Medical therapy of macroprolactinomas in males: I. Prevalence of hypopituitarism at diagnosis. II. Proportion of cases exhibiting recovery of pituitary function.

摘要: Hyperprolactinaemia frequently causes secondary hypogonadism through central suppression of gonadotropin secretion. Macroprolactinomas (>1 cm diameter) are more common in males and may additionally cause generalised hypopituitarism. Recovery the thyrotropic and/or corticotropic axes is well described following selective adenomectomy, but remains poorly defined relation to medical (dopamine-agonist) therapy macroprolactinomas. We therefore performed a retrospective examination case records male patients who had received alone for macroprolactinoma between 1980–2001 (n = 35) whom tumor shrinkage was documented by interval pituitary imaging (reported throughout single neuroradiologist). Mean prolactin level at baseline 59,932 mU/L (median 31,400; range 3,215–332,000); mean period follow up 4.2 years 2.6; range: 1.0–15). Defects were evident diagnosis: LH/FSH-testosterone 27; 77%), TSH-T4 14; 41%-not including one with pre-existing 1° hypothyroidism), ACTH-cortisol 8; 23%). Overall, 14 men (40%) deficient 1 axis, seven (20%) 2 3 axes. Growth hormone secretory status not systematically evaluated. In all 6 patients, levels fell normal or near-normal (mean 764 mU/L; median 260; <10–4,833). Of adequate reassessment been performed, thyrotroph function recovered 4/9, corticotroph 4/6 gonadotroph 16/26 cases. four cases (11%) previously described, development visual impairment as result chiasmal traction syndrome necessitated dose reduction allow degree controlled re-expansion. The prevalence diagnosis TSH ACTH deficiency macroprolactinomas 41% 23%, respectively. Among eight insufficiency secretion underwent complete over several treatment, recovery least axis occurred six (75%). This study highlights importance screening ACTH- TSH-deficient during dopamine agonist order identify where hypopituitarism has resolved.