Prolactinomas in men: a multicentre and retrospective analysis of treatment outcome

To assess treatment outcome in male patients with micro- and macroprolactinomas.

Multicentre and retrospective study.

Eighty-eight male patients (15 micro- and 73 macroprolactinomas), aged 40·3 ± 14·7 years, were studied. Time of follow-up ranged from 3 to 244 months.

Clinical, hormonal and radiological data were registered at diagnosis and follow-up. Treatment outcome was evaluated in relation to the modality of therapy (dopamine agonists, surgery and radiation therapy).

Dopamine agonists normalized prolactin levels in 73·3% and 65·2% of patients with micro- and macroprolactinomas, respectively. Disappearance of tumour was reached in 53·3% and 28·3% of subjects with micro- and macroprolactinomas, respectively. Tumour absence at last visit was achieved in 7 of 14 patients with macroprolactinoma and treated by means of dual therapy (dopamine agonists and neurosurgery) and in 9 of 13 patients with macroprolactinoma managed with triple therapy (dopamine agonists, neurosurgery and radiation therapy). Normalization of prolactin levels at last visit was present in 68·9%, 79·6% and 69·2% of patients treated by medical therapy, dual therapy and triple therapy, respectively (differences not significant). Multivariate logistic regression analysis showed that the time on therapy was the only significant variable related to tumour disappearance.

We conclude that medical therapy normalizes prolactin and reduces tumour size in the majority of men with prolactinomas. The addition of pituitary surgery with or without radiation therapy does not offer significant advantages over medical therapy with dopamine agonists in male patients with macroprolactinomas.