Optimal testosterone level to improve symptoms of hypogonadism without causing dopa-testotoxicosis in male macroprolactinoma
Abstract
BACKGROUND: Male prolactinoma treatment by dopamine agonists (DA) restores sexual function. However, excessive DA dose can lead to impulse control disorder.
OBJECTIVES: The aim of this retrospective study was to determine the level of testosterone that eliminates symptoms and provides fertility in male macroprolactinoma, without causing these adverse effects.
MATERIALS AND METHODS: Twenty-seven male patients with macroprolactinoma were included. There were 16 macro (≥1-2.8cm), 7 large macro (≥2.9-3.9cm) and 4 giant (≥4cm) adenomas. Prolactin (PRL) and testosterone (T) levels were evaluated. A timeline was created to analyze improvement in symptoms of hypogonadism and infertility. Testosterone levels were compared with age-matched controls.
RESULTS: Mean PRL, basal tumor diameter and shrinkage were 2846±3415ng/mL, 27.2±10.2mm and 63.4%, respectively. Basal T levels were 1.6±1.0ng/mL for patients and 4.4±1.5ng/mL for controls (P<0.001). Mean T level in the asymptomatic period was significantly lower than in controls (3.2±0.4ng/mL vs. 4.4±1.5ng/mL, respectively; P=0.002), while mean PRL was 27.2ng/mL. Fertility was achieved in 6 of the patients seeking fertility, and there was no difference in T level between these patients and controls (3.7±0.8ng/mL and 4.4±1.5ng/mL, respectively; P=0.14); when fertility was achieved, mean PRL was 26.9±23ng/mL.
CONCLUSION: Patients should be carefully questioned regarding complaints at each consultation, and DA dose should not be increased…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 6 participants or records.
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