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Prolactinomas in males: any differences?
Hadar Duskin-Bitan1,2, Ilan Shimon3,4
1Institute of Endocrinology and Metabolism, Rabin Medical Center - Beilinson Hospital, 4941492, Petach Tikva, Israel.
Context:
Prolactinomas in men are usually large and invasive, presenting with signs and symptoms of hypogonadism and mass effects, including visual damage. Prolactin levels are high, associated with low testosterone, anemia, metabolic syndrome and if long-standing also osteoporosis.
Results:
Medical treatment with the dopamine agonist, cabergoline, became the preferred first-line treatment for male prolactinomas as well as for giant tumors, leading to prolactin normalization in ~ 80% of treated men, and tumor shrinkage, improved visual fields and recovery of hypogonadism in most patients. Multi-modal approach including surgery and occasionally radiotherapy together with a high-dose cabergoline is saved for resistant and invasive adenomas. Experimental treatments including temozolomide or pasireotide may improve clinical response in men harboring resistant prolactinomas.
Conclusions:
Compared to other pituitary adenomas, secreting and non-secreting, where pituitary surgery is the recommended first-line treatment, men with prolactinomas will usually respond to medical treatment with no need for any additional treatment.
Insights
Men with prolactinomas typically respond well to cabergoline, a dopamine agonist, which normalizes prolactin levels and improves symptoms. This medical treatment is often sufficient, unlike other pituitary adenomas requiring surgery.
Area of Science:
- Endocrinology
- Oncology
Background:
- Male prolactinomas are often large, invasive pituitary tumors causing hypogonadism and mass effects like vision loss.
- High prolactin levels correlate with low testosterone, anemia, metabolic syndrome, and osteoporosis.
Purpose of the Study:
- To review the current management of prolactinomas in men.
- To highlight the efficacy of medical treatment, particularly cabergoline.
Main Methods:
- Review of current literature on male prolactinoma treatment.
- Analysis of outcomes for medical (cabergoline) and multimodal therapies.
Main Results:
- Cabergoline is the preferred first-line treatment, achieving normalization in ~80% of men.
- It leads to tumor shrinkage, improved vision, and recovery from hypogonadism.
- Resistant cases may require multimodal therapy (surgery, radiotherapy, high-dose cabergoline) or experimental agents.
Conclusions:
- Medical treatment with cabergoline is highly effective for male prolactinomas.
- Unlike other pituitary adenomas, prolactinomas in men often do not require surgery as first-line therapy.
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