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Prolactinomas in males: any differences?

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.

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Author information

HD-B performed the literature search and data analysis, and IS critically revised the manuscript.

Correspondence to Ilan Shimon.

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Duskin-Bitan, H., Shimon, I. Prolactinomas in males: any differences?. Pituitary 23, 52–57 (2020). https://doi.org/10.1007/s11102-019-01009-y

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Keywords

  • Cabergoline
  • Dopamine agonist
  • Men
  • Prolactin
  • Prolactinoma