Endocrine Abstracts

Introduction: Patients with prolactinomas suffer from a wide range of symptoms, of which the effect on health-related quality of life (HR-QoL) needs further investigation. Moreover, the first-line treatment for patients with prolactinomas, dopamine agonists (DAs), albeit being effective in lowering prolactin levels, might further hamper HR-QoL due to side effects. To assess the impact of symptoms and treatment modality on HR-QoL, a cohort of patients with prolactinoma was cross-sectionally investigated.

Methods: Baseline clinical characteristics, symptoms (measured using the PRO-CTCAE, and HADS questionnaire), treatment outcomes, and HR-QoL (measured using the SF-36 questionnaire) of 210 DA treated (DAT) patients (mean age 49.4±15.4 years; 122 females (58.1%)), and 106 patients not treated with DA (mean age 40.9±12.9 years; 87 females (82.1%)) are described in this Dutch multicenter prospective observational cohort study.

Results: Current prolactin levels -available for 229 patients- were elevated above the sex upper limit of normal in 54/210 DAT patients (34.8%), and in 52/106 patients not treatment with DA (70.3%, P<0.001). Galactorrhea was reported more frequently by 13/44 (29.5%) patients not treated with DA vs 15/119 (12.6%) DAT patients (P=0.011), and was more frequently reported by female patients (25.0% vs 1.8%, P<0.001). Side effects of DA treatment – reported by 155/210 DAT patients – were gastro-intestinal (GI) tract symptoms (total 63/155 (40.6%), males 14/68 (20.6%) vs females 49/87 (56.3%), P<0.001); fatigue (total 77/155 (50.0%), males 22/68 (32.4%) vs females 55/86 (64.0%), P<0.001), and concentration loss (total 41/155 (26.6%)). DA treatment did not influence risk for anxiety (36/143 vs 18/65, P=0.747) and depression (30/144 vs 17/65, P=0.394), and was not different in males and females. All HR-QoL domains, bar physical functioning and pain, were lower in patients with prolactinoma compared to the Dutch population (General Health domain 55.0±14.5 in patients with prolactinoma vs 70.7±20.7 in the Dutch population, P<0.001). Female patients had lower domain scores on Social Functioning (68.4±29.0 vs 77.9±26.1, P<0.025), Fatigue (48.4±22.8 vs 59.9±22.0, P<0.001), and Pain (77.0±26.3 vs 85.3±18.9, P<0.025).

Conclusions: Based on this cross-sectional analysis of the Dutch national cohort of patients with prolactinomas, 66.5% of patients were currently treated with DA. Despite DA treatment, a proportion of patients had prolactin levels above the ULN. Significant sex differences for most outcomes of interest (i.e. current treatment, current tumor size, symptoms at present) were observed, necessitating further research into sex differences in patients with prolactinoma. Moreover, HR-QoL was significantly affected in patients with prolactinoma, highlighting the impact of the prolactin-producing tumor.