Evaluation of the gender effect in operated prolactinomas

Year 2023, Volume: 9 Issue: 5 - September 2023, 1135 - 1141, 04.09.2023

Dilan Özaydın , Ahmet Numan Demir , Necmettin Tanrıöver

https://doi.org/10.18621/eurj.1340508

Cited By: 1

Abstract

Objectives: To investigate the differences between the characteristics of disease presentation and treatment outcomes on the basis of gender in patients with operated prolactinoma.

Methods: Prolactinoma patients who underwent endoscopic transsphenoidal surgery at Istanbul University-Cerrahpasa, Neurosurgery clinics between 2013-2023 were included in this study. Surgical indications, secondary treatments, clinical, demographic, biochemical, radiological findings, and pathological data were analyzed. Data were compared between the gender groups.

Results: Thirty-two men and 28 women were included in the study. The mean age of the men was 44 years and that of the women was 29 years. While men were more likely to have decreased libido, women were more likely to have menstrual irregularities (p < 0.001). The tumor was larger in men (p = 0.001), presenting with a more frequent suprasellar invasion (p = 0.001) and cavernous sinus invasion (p < 0.001). Pituitary hormone deficiency (p < 0.001) and visual field defects (p < 0.001) occurred more frequently in men.

Conclusions: Male prolactinoma patients tend to have more invasive and larger tumors. Men are less likely than women to go into remission with surgery. This difference in presentation may be due to indistinct symptoms in male patients and late diagnosis.

Keywords

Prolactinoma, remission, sex, surgery

References

• 1. Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA 2017;317:516-24.
• 2. Majumdar A, Mangal NS. Hyperprolactinemia. J Hum Reprod Sci 2013;6:168-75.
• 3. Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, et al; Endocrine Society. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:894-904.
• 4. De Sousa SMC. Dopamine agonist therapy for prolactinomas: do we need to rethink the place of surgery in prolactinoma management? Endocr Oncol 2022;2:R31-R50.
• 5. Zamanipoor Najafabadi AH, Zandbergen IM, de Vries F, Broersen LHA, van den Akker-van Marle ME, Pereira AM, et al. Surgery as a viable alternative first-line treatment for prolactinoma patients. a systematic review and meta-analysis. J Clin Endocrinol Metab 2020;105:e32-41.
• 6. Chen J, Liu H, Man S, Liu G, Li Q, Zuo Q, et al. Endoscopic vs. microscopic transsphenoidal surgery for the treatment of pituitary adenoma: a meta-analysis. Front Surg 2022;8:806855.
• 7. Colao A, Sarno AD, Cappabianca P, Briganti F, Pivonello R, Somma CD, et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol 2003;148:325-31.
• 8. Burdman JA, Pauni M, Heredia Sereno GM, Bordón AE. Estrogen receptors in human pituitary tumors. Horm Metab Res 2008;40:524-7.
• 9. Yoo F, Chan C, Kuan EC, Bergsneider M, Wang MB. Comparison of male and female prolactinoma patients requiring surgical intervention. J Neurol Surg B Skull Base 2018;79:394-400.
• 10. Akin S, Isikay I, Soylemezoglu F, Yucel T, Gurlek A, Berker M. Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases. Acta Neurochir (Wien) 2016;158:933-42.
• 11. Demir D, Demir AN, Sulu C, Zulfaliyeva G, Cetintas SC, Ozkaya HM, et al. The combination of dopamine agonist treatment and surgery may be the best option in challenging prolactinoma cases: a single-centre experience. World Neurosurg 2023;175:e1166-74.
• 12. Colao A. Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Metab 2009;23:575-96.
• 13. Ciccarelli A, Guerra E, De Rosa M, Milone F, Zarrilli S, Lombardi G, et al. PRL secreting adenomas in male patients. Pituitary 2005;8:39-42.
• 14. Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 1981;304:156-8.
• 15. Delgrange E, Trouillas J, Maiter D, Donckier J, Tourniaire J. Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study. J Clin Endocrinol Metab 1997;82:2102-7.
• 16. Fainstein Day P, Glerean M, Lovazzano S, Pietrani M, Christiansen S, Balzaretti M, et al. Gender differences in macroprolactinomas: study of clinical features, outcome of patients and ki-67 expression in tumor tissue. Front Horm Res 2010;38:50-8.
• 17. Colao A, Sarno AD, Cappabianca P, Briganti F, Pivonello R, Somma CD, et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol 2003;148:325-31.
• 18. Delgrange E, Sassolas G, Perrin G, Jan M, Trouillas J. Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochir (Wien) 2005;147:751-8.
• 19. Hasanov R, Aydoğan Bİ, Kiremitçi S, Erden E, Güllü S. The prognostic roles of the Ki-67 proliferation index, P53 expression, mitotic index, and radiological tumor invasion in pituitary adenomas. Endocr Pathol 2019;30:49-55.
• 20. Arasho BD, Schaller B, Sandu N, Zenebe G. Gender-related differences in pituitary adenomas. Exp Clin Endocrinol Diabetes 2009;117:567-72.
• 21. Oh MC, Aghi MK. Dopamine agonist-resistant prolactinomas. J Neurosurg 2011;114:1369-79.
• 22. Han YL, Chen DM, Zhang C, Pan M, Yang XP, Wu YG. Retrospective analysis of 52 patients with prolactinomas following endoscopic endonasal transsphenoidal surgery. Medicine (Baltimore) 2018;97:e13198.