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Aromatase inhibitors as a therapeutic strategy for male prolactinoma resistant to dopamine agonists: a retrospective cohort study and literature review

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A Correction to this article was published on 11 December 2023

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Abstract

Purpose

To assess the effect of letrozole, an aromatase inhibitor (AI), in patients with resistant prolactinoma that presented an increase in serum prolactin (PRL) levels during testosterone replacement therapy (TRT).

Methods

A retrospective cohort study in a single tertiary care center. From March 2012 to July 2023, 53 male patients over 18 years with prolactinoma were followed in our Neuroendocrine Unit. Of those, 90.6% presented macroadenomas, 41% of them were resistant to cabergoline and 25% presented persistent hypogonadism to whom TRT was indicated. Among them, five presented a significant increase in PRL levels and AI was initiated. All five patients had resistant prolactinomas. One of them was excluded due to tumor aggressiveness and concomitant use of temozolomide during AI therapy.

Results

Four patients were included in the analysis, with a mean age of 28.5 (± 7.5) years, median prolactin of 1060 (600 to 6700) ng/mL and median of the largest tumor diameter of 3.6 (1.5 to 5) cm at the time of prolactinoma diagnosis. On TRT, all presented an increase in serum PRL levels (231 to 396%), with a subsequent decrease (61 to 93%) after adding AI. During AI treatment for a median time of 60.5 (21 to 120) months, tumor shrinkage was observed in two cases (-8 and -3 mm in the maximum diameter) and tumor stability in the other two. No major side effects occurred and AI was well tolerated.

Conclusion

AI might be an option for men with resistant prolactinoma who have an increase in PRL levels on TRT. Nevertheless, prospective randomized clinical trials are needed to ensure efficacy and security for this approach.

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Change history

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Funding

This study received no specific grant from any funding agency.

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Authors and Affiliations

  1. Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil

    D. Zúñiga, M. A. M. Stumpf, A. L. S. Monteiro & A. Glezer

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  1. D. Zúñiga
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  2. M. A. M. Stumpf
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  4. A. Glezer
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Contributions

DG and MAMS wrote the main manuscript text, and prepared the figures and tables; ALSM collected the data; AG reviewed the literature; all authors edited the main article, reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to M. A. M. Stumpf.

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Research involving human participants and/or animals

The study adhered to the principles outlined in the Declaration of Helsinki and received approval from the local Research Ethics Committee.

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Written informed consent was obtained from each patient for publication of this study.

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Zúñiga, D., Stumpf, M.A.M., Monteiro, A.L.S. et al. Aromatase inhibitors as a therapeutic strategy for male prolactinoma resistant to dopamine agonists: a retrospective cohort study and literature review. J Endocrinol Invest 47, 1295–1303 (2024). https://doi.org/10.1007/s40618-023-02231-z

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