PROLACTINOMA IN 53 MEN - CLINICAL CHARACTERISTICS AND MODES OF TREATMENT (MALE PROLACTINOMA)

The data of 53 men treated for hyperprolactinemia were reviewed retros pectively to determine the efficacy of the medical and surgical treatm ent. The clinical assessment, radiological and neuro-ophthalmological investigations and hormonal measurements were performed before treatme nt as well as during the follow-up period. imaging evaluation included computed tomography and/or nuclear magnetic resonance of the pituitar y. The hormonal profile examined was PRL, FSH, LH and testosterone, as well as TSH, T4, T3 and cortisol. Thirty patients were treated solely by dopamine agonists (DA), twenty-two men had pituitary surgery in ad dition to DA treatment, and one patient was operated with no need for medical treatment. Decreased sexual function was the most frequent pre senting symptom (85% of the men), Most of the patients had large invas ive macroadenomas, with suprasellar extension. More than 40% had visua l field defects. Baseline PRL (mean rt SE) was 51,842 +/- 9,292 mU/L a nd decreased to a level below 575 mU/L in 70% of the patients after DA therapy. Mean testosterone, FSH, and LH levels increased slightly but significantly from the low baseline values. Complete clinical respons e to DA was achieved in 49% of the men and the tumor mass disappeared entirely in 21%, and incompletely in 42%. The surgical success rate (t ranssphenoidal or trans-cranial operation) was low - only one of the 2 3 patients operated recovered completely, and most of the patients wer e left with hormonal deficits and hyperprolactinemia. These findings i ndicate that continuous medical treatment with DA should be the prefer red mode of treatment for male prolactinomas. Removal of these large t umors is recommended only when the tumors are life-threatening or if d rug resistance or severe adverse reactions to DA develop.