Surgical treatment for male prolactinoma

Abstract

A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index.Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases

Pituitary Hyperplasia, Hormonal Changes and Prolactinoma Development in Males Exposed to Estrogens—An Insight From Translational Studies

“…Pituitary adenomas are generally less vascularized than normal pituitary tissue, though a significantly higher degree of vasculature, also observed in our estrogenized Orx males ( Figure 2), has been shown in macroprolactinomas when compared with noninvasive microprolactinomas [71]. Male patients typically have higher serum PRL levels and larger tumor volumes, exerting more aggressive and/or refractive behavior in comparison with female patients [10,72,73]. Some authors indicate higher [74], while others lower [11], expression of ERα in prolactinomas from male patients.…”

“…Similar prevalence, but a higher incidence of pituitary prolactinoma formation is observed in women at a younger age in comparison with men [7,8] and disappears after menopause [9]. Moreover, male patients have a higher serum PRL level and larger tumor volume in comparison with female patients with prolactinoma [10,11]. Typically, prolactinomas have a more aggressive clinical behavior in men [12,13].…”

Pituitary lactotroph adenomas resistant to dopamine agonist treatment: histological and immunohistochemical characteristics

“…Сочетанная иммуноэкспрессия ПРЛ и СТГ без клинико-лабораторных проявлений акромегалии встречается в ЛАГ [12]. Возможно, это связано с общей клеткой-предшественницей, из которой в присутствии эстрогенов происходит развитие лактотрофной клетки, а в отсутствие эстрогенов по умолчанию формируется соматотрофная клетка.…”

Clinical management of difficult to treat macroprolactinomas

“…A recent retrospective study analyzed the surgical outcome of 184 men with surgically treated Prolactinomas. Among them, 178 patients had a macroprolactinoma (152 had a maximal size below 4 cm and 26 with a maximal size >4 cm) and 61/152 (33.1%) of cases were invasive [84]. A post-surgical initial remission of PRL levels was observed in only 10% of invasive cases (i.e.…”

“…A post-surgical initial remission of PRL levels was observed in only 10% of invasive cases (i.e. suprasellar and/or parasellar and/or sphenoidal invasion) [84]. In case of resistance to DA, surgery is a valuable therapeutic option which results in normalization of PRL in half of patients [85].…”