madman
Super Moderator
Abstract
Context Prolactinomas in men are usually large and invasive, presenting with signs and symptoms of hypogonadism and mass effects, including visual damage. Prolactin levels are high, associated with low testosterone, anemia, metabolic syndrome and if long-standing also osteoporosis.
Results Medical treatment with the dopamine agonist, cabergoline, became the preferred first-line treatment for male prolactinomas as well as for giant tumors, leading to prolactin normalization in ~ 80% of treated men, and tumor shrinkage, improved visual fields and recovery of hypogonadism in most patients. Multi-modal approach including surgery and occasionally radiotherapy together with a high-dose cabergoline is saved for resistant and invasive adenomas. Experimental treatments including temozolomide or pasireotide may improve clinical response in men harboring resistant prolactinomas.
Conclusions Compared to other pituitary adenomas, secreting and non-secreting, where pituitary surgery is the recommended first-line treatment, men with prolactinomas will usually respond to medical treatment with no need for any additional treatment.
In summary, prolactinomas in men are usually large and invasive tumors associated with high prolactin levels and hypogonadism. Primary medical treatment is recommended in most cases, with good response to long-term DA treatment, prolactin and testosterone normalization in most cases, along with significant tumor shrinkage and frequently adenoma disappearance. Medical treatment is safe in most men without adverse effects that rarely include mild dizziness, nausea, and behavioral changes.
Context Prolactinomas in men are usually large and invasive, presenting with signs and symptoms of hypogonadism and mass effects, including visual damage. Prolactin levels are high, associated with low testosterone, anemia, metabolic syndrome and if long-standing also osteoporosis.
Results Medical treatment with the dopamine agonist, cabergoline, became the preferred first-line treatment for male prolactinomas as well as for giant tumors, leading to prolactin normalization in ~ 80% of treated men, and tumor shrinkage, improved visual fields and recovery of hypogonadism in most patients. Multi-modal approach including surgery and occasionally radiotherapy together with a high-dose cabergoline is saved for resistant and invasive adenomas. Experimental treatments including temozolomide or pasireotide may improve clinical response in men harboring resistant prolactinomas.
Conclusions Compared to other pituitary adenomas, secreting and non-secreting, where pituitary surgery is the recommended first-line treatment, men with prolactinomas will usually respond to medical treatment with no need for any additional treatment.
In summary, prolactinomas in men are usually large and invasive tumors associated with high prolactin levels and hypogonadism. Primary medical treatment is recommended in most cases, with good response to long-term DA treatment, prolactin and testosterone normalization in most cases, along with significant tumor shrinkage and frequently adenoma disappearance. Medical treatment is safe in most men without adverse effects that rarely include mild dizziness, nausea, and behavioral changes.
