Hypopituitarism patterns and prevalence among men with macroprolactinomas

Abstract

Macroprolactinomas in men caused partial hypopituitarism, affecting testosterone in all adenoma size groups and cortisol more in patients with larger adenomas. However, most of the men did not have pituitary hormones affected, beside testosterone. Most patients recovered central hypocortisolism but not hypothyroidism following treatment.

Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients

“…A previous study on prolactinoma but not NFPA showed that the group of larger tumor had significantly high prevalence of secondary adrenocortical insufficiency which was defined as peak cortisol after ACTH stimulation test <16.3 μg/ dL (450 nmol/L) [25]. Similarly in this study, the proportion of subjects with cortisol peak less than 15 μg/ dL was significantly high in the group of larger NFPA (Supplemental Fig.…”

Management of macroprolactinomas

“…The data regarding other pituitary hormones is less consistent. We found some recovery of the corticotrophs with no thyrotroph recovery [55], Colao et al [30], found similar patterns, Karavitaki et al [21] showed recovery of thyrotrophs in 25 % of affected patients but no recovery of ACTH secretion and Sibal et al [35] demonstrated re-secretion of both ACTH and TSH in some patients in their cohort.…”

“…Several studies evaluated the rates of pituitary axes dysfunction in patients harboring macroprolactinomas and the recovery rates of these deficits following treatment [30, 35, 54, 55]. The gonadotroph axis is most often damaged (73–86 %), presumably due to the double effect of the macroprolactinoma on this axis: increased pressure on the gonadotroph cells from the expanding mass and suppression of GnRH secretion by PRL effect in the hypothalamus [7].…”

“…Nevertheless, as has been previously shown [56], normal testosterone levels do not exclude the presence of PRL-secreting adenoma. Central hypothyroidism and hypocortisolism might also be induced by macroprolactinomas, though less often (18–41 % and 12–23 %, respectively) [30, 35, 54, 55]. Somatotroph axis evaluation is limited in patients with PRL-secreting tumors, due to the possibility of GH and PRL co-secretion in 10 % of these adenomas.…”

“…Recovery of the gonadotroph axis was reported in most patients with macroprolactinomas [21, 30, 54, 55]. The data regarding other pituitary hormones is less consistent.…”