Prolactinomas in Moroccan Population: Clinical, Paraclinical, Therapeutic, and Evolutionary Aspects

Prolactinomas are usually benign tumors and are the most common type of secretory adenomas. Their diagnosis is well coded, and their severity depends on the tumor size identified by magnetic resonance imaging. The aim of this work is to study the epidemiological, clinical, paraclinical, and therapeutic profile of prolactinomas through a retrospective and descriptive study of 95 cases of prolactinomas conducted at the Endocrinology, Diabetology and Nutrition Department of the Hassan II University Hospital of Fez between January 2015 and November 2020. The mean age of patients in our series was 33.8 years (14-63) with a clear female predominance of 88.4%. Based on adenoma size, 37 cases were microprolactinomas and 58 cases were macroprolactinomas representing 38.9% and 61.1% respectively. Menstrual disorders were present in 50.5% of the women, and 68.4% had galactorrhea, while 44.2% of patients complained about local mass effects, especially headaches. The average size of adenomas was 15.7 mm (4-70 mm). The mean initial plasma prolactin (PRL) level was 423.2 ng/mL (103-7,663 ng/mL). Of our patients, 97.9% received medical therapy with dopamine agonists, particularly with cabergoline which represents the mainstay of therapy (85.3%), while 2.1% of patients underwent surgery due to resistance to treatment. In terms of evolution after treatment, three cases of resistance to treatment were reported. Thirty patients with microprolactinomas had a normalization of prolactin level within an average of five months, and we saw a regression of the size of the adenoma in 43.2% of patients, stabilization in 24.3% and a progression of the process in 5.4% of cases. Although in macroprolactinomas we found a normalization of prolactin level in 43 patients within an average of one year, the tumor syndrome disappeared in 31.6% of cases. Radiological monitoring also revealed a favorable tumor response in 82.7% of patients.