Prolactinomas and hypogonadism in men. Clinical and developmental aspects after treatment: 21 cases

Abstract

Prolactinomas are benign hormone-secreting pituitary tumors, account for a third of all pituitary adenomas and occur both in women and men. In men, usually harboring macroadenomas, the most common symptoms are related to hypogonadism, including decreased libido, erectile dysfunction and gynecomastia. The study included 21 men with prolactinomas, All were diagnosed, treated and followed in the Endocrine Clinic at Bologhine Hospital Information on clinical presentation, laboratory tests [total testosterone level, PRL] pituitary imaging and visual field assessment, at presentation and during follow-up period were collected. Response to treatment and clinical improvement were also reviewed. The classical hallmark of prolactinomas in males beside elevated PRL level, is a suppressed gonadotropins, low testosterone levels and mild anemia. Our study demonstrates that about 90.04% men with prolactinomas presented borderline or low testosterone levels, However, when these men were treated with a dopamine agonist and PRL was suppressed to normal, testosterone levels increased further to higher concentrations, normalization was achieved only 23%, Moreover, the proportion of patients complaining of symptoms related to hypogonadism was 95.3% and almost all men improved clinically when their testosterone was raised further following treatment. Men with the more aggressive tumors suffering from permanently damaged gonadotrophs due to tumor mass pressure, in addition to the hyperprolactinemia-induced testosterone suppression, present with lower testosterone levels that increase after PRL normalization, but still to lower levels, in this group there was 100% of patient who underwent surgery, and 77% of patients with medical treatment. Patients with procreation desire: most had succeeded to have children after treatment, even the borderline testosterone levels for some patients.