=0.2). Among the factors associated with the use of surgery found in our work, only initial tumour size was correlated with surgical treatment.

Conclusion: Macroprolactinoma is a rare and potentially serious disease. Prolonged and regular multidisciplinary collaboration is essential for optimal management of these patients. Thus, a multicentric study and the creation of a national registry are needed to better codify the management of this pathology.

Endocrine Abstracts

EP1238