The impact of prolactinoma in human reproduction
Hurtado Amador, R.; Ayala, A.R.; Hernández Marín, I.
Ginecologia y Obstetricia de Mexico 72(1): 3-9
2004
ISSN/ISBN: 0300-9041 PMID: 15239558 Document Number: 582110
Prolactinomas represent a 60% of pituitary tumors with various symptoms, hormonal and reproductive abnormalities. Assessment of epidemiology of prolactinomas in our hospital. We reviewed the clinical charts of 32 patients seen throughout 1991-2001. Twenty seven patients (84%) were females and 5 (16%) males. Average age was 30.3 +/- SD 11.3 years with a range of 6 to 58 years. Menstrual irregularities was the most frequent finding in patients with micro and macroadenoma; infertility was seen in 4 (33%) patients with pituitary microadenoma and 2 (10%) with macroadenoma. A patient with macroadenoma had delayed puberty and another with microadenoma isosexual precocious puberty. All cases showed hyperprolactinemia (microadenomas x 94.5 +/- SD 96.4 ng/mL; macroadenomas x 108.8 +/- SD 79.4 ng/mL). Hypothyroidism and hypogonadal hypogonadotropism were the most common associated diagnoses before an after treatment for both groups. Radiologic presence of microadenoma was observed in 12 (38%) patients and in 20 (26%) with macroadenoma. Bitemporal hemianopsia was the most common finding during visual field evaluation (28% microadenoma, 44% macroadenoma). Pharmacologic treatment with bromocriptine (2.5 - 7.5 mg) prevailed and showed a major impact upon symptoms improvement and significant decrease of serum prolactin levels (p < 0.05). Only five patients out of 20 who underwent surgery developed transient diabetes insipidus. Tumor relapse was observed in 10 (63%) of 16 patients with macroadenomas that required surgery. In our study prolactinomas prevailed among females in reproductive age with a higher incidence of macroadenomas. The most common alterations related to reproductive tract were menstrual irregularities, galactorrhea, infertility, hyperprolactinemia, hypogonadism and hypothyroidism. Abnormalities of puberty were also seen. Treatment with dopaminergic agonists (bromocriptine) was highly effective to decrease prolactin circulating levels.