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Proportion and predictors of Hypogonadism Recovery in Men with Macroprolactinomas treated with dopamine agonists

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Abstract

Introduction

Hypogonadism is the most common form of hypopituitarism in men with macroprolactinoma. However, evidence on factors related to hypogonadism recovery is limited.

Objectives

We estimated the proportion of hypogonadism in men with macroprolactinoma exclusively treated with dopamine agonists, and we assessed the factors predicting hypogonadism recovery.

Patients and methods:

This was a multicenter retrospective study of men with macroprolactinoma identified using ICD 9 and 10 codes and treated between 2009 and 2019 in five centers in the United Arab Emirates and Saudi Arabia. We evaluated hypogonadism, defined as low total testosterone (TT) level with normal or low gonadotropins on presentation and during the last clinic visit.

Results

A total of 79 patients (median age 32 years) were included in the study. The most common symptoms at presentation were headache (73.7%), erectile dysfunction (55.4%), and low libido (54.3%). The median tumor size was 2.9 cm (1.0–9.7) at diagnosis. Sixty-three patients (79.7%) had hypogonadism at baseline. Growth hormone deficiency (GHD) and hypothyroidism were present in 34.4% and 32.9% of patients, respectively. The median serum prolactin (PRL) level was 20,175 (min-max 2254 − 500,000) mIU/l with a median serum TT of 4.5 (min-max 0.4–28.2) nmol/l. Most patients were treated with cabergoline (n = 77, 97.5%) with a median of 6 (min-max 0.6–22) years. At follow-up, 65% of patients recovered their pituitary-testicular axis. Patients with recovered hypogonadism had smaller median tumor size (2.4 [1-5.4] vs. 4.3 [1.6–9.7], p = 0.003), lower PRL level (18, 277 [2254 − 274, 250] vs. 63,703 [ 3,365–500,000], p = 0.008 ), higher TT level (4.6 [0.6–9.2] vs. 2.3 [0.5–7.3], p = 0.008), lower PRL normalization time on medical therapy (8 months (0.7–72) vs. 24 (3-120), p = 0.009) as well as lower frequency of GHD (17.1% vs. 60%, p = 0.006) and secondary hypothyroidism (17.9% vs. 57.1%, p = 0.003) compared with those with persistent hypogonadism respectively. Age at diagnosis, presenting symptoms and duration of medical therapy did not predict hypogonadism recovery.

Conclusions

About two-thirds of men with macroprolactinoma recover from hypogonadism, mostly with 24 months of therapy. Smaller adenoma size, lower prolactin level, earlier prolactin normalization, and higher testosterone patients were related to testosterone normalization.

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Authors and Affiliations

  1. Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates

    Khaled M Al Dahmani

  2. Department of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates

    Khaled M Al Dahmani

  3. Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia

    Mussa H. Almalki

  4. Department of Medicine, College of Medicine, King Saud bin Abdul, King Fahad Medical City, Aziz University for Health Sciences, Riyadh, Saudi Arabia

    Mussa H. Almalki

  5. Endocrinology and Diabetes Unit, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia

    Aishah Ekhzaimy

  6. Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

    Faisal Aziz

  7. Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates

    Alaaeldin Bashier

  8. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Moeber M. Mahzari

  9. Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Moeber M. Mahzari

  10. Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates

    Salem A. Beshyah

  11. Department of Endocrinology, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates

    Salem A. Beshyah

Authors
  1. Khaled M Al Dahmani
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  2. Mussa H. Almalki
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  3. Aishah Ekhzaimy
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  4. Faisal Aziz
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  5. Alaaeldin Bashier
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  6. Moeber M. Mahzari
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  7. Salem A. Beshyah
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Contributions

All the named authors fulfilled the ICMJE criteria of authorship. They all reviewed the manuscript for intellectual content and approved its final version.

Corresponding author

Correspondence to Mussa H. Almalki.

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Conflict of interest

None of the authors declared any conflict of interest.

Compliance with ethical principles

Research ethics committees of all participating centers approved the study. Cases were identified using ICD 9 and 10 codes (253.2, D35.2, respectively. The condition of consent was waived due to the study’s retrospective nature.

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Al Dahmani, K.M., Almalki, M.H., Ekhzaimy, A. et al. Proportion and predictors of Hypogonadism Recovery in Men with Macroprolactinomas treated with dopamine agonists. Pituitary 25, 658–666 (2022). https://doi.org/10.1007/s11102-022-01242-y

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  • DOI: https://doi.org/10.1007/s11102-022-01242-y

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