Comparison of Male and Female Prolactinoma Patients Requiring Surgical Intervention

Abstract

Prolactinomas are the most common functional pituitary adenoma. Symptoms of a prolactinoma stem from hormonal causes (menstrual irregularities, galactorrhea, and reduced libido) or from tumor mass effect (visual changes and headache). Gender differences have been noted in prolactinomas, with males presenting with larger tumors and sequelae of mass effect, while females present commonly with hormonal symptoms. The purpose of this study is to evaluate differences in patient and disease characteristics, and outcomes between male and female prolactinoma patients undergoing surgery. This was a retrospective chart review. This was done at the tertiary medical center. The medical records of prolactinomas patients who underwent endoscopic endonasal surgery between March 2008 and August 2016 were reviewed. Demographic information, tumor characteristics, and treatment characteristics and outcomes were collected. Statistical analysis was performed using chi-squared test or Student's -test as applicable. Seventy-nine patients were identified, 22 males and 57 females. The average age for males was 38 years and for females was 35 years. Males were more likely to present with decreased libido ( < 0.0001), whereas females more often presented with galactorrhea ( < 0.0001) and menstrual irregularities. Tumor size was larger in males ( = 0.0044) with higher likelihood of suprasellar extension ( = 0.0409) and cavernous sinus invasion ( = 0.0026). Males were more likely to have a subtotal resection rather than gross total resection ( = 0.0086) and less likely to have normalization of prolactin levels following surgery ( = 0.0019) Male prolactinoma patients tend to have larger tumors with more aggressive features. This may have a role in the differences in outcomes noted in this study.

Aggressive prolactinoma (Review)

“…Overall, the cluster of elements used for evaluating the potential aggressive behavior starts with high prolactin levels at first admission and large diameter upon computed tomography or magnetic resonance imaging; yet these themselves do not necessarily indicate an APRL (27,28). If the patient is a male or there is an early age at diagnosis or a genetic predisposition is identified, the prognosis may be poor (27,29). Furthermore, the development of DA (mostly cabergoline) resistance represents another useful clue (27,30).…”

Pituitary adenomas

“…Prolactinomas are more often missed in men than women due to subtle non-specific symptoms (see Clinical features ) in the former, whereas in women a relatively mild hyperprolactinaemia usually causes menstrual disturbance (oligo-amenorrhoea/ amenorrhoea) 1011. Men often fail to seek medical advice due to embarrassment or denial about their lowered libido or erectile dysfunction or attributing them to other factors, leading to larger prolactinomas at diagnosis 1011…”

“…Men often fail to seek medical advice due to embarrassment or denial about their lowered libido or erectile dysfunction or attributing them to other factors, leading to larger prolactinomas at diagnosis 1011…”

Respuesta clínica y bioquímica al manejo de macroprolactinomas en hombres latinoamericanos, Cali, Colombia y la Habana, Cuba

“…Finally, in prolactinomas with mass effect surgery or radiosurgery may be indicated, however, there is a greater probability of hypopituitarism and recurrence (12). Other indications for surgical treatment include intolerance to the side effects of medications, the desire to become pregnant, or those related to the patient's preference (13).…”

“…Yoo et al (13) described that men undergoing resection surgery were less likely to normalize serum prolactin levels, since the tumor is more aggressive and is able to spread to the suprasellar region or the cavernous sinus. In the review by Penn et al (14) they showed that even though surgical treatment of prolactinoma is a safe procedure, with efficacy in hormonal and symptom control, it is less likely that it will not remit with surgery alone in men.…”