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J Neurol Surg B Skull Base 2018; 79(04): 394-400
DOI: 10.1055/s-0037-1615748
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Comparison of Male and Female Prolactinoma Patients Requiring Surgical Intervention

Frederick Yoo
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Carmen Chan
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Edward C. Kuan
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Marvin Bergsneider
2   Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Marilene B. Wang
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

16 July 2017

19 November 2017

Publication Date:
26 December 2017 (online)

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Abstract

Objectives Prolactinomas are the most common functional pituitary adenoma. Symptoms of a prolactinoma stem from hormonal causes (menstrual irregularities, galactorrhea, and reduced libido) or from tumor mass effect (visual changes and headache). Gender differences have been noted in prolactinomas, with males presenting with larger tumors and sequelae of mass effect, while females present commonly with hormonal symptoms. The purpose of this study is to evaluate differences in patient and disease characteristics, and outcomes between male and female prolactinoma patients undergoing surgery.

Design This was a retrospective chart review.

Setting This was done at the tertiary medical center.

Participants The medical records of prolactinomas patients who underwent endoscopic endonasal surgery between March 2008 and August 2016 were reviewed.

Main Outcome Measures Demographic information, tumor characteristics, and treatment characteristics and outcomes were collected. Statistical analysis was performed using chi-squared test or Student's t-test as applicable.

Results Seventy-nine patients were identified, 22 males and 57 females. The average age for males was 38 years and for females was 35 years. Males were more likely to present with decreased libido (p < 0.0001), whereas females more often presented with galactorrhea (p < 0.0001) and menstrual irregularities. Tumor size was larger in males (p = 0.0044) with higher likelihood of suprasellar extension (p = 0.0409) and cavernous sinus invasion (p = 0.0026). Males were more likely to have a subtotal resection rather than gross total resection (p = 0.0086) and less likely to have normalization of prolactin levels following surgery (p = 0.0019)

Conclusion Male prolactinoma patients tend to have larger tumors with more aggressive features. This may have a role in the differences in outcomes noted in this study.

Keywords

pituitary adenomas - prolactinoma - gender - endoscopic

Note

A portion of the data presented in this article was presented at the North American Skull Base Society meeting on March 3–5, 2017, in New Orleans, LA.


 

