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Predicting hypogonadotropic hypogonadism persistence in male macroprolactinoma

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Abstract

Purpose

To study the baseline characteristics predicting hypogonadotropic hypogonadism (HH) persistence in men with macroprolactinoma that achieved prolactin normalization.

Design

Retrospective cohort study.

Methods

Male patients diagnosed with macroprolactinoma and HH that received cabergoline treatment with subsequent prolactin normalization were included: men that achieved eugonadism, and men that remained hypogonadal. Patient’s demographic, clinical and biochemical parameters, sellar imaging, and visual fields tests were obtained. Univariate and multivariate models were used to identify predictors of HH persistence.

Results

Fifty-eight male patients (age 49.2 ± 12.6 years) with a median baseline prolactin of 1154 ng/mL (IQR 478–2763 ng/mL) and adenoma (maximal) diameter of 25.9 ± 14.8 mm were followed for a median of 5.6 years (IQR 3.0–10.7). Twelve men (21%) suffered from HH persistence at the end of follow-up and 46 men achieved eugonadism. Forty-two out of 46 men (91%) accomplished eugonadism within the first year following prolactin normalization. In a multivariate logistic regression model, hypopituitarism (OR 10.1; 95% CI 1.10–101.94), visual field defect (OR 9.9; 95% CI 1.07–92.33), and low baseline testosterone levels (OR 0.5; 95% CI 0.29–0.93) were independent predictors of HH persistence.

Conclusion

In our cohort of men with macroprolactinoma that reached prolactin normalization with cabergoline treatment, 21% had HH persistence. Pituitary hormone deficiency, visual field defects, and low baseline testosterone levels were independently associated with HH persistence. 91% of men achieved eugonadism within the first year following prolactin normalization. These findings may support informed clinical decision-making regarding the initiation of testosterone replacement in men with macroprolactinomas.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors

Contributions

All authors contributed to study conception and design. YR, IS performed a literature search. YR, HDB, HMI, IS contributed to data collection. YR, IS contributed to data analysis and synthesis. YR, IS drafted the first version of the manuscript. All authors contributed to writing and critically reviewing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ilan Shimon.

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The authors have no relevant financial or non-financial interests to disclose.

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Rudman, Y., Duskin-Bitan, H., Masri-Iraqi, H. et al. Predicting hypogonadotropic hypogonadism persistence in male macroprolactinoma. Pituitary 25, 882–890 (2022). https://doi.org/10.1007/s11102-022-01259-3

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