Objective To study the outcome of men with macroprolactinoma following cabergoline treatment based on tumour size. Design Retrospective cohort study. Methods The study included 94 men, divided into three groups according to adenoma diameter: 10–19 mm (Group A, n = 36); 20–39 mm (Group B, n = 41); or ≥40 mm (Group C, giant prolactinomas, n = 17). Patients were followed for a mean of 7.5 years with sellar magnetic resonance imaging, visual fields and hormone measurements. Results Mean baseline prolactin was 767, 2090 and 24,806 ng/ml in Groups A, B and C, respectively (p < .01). Prolactin suppression below three times the upper limit of normal (ULN) was achieved in 34 (94%; mean weekly cabergoline dose of 1.2 mg), 37 (90%; cabergoline dose, 2.1 mg) and 15 (88%; cabergoline dose, 2.8 mg) men (p = .31) in each group. After excluding patients who underwent surgery and radiotherapy, cabergoline suppressed prolactin below three times ULN in 32/35 (91%), 29/37 (78%) and 11/14 (79%) men in Groups A, B and C, respectively (p = .27). Visual deficits were observed in 5 (14%), 12 (29%) and 10 (59%) patients (p < .01); improvement was achieved in 5/5 (100%), 11/12 (92%) and 10/10 (100%) of men in Groups A, B and C. Low baseline testosterone was measured in 26 (72%), 39 (95%) and 17 (100%) patients in the three groups (p < .01). Following multi‐modal treatment, hypogonadism persisted in 3 (8%), 5 (12%) and 2 (12%) men, respectively (p = .85). Conclusion Macroprolactinomas in men were controlled with cabergoline in 84% of cases, independent of tumour size. Pituitary surgery and adjuvant radiotherapy further improved long‐term response to 91%.
Day-to-day BPV is associated with 30-day, but not with 1-year mortality in hospitalized elderly patients.
To study the baseline characteristics predicting hypogonadotropic hypogonadism (HH) persistence in men with macroprolactinoma that achieved prolactin normalization. Design:Retrospective cohort study. Methods:Male patients diagnosed with macroprolactinoma and HH that received cabergoline treatment with subsequent prolactin normalization were included: men that achieved eugonadism, and men that remained hypogonadal. Patient's demographic, clinical and biochemical parameters, sellar imaging and visual elds tests were obtained.Univariate and multivariate models were used to identify predictors of HH persistence. Results:Fifty-eight male patients (age, 49.2±12.6 years) with a median baseline prolactin of 1154 ng/mL (IQR, 478-2763 ng/mL) and adenoma (maximal) diameter of 25.9±14.8 mm were followed for a median of 5.6 years (IQR, 3.0-10.7). Twelve men (21%) suffered from HH persistence at the end of follow-up and 46 men achieved eugonadism. Forty-two out of 46 men (91%) accomplished eugonadism within the rst year following prolactin normalization.In a multivariate logistic regression model, hypopituitarism (OR=10.1; 95% CI 1.10 -101.94), visual eld defect (OR=9.9; 95% CI 1.07 -92.33), and low baseline testosterone levels (OR=0.5; 95% CI 0.29 -0.93) were independent predictors of HH persistence. Conclusion:In our cohort of men with macroprolactinoma that reached prolactin normalization with cabergoline treatment, 21% had HH persistence. Pituitary hormone de ciency, visual eld defects, and low baseline testosterone levels were independently associated with HH persistence. 91% of men achieved eugonadism within the rst year following prolactin normalization. These ndings may support informed clinical decision-making regarding the initiation of testosterone replacement in men with macroprolactinomas.
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