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Dzialach L, Sobolewska J, Zak Z, Respondek W, Witek P. Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment. Front Endocrinol (Lausanne) 2024; 15:1338345. [PMID: 38370355 PMCID: PMC10870150 DOI: 10.3389/fendo.2024.1338345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.
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Affiliation(s)
- Lukasz Dzialach
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Sobolewska
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Zak
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Wioleta Respondek
- Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Brodnowski Hospital, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
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Boukerrouni A, Cuny T, Anjou T, Raingeard I, Ferrière A, Grunenwald S, Maïza JC, Marquant E, Sahakian N, Fodil-Cherif S, Salle L, Niccoli P, Randrianaivo H, Sonnet E, Chevalier N, Thuillier P, Vezzosi D, Reynaud R, Dufour H, Brue T, Tabarin A, Delemer B, Kerlan V, Castinetti F, Barlier A, Romanet P. Genetic testing in prolactinomas: a cohort study. Eur J Endocrinol 2023; 189:567-574. [PMID: 37956455 DOI: 10.1093/ejendo/lvad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Prolactinomas represent 46%-66% of pituitary adenomas, but the prevalence of germline mutations is largely unknown. We present here the first study focusing on hereditary predisposition to prolactinoma. OBJECTIVE We studied the prevalence of germline mutations in a large cohort of patients with isolated prolactinomas. MATERIALS AND METHODS A retrospective study was performed combining genetic and clinical data from patients referred for genetic testing of MEN1, AIP, and CDKN1B between 2003 and 2020. SF3B1 was Sanger sequenced in genetically negative patients. RESULTS About 506 patients with a prolactinoma were included: 80 with microprolactinoma (15.9%), 378 with macroprolactinoma (74.7%), 48 unknown; 49/506 in a familial context (9.7%). Among these, 14 (2.8%) had a (likely) pathogenic variant (LPV) in MEN1 or AIP, and none in CDKN1B. All positive patients had developed a macroprolactinoma before age 30. The prevalence of germline mutations in patients with isolated macroprolactinoma under 30 was 4% (11/258) in a sporadic context and 15% (3/20) in a familial context. Prevalence in sporadic cases younger than 18 was 15% in men (5/33) and 7% in women (4/57). No R625H SF3B1 germline mutation was identified in 264 patients with macroprolactinomas. CONCLUSIONS We did not identify any LPVs in patients over 30 years of age, either in a familial or in a sporadic context, and in a sporadic context in our series or the literature. Special attention should be paid to young patients and to familial context.
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Affiliation(s)
- Amina Boukerrouni
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Thibaut Anjou
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, 34000 Montpellier, France
| | - Amandine Ferrière
- Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, 33318 Pessac, France
| | - Solange Grunenwald
- Department of Endocrinology and Metabolic Disease, Hospital Larrey CHU (University Hospital Centre), 31029 Toulouse, France
| | - Jean-Christophe Maïza
- Department of Endocrinology, Diabetes and Nutrition, GHSR, Centre Hospitalo-Universitaire de la Réunion, 97416 Saint-Pierre, La Réunion, France
| | - Emeline Marquant
- Aix Marseille Univ, APHM, INSERM, MMG, Department of pediatrics, hospital La Timone Enfants, MarMaRa Institute, 13005 Marseille, France
| | - Nicolas Sahakian
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Sarah Fodil-Cherif
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, 34000 Montpellier, France
| | - Laurence Salle
- Inserm, University Limoges, CHU de Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | | | - Hanitra Randrianaivo
- UF de Génétique Médicale, GHSR, CHU de La Réunion, 97416 Saint Pierre, La Réunion, France
| | - Emmanuel Sonnet
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Nicolas Chevalier
- Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet 2, Service d'Endocrinologie, Diabétologie et Médecine de la Reproduction, 151 route de Saint-Antoine de Ginestière, CS 23079, Nice 06202 Cedex 3, France
| | - Philippe Thuillier
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Delphine Vezzosi
- Institut CardioMet, 31000 Toulouse, France
- Service d'endocrinologie, Hôpital Larrey, 24, Chemin de Pouvourville, Toulouse 31029 Cedex 9, France
| | - Rachel Reynaud
- Aix Marseille Univ, APHM, INSERM, MMG, Department of pediatrics, hospital La Timone Enfants, MarMaRa Institute, 13005 Marseille, France
| | - Henry Dufour
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Neurosurgery Hospital la Timone Adulte, MarMaRa Institute, 13005 Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Antoine Tabarin
- Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, 33318 Pessac, France
| | - Brigitte Delemer
- Endocrinology, Diabetology and Nutrition Unit, University Hospital of Reims, 51454 Reims, France
| | - Véronique Kerlan
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Frédéric Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
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Alcohol intake and risk of pituitary adenoma. Cancer Causes Control 2022; 33:353-361. [PMID: 34982318 PMCID: PMC9245588 DOI: 10.1007/s10552-021-01523-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The association between alcohol intake and incidence of pituitary adenoma has not been reported previously. We examined this association in three large, prospective cohort studies. METHODS Using data from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-Up Study, we computed multivariable-adjusted hazard ratios (MVHR) and 95% confidence intervals (CI) for pituitary adenoma by levels of alcohol intake using Cox proportional hazards regression. RESULTS We identified 292 incident cases of pituitary adenoma (225 among women, 67 among men) among 235,973 participants with 6,548,732 person-years of follow-up. Compared with intake of ≤ 0.5 g/day, cumulative average alcohol intake in all categories was associated with reduced risk of pituitary adenoma (MVHR = 0.60, 95% CI 0.43-0.83 for 0.5-≤ 2 g/day, MVHR = 0.57, 95% CI 0.41-0.79 for > 2.0-≤ 8.0, MVHR = 0.70, 95% CI 0.47-1.04 for > 8.0-≤ 15.0, and MVHR = 0.51, 95% CI 0.32-0.83 for > 15.0 g/day). Significant inverse findings were present in women and were similar but non-significant in men. For specific alcoholic beverages, inverse associations were statistically significant for total wine (MVHR = 0.58, 95% CI 0.43-0.79 comparing 0.5-≤ 2 to ≤ 0.5 g/day), red wine (MVHR = 0.65, 95% CI 0.46-0.92 comparing 0.5-≤ 2 to ≤ 0.5 g/day), and white wine (MVHR = 0.72, 95% CI 0.53-0.97 comparing 0.5-≤ 2 to ≤ 0.5 g/day). Results were consistent using baseline intake, recent intake, and with an 8-year lag. CONCLUSION In three prospective cohorts, compared to almost no consumption, alcohol consumption was associated with reduced risk of pituitary adenoma. Sensitivity analyses suggest that these results are unlikely to be the result of reverse causation or diagnostic bias.
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Alikasifoglu A, Celik NB, Ozon ZA, Gonc EN, Kandemir N. Management of prolactinomas in children and adolescents; which factors define the response to treatment? Pituitary 2022; 25:167-179. [PMID: 34518999 DOI: 10.1007/s11102-021-01184-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Prevalence, presentation and clinical outcome of prolactinomas vary in children and adults. In this study, we evaluated the clinical features and outcome of children and adolescents with prolactinoma to identify the differences from that of adults, and thus to establish the management strategies for this age group. METHODS Patients with prolactinoma diagnosed before 18 years of age from a single center in the last 20-years were included. Clinical and laboratory data, radiological findings and treatment outcome were evaluated retrospectively. RESULTS Twenty-eight patients (23 female; 82.1%) with prolactinoma were included. Median age at diagnosis was 15.2 years (12.6-17.7 years) in girls, 12.9 years (12.0-16.7 years) in boys. First line treatment was cabergoline in 82% of patients and normal prolactin level was achieved with maximum dose of 2 mg/week in 78%. Surgery was required in 28% of patients. Adenomas < 13.5 mm responded conventional doses of CAB. Adenomas > 30 mm were drug resistant or required surgery. Adenomas between 13.5 mm and 30 mm with invasion/extension were more likely to have drug resistance. CAB had to be continued following surgery in all patients. One macroprolactinoma had