Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas

Abstract

While prolactinoma patients have high bone turnover, current data are inconclusive when it comes to determining whether correction of hyperprolactinemia and associated hypogandism improves osteodensitometric data in men and women over the long term. In a large cohort of including 40 men and 60 women, we studied the long-term impact of prolactinoma treatment on bone mineral density (BMD) in men versus women, assessed adverse effects of a primary surgical or medical approach, and evaluated data for risk factors for impaired BMD at last follow-up using multivariate regression analyses. Median duration of follow-up was 79 months (range 13–408 months). Our data indicate that the prevalence of impaired BMD remained significantly higher in men (37%) than in women (7%, p < 0.001), despite the fact that hyperprolactinemia and hypogonadism are under control in the majority of men. We found that persistent hyperprolactinemia and male sex were independent risk factors for long-term bone impairment. Currently, osteoporosis prevention and treatment focus primarily on women, yet special attention to bone loss in men with prolactinomas is advised. Bone impairment as “end organ” reflects the full range of the disease and could become a surrogate marker for the severity of long-lasting hyperprolactinemia and associated hypogonadism.

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

“…The renewed acceptance of surgical treatment of prolactinomas, however, primarily applies to patients with a microprolactinoma, in whom a short-term cure rate of about 90% can be anticipated [27][28][29][30][31]. However, the indication for upfront surgery in macroprolactinomas remains controversial, and long-term data on patients in large cohorts is limited [8,[32][33][34].…”

Impact of primary medical or surgical therapy on prolactinoma patients’ BMI and metabolic profile over the long-term

“…After a mean follow-up of 51.9 months [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , long-term control of hyperprolactinemia (92% vs. 72%) and hypogandism (78% vs. 83%) was attained in the majority of patients, independent of the primary treatment (TSS vs. DAs, respectively). The prevalence of secondary hypothyroidism and secondary adrenal insufficiency was not significantly altered compared to baseline, independent of the primary treatment strategy (i.e.…”

“…Namely, while amenorrhea in women is easily detected and investigated, men often do not report the non-specific symptoms of hypogonadism, such as loss of libido. Consequently, men suffer from hyperprolactinemia and hypogonadism over a much longer period, a reason that macroprolactinomas are more commonly seen in them [44] , [45] . Whether hypogonadism and its associated lack of energy and physical exercise contributes to the increased BMI in females and males remains speculative.…”

Machine Learning for Outcome Prediction in First-Line Surgery of Prolactinomas

“…However, in contrast to previous reports, most patients with low remission rates will need prolonged treatment with DAs (4). Additionally, potential long-time effects (5,6), -including personality changes (7-10) -contributed to the increased acceptance of first-line surgery in prolactinomas in recent years (11)(12)(13)(14)(15). Although upfront surgery has recently been given a more dominant role in the treatment of prolactinomas (16,17), their indication still remains controversial in selected patients (18,19).…”