Anemia in a cohort of men with macroprolactinomas: increase in hemoglobin levels follows prolactin suppression

Abstract

Men with hypogonadism tend to have low hemoglobin (HGB) levels. We have investigated a cohort of 36 consecutive male patients with macroprolactinomas to evaluate HGB during presentation and following treatment with cabergoline to suppress prolactin (PRL). Patients' mean age at diagnosis was 48 years, the mean adenoma size measured 31 mm. The median PRL at baseline was 1,969 ng/ml; the mean testosterone level was low, 1.5 ng/ml. PRL had been successfully normalized in all but six men by using cabergoline. Mean baseline HGB at diagnosis was 13.1 gr%. Sixteen patients had HGB ≤ 13 gr%, including 4 men with HGB ≤ 11.5 gr%. In the subgroup of 15 men with very low testosterone (≤ 1 ng/ml), baseline HGB was 12.6 gr% compared with 13.5 gr% in patients with higher testosterone (P < 0.005). In 30 men in whom follow-up CBC data were available, mean baseline HGB increased from 13.2 to 13.9 gr% following PRL suppression by cabergoline. Baseline HGB levels inversely correlated with tumor size, reaching levels of 13.7 gr% in 10 men with macroprolactinomas of 10-20 mm in size, 13.0 gr% in 18 subjects with macroadenomas of 21-40 mm, and 12.4 gr% in 7 patients with giant prolactinomas (>40 mm). In 22 men with normal follow-up testosterone, current HGB levels measured 14.5 gr%, but only 12.8 gr% in 9 men with current low testosterone (P < 0.0005). In men with macroprolactinomas, anemia is common. It is associated with hypogonadism and tumor size, and improves following treatment that normalizes PRL and increases testosterone.

Clinical significance of anaemia associated with prolactin-secreting pituitary tumours in men

“…Anaemia was always linked to the presence of macroprolactinoma and more frequently associated with total hypopituitarism. An association between anaemia and pituitary adenoma has been identified, mainly in men (5,6). In a retrospective analysis performed in 197 patients (100 men) older than 50 years of age with pituitary adenomas, 31 (46.3%) of 67 men with low serum concentrations of testosterone were anaemic (haematocrit < 40% for men).…”

“…It has been reported that haematopoiesis is compromised in men who have low concentrations of testosterone because of a pituitary adenoma, supporting a direct relationship between serum testosterone levels and haematopoiesis in men (5). More recently, an association between anaemia and macroprolactinomas in male patients has also been documented (6). In this setting, anaemia was related to hypogonadism and tumour size, and an improvement in haemoglobin concentrations have been reported after achieving normalisation of PRL levels and increase in testosterone concentrations with appropriate therapy (6).…”

“…More recently, an association between anaemia and macroprolactinomas in male patients has also been documented (6). In this setting, anaemia was related to hypogonadism and tumour size, and an improvement in haemoglobin concentrations have been reported after achieving normalisation of PRL levels and increase in testosterone concentrations with appropriate therapy (6).…”

Niezwykłe współwystępowanie nietypowego guza przysadki wydzielającego TSH i przewlekłej białaczki limfatycznej

“…Moreover, other haematological disturbances have been observed in patients with prolactinoma, Sheehan's or Cushing's syndrome [7][8][9]. Acute leukemias have been observed in patients with acromegaly, craniopharyngioma, and Cushing's disease [9][10][11][12].…”

Erythropoietin promotes the growth of pituitary adenomas by enhancing angiogenesis

“…So far, whether rhEPO administration demonstrates similar adverse effect on pituitary adenoma has not been deciphered. Since many patients bearing pituitary adenomas receive conservative treatment and anemia is common in these patients, especially those with macroprolactinomas (17–19), unveiling the potential risk of rhEPO on pituitary adenomas has high clinical value in guiding clinicians who care for anemia patients with pituitary adenomas.…”