PNA Medical Corner: Gender and Prolactinoma

This month’s PNA Medical Corner focuses on a article co-written by PNA member Dr. Martin Bergsneider of UCLA. The article compares rates of surgery for male and female prolactinoma patients and finds that men tend to have larger tumors and more problems with hormonal levels after the surgery.

Comparison of Male and Female Prolactinoma Patients Requiring Surgical Intervention.
Yoo F, Chan C, Kuan EC, Bergsneider M, Wang MB.
J Neurol Surg B Skull Base. 2018 Aug;79(4):394-400. doi: 10.1055/s-0037-1615748. Epub 2017 Dec 26.

Abstract

Objectives

Prolactinomas are the most common functional pituitary adenoma. Symptoms of a prolactinoma stem from hormonal causes (menstrual irregularities, galactorrhea, and reduced libido) or from tumor mass effect (visual changes and headache). Gender differences have been noted in prolactinomas, with males presenting with larger tumors and sequelae of mass effect, while females present commonly with hormonal symptoms. The purpose of this study is to evaluate differences in patient and disease characteristics, and outcomes between male and female prolactinoma patients undergoing surgery.

Design

This was a retrospective chart review.

Setting  

This was done at the tertiary medical center.

Participants  

The medical records of prolactinomas patients who underwent endoscopic endonasal surgery between March 2008 and August 2016 were reviewed.

Main Outcome Measures

Demographic information, tumor characteristics, and treatment characteristics and outcomes were collected. Statistical analysis was performed using chi-squared test or Student's t -test as applicable.

Results

Seventy-nine patients were identified, 22 males and 57 females. The average age for males was 38 years and for females was 35 years. Males were more likely to present with decreased libido ( p  < 0.0001), whereas females more often presented with galactorrhea ( p  < 0.0001) and menstrual irregularities. Tumor size was larger in males ( p  = 0.0044) with higher likelihood of suprasellar extension ( p  = 0.0409) and cavernous sinus invasion ( p  = 0.0026). Males were more likely to have a subtotal resection rather than gross total resection ( p  = 0.0086) and less likely to have normalization of prolactin levels following surgery ( p  = 0.0019)

Conclusion

Male prolactinoma patients tend to have larger tumors with more aggressive features. This may have a role in the differences in outcomes noted in this study.

KEYWORDS:
endoscopic; gender; pituitary adenomas; prolactinoma
PMID:30009121 PMCID:PMC6043172 [Available on 2019-08-01] DOI:
10.1055/s-0037-1615748

 

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