Keywords
Men
surgical procedures
dopamine agonists
hyperprolactinemia
prolactine
How to Cite
Abstract
Introduction: Prolactinomas are the most common producing pituitary tumors in clinical practice. Although they are more common in women, in men their behavior is different, more aggressive, and with an uncertain response to pharmacological treatment.
Objective: To describe the clinical and biochemical characteristics and the response to pharmacological and surgical treatment of a group of men with invasive macroprolactinomas.
Materials and methods: A retrospective cohort study was carried out with the clinical data of men diagnosed with invasive macroprolactinomas from the Pituitary Diseases Clinic of the National Institute of Endocrinology, Havana, Cuba and from the Imbanaco Clinic, Cali, Colombia (2022-2017), with an age range between 10-80 years. An analysis of the demographic and clinical characteristics, signs, symptoms, hormonal biochemical profile, magnetic resonance imaging of the anatomy of the hypothalamic-pituitary region, medical and surgical treatment was performed. Proportions and measures of central tendency were estimated through univariate analysis. The two types of treatment were compared using Student's t-test or Kruskal-Wallis test.
Results: 30 men were analyzed, mean age was 44±13.8 years; 5.2 ±4.1 years of disease evolution; 96% presented headache, 80% hypopituitarism. The mean baseline serum prolactin was 487?g/L. Treatment with surgery plus dopamine agonists was performed in 53%, with a decrease of 86% and 96% in serum prolactin at 6 and 12 months, respectively; patients receiving dopamine agonists had a 71% and 95% decrease in serum prolactin at 6 and 12 months, respectively. Initially, patients with surgical treatment obtained a greater reduction in tumor size, but there were no differences at one year of follow-up.
Conclusion: Combined treatment with surgery plus dopaminergic agonists did not have a greater reduction in prolactin levels during the first year of treatment, regardless of tumor size. In male patients with invasive macroprolactinomas, pharmacological treatment with dopamine agonists is the first-line treatment of choice.
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