  • References

  • 1 Tampourlou M, Trifanescu R, Paluzzi A, Ahmed SK, Karavitaki N. THERAPY OF ENDOCRINE DISEASE: surgery in microprolactinomas: effectiveness and risks based on contemporary literature. Eur J Endocrinol 2016; 175 (03) R89-R96
    CrossrefPubMedGoogle Scholar
  • 2 Melmed S, Casanueva FF, Hoffman AR. , et al; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (02) 273-288
    CrossrefPubMedGoogle Scholar
  • 3 Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. ; Cabergoline Comparative Study Group. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. N Engl J Med 1994; 331 (14) 904-909
    CrossrefPubMedGoogle Scholar
  • 4 Colao A. Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Metab 2009; 23 (05) 575-596
    CrossrefPubMedGoogle Scholar
  • 5 Cho DY, Liau WR. Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 2002; 58 (06) 371-375 , discussion 375–376
    CrossrefPubMedGoogle Scholar
  • 6 Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 2008; 62 (05) 1006-1015 , discussion 1015–1017
    CrossrefPubMedGoogle Scholar
  • 7 Akin S, Isikay I, Soylemezoglu F, Yucel T, Gurlek A, Berker M. Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases. Acta Neurochir (Wien) 2016; 158 (05) 933-942
    CrossrefPubMedGoogle Scholar
  • 8 Dallapiazza RF, Jane Jr JA. Outcomes of endoscopic transsphenoidal pituitary surgery. Endocrinol Metab Clin North Am 2015; 44 (01) 105-115
    CrossrefPubMedGoogle Scholar
  • 9 Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA 2017; 317 (05) 516-524
    CrossrefPubMedGoogle Scholar
  • 10 Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxf) 1994; 41 (03) 359-364
    CrossrefPubMedGoogle Scholar
  • 11 Ramot Y, Rapoport MJ, Hagag P, Wysenbeek AJ. A study of the clinical differences between women and men with hyperprolactinemia. Gynecol Endocrinol 1996; 10 (06) 397-400
    CrossrefPubMedGoogle Scholar
  • 12 Delgrange E, Trouillas J, Maiter D, Donckier J, Tourniaire J. Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study. J Clin Endocrinol Metab 1997; 82 (07) 2102-2107
    PubMedGoogle Scholar
  • 13 Delgrange E, Vasiljevic A, Wierinckx A. , et al. Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth. Eur J Endocrinol 2015; 172 (06) 791-801
    CrossrefPubMedGoogle Scholar
  • 14 Fainstein Day P, Glerean M, Lovazzano S. , et al. Gender differences in macroprolactinomas: study of clinical features, outcome of patients and ki-67 expression in tumor tissue. Front Horm Res 2010; 38: 50-58
    PubMedGoogle Scholar
  • 15 Colao A, Sarno AD, Cappabianca P. , et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol 2003; 148 (03) 325-331
    CrossrefPubMedGoogle Scholar
  • 16 Colao A, Lombardi G. Growth-hormone and prolactin excess. Lancet 1998; 352 (9138): 1455-1461
    CrossrefPubMedGoogle Scholar
  • 17 Verhelst J, Abs R, Maiter D. , et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 1999; 84 (07) 2518-2522
    CrossrefPubMedGoogle Scholar
  • 18 Ciccarelli A, Guerra E, De Rosa M. , et al. PRL secreting adenomas in male patients. Pituitary 2005; 8 (01) 39-42
    CrossrefPubMedGoogle Scholar
  • 19 Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 1981; 304 (03) 156-158
    CrossrefPubMedGoogle Scholar
  • 20 Gooren LJ, Assies J, Asscheman H, de Slegte R, van Kessel H. Estrogen-induced prolactinoma in a man. J Clin Endocrinol Metab 1988; 66 (02) 444-446
    CrossrefPubMedGoogle Scholar
  • 21 Kovacs K, Stefaneanu L, Ezzat S, Smyth HS. Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration. A morphologic study. Arch Pathol Lab Med 1994; 118 (05) 562-565
    PubMedGoogle Scholar
  • 22 Serri O, Noiseux D, Robert F, Hardy J. Lactotroph hyperplasia in an estrogen treated male-to-female transsexual patient. J Clin Endocrinol Metab 1996; 81 (09) 3177-3179
    PubMedGoogle Scholar
  • 23 García-Malpartida K, Martín-Gorgojo A, Rocha M, Gómez-Balaguer M, Hernández-Mijares A. Prolactinoma induced by estrogen and cyproterone acetate in a male-to-female transsexual. Fertil Steril 2010; 94 (03) 1097.e13-1097.e15
    PubMedGoogle Scholar
  • 24 Delgrange E, Sassolas G, Perrin G, Jan M, Trouillas J. Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochir (Wien) 2005; 147 (07) 751-757 , discussion 757–758
    CrossrefPubMedGoogle Scholar
  • 25 Robert F. Morphology of human prolactinomas: a study on invasive prolactin-secreting adenomas. In: Tolis G. , ed. Prolactin and Prolactinomas. New York: Raven; 1983: 339-349
    Google Scholar
  • 26 Faraoni EY, Camilletti MA, Abeledo-Machado A. , et al. Sex differences in the development of prolactinoma in mice overexpressing hCGβ: role of TGFβ1. J Endocrinol 2017; 232 (03) 535-546
    CrossrefPubMedGoogle Scholar
  • 27 Arasho BD, Schaller B, Sandu N, Zenebe G. Gender-related differences in pituitary adenomas. Exp Clin Endocrinol Diabetes 2009; 117 (10) 567-572
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Oh MC, Aghi MK. Dopamine agonist-resistant prolactinomas. J Neurosurg 2011; 114 (05) 1369-1379
    CrossrefPubMedGoogle Scholar
  • 29 Bhasin S, Cunningham GR, Hayes FJ. , et al; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95 (06) 2536-2559
    CrossrefPubMedGoogle Scholar
  • 30 Leonard MP, Nickel CJ, Morales A. Hyperprolactinemia and impotence: why, when and how to investigate. J Urol 1989; 142 (04) 992-994
    CrossrefPubMedGoogle Scholar