Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTIONProlactinomas showed significant variability in treatment response, with an overall display of dopamine agonist (DA) responsiveness in our cohort. This study evaluates the clinical and tumor characteristics separating DA-responsive and resistant patients in a Malaysian tertiary endocrine center. METHODOLOGYA retrospective analysis was done on 74 patients with prolactinoma treated between 2015 and 2025. Inclusion criteria encompassed hyperprolactinemia and MRI-documented adenomas. Clinical results were analyzed using established criteria: DA responsiveness, DA resistance, surgical remission, and long-term cure. RESULTBaseline characteristics revealed substantial gender differences, with male patients presenting at an older age (51.4 ± 15.0 vs 34.5 ± 9.6 years, p < 0.001), higher baseline prolactin levels (72,274.9 ± 100,505.4 vs 7,105.9 ± 9,152.7 mIU/L, p = 0.005), and larger tumor size (25.1 ± 16.8 vs 11.5 ± 8.5 mm, p = 0.002). Male patients generally presented with more aggressive disease features and greater tumor invasiveness, including increased cavernous sinus invasion (57.1% vs 22.6%, p = 0.0098) and optic chiasm compression (52.4% vs 7.5%, p < 0.001). When comparing treatment response, DA-resistant tumors revealed clinically relevant patterns, including higher baseline prolactin levels (median 9,642 vs 4,111 mIU/L, p = 0.090) and more frequent cavernous sinus invasion (60% vs 31.8%, p = 0.207). Dopamine agonist resistance rates were similar between genders. The sample demonstrated 89.2% total DA response, with comparable long-term cure rates (31.1% overall), albeit male patients required much higher doses of hormonal replacement therapy (57.1% vs 3.8%, p < 0.001). CONCLUSIONOur findings demonstrate that prolactinomas in males typically present later in life, are more aggressive and larger, and have a higher prolactin level, but the overall DA response remains good. Despite increased baseline prolactin and invasiveness in males, DA responsiveness was similar between genders. The long-term outcomes were positive, albeit more males required hormone replacement. These findings demonstrate that DA remains as effective first-line therapy for prolactinomas.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4410919823