Long-term follow-up of primary medical versus surgical treatment of prolactinomas in men: Effects on hyperprolactinemia, hypogonadism and bone health.

Andereggen, Lukas; Frey, Janine; Andres, Robert; El-Koussy, Marwan; Beck, Jürgen; Seiler, Rolf; Christ, Emanuel (2017). Long-term follow-up of primary medical versus surgical treatment of prolactinomas in men: Effects on hyperprolactinemia, hypogonadism and bone health. World neurosurgery, 97, pp. 595-602. Elsevier 10.1016/j.wneu.2016.10.059

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OBJECTIVE

In men with prolactinomas, an impaired bone density is the principle consequence of hyperprolactinemia-induced hypogonadism. While dopamine (DA-) agonists are the first-line approach in prolactinomas, surgery can be considered in selected cases. In the present study, we aimed to investigate on the long-term control of hyperprolactinemia, hypogonadism and bone health comparing primary medical and surgical therapy in men who had not had prior DA-agonist treatment.

METHODS

Retrospective case-note study of 44 consecutive men with prolactinomas and no prior DA-agonists managed in a single tertiary referral center. Clinical, biochemical and radiological response to the first-line approach were analyzed in the two cohorts.

RESULTS

Mean age at diagnosis was 47 years (range 22-78). The prevalence of hypogonadism was 86%, and 27% of patients had pathological bone density at baseline. The primary therapeutic strategy was surgery for 34% and DA-agonists for 66% of patients. Median long-term follow-up was 63 months (range 17-238). Long-term control of hyperprolactinemia required DA-agonists in 53% of patients with primary surgical therapy, versus 90% of patients with primary medical therapy (p=.02). Hypogonadism was controlled in 73% of patients. The prevalence of patients with pathological bone density was 37% at last follow-up, with no differences between the two therapeutic cohorts (p=.48).

CONCLUSIONS

Despite control of hyperprolactinemia and hypogonadism in the majority of patients independent of the primary treatment modality, the prevalence of an impaired bone health status remains high, and osteodensitometry should be recommended.

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