Influence of age on the clinical presentation of prolactinomas in male patients

Objective: Secreting pituitary adenomas are usually not considered a diseas e of older people. However, in male patients, prolactin-secreting pituitary tumours occur at a similar frequency throughout the entire life span, givi ng the opportunity to study in this gender the influence of age on the clin ical presentation and response to treatment of these tumours. Methods: We c onducted a retrospective study including 9 male patients aged greater than or equal to 60 (range 60-73) years and 10 aged less than or equal to 30 (ra nge 17-30) years presenting with a prolactinoma in order to compare clinica l presentation, results of pituitary function tests, and response to dopami ne agonist therapy between older and younger patients. Results: Four of the 9 elderly as well as the 10 younger patients came to medical attention for typical features of male prolactinomas including visual field defect in 5 (2 elderly), headaches in 2 (1 elderly), impotence in 3 (1 elderly), gynaec omastia and/or galactorrhoea in 2, and arrested puberty in 2. The remaining 5 older people presented for other various reasons: symptoms related to co rtisol deficiency in 2, lethargy with clinical signs of hypopituitarism in 1, spontaneous multiple vertebral fractures in 1, and incidental discovery of a pituitary mass in 1. Basal prolactin levels (3,051 +/- 4,151 vs. 3,365 +/- 4,949 mu g/l) and mean tumour diameter (30 +/- 16 vs. 25 +/- 13 mm) we re similar in old and young patients. Cortisol deficiency was significantly more frequent in the elderly (n = 6) than in the young (n = 1) patients (p 0.02, Fisher's exact test). Secondary hypothyroidism was found in 2 elderl y only, but not in young patients. Sixteen patients (8 elderly) received br omocriptine therapy for at least 6 months with a good tolerance. Normalizat ion of the prolactin levels was achieved in 6 older (75%) and 4 younger pat ients (50%). Conclusions: The presentation of a prolactinoma in the elderly man is very heterogeneous and can be misleading. At the time of diagnosis, hypopituitarism is more frequent among older than younger patients despite a similar tumour size. We found dopamine agonists equally effective in the elderly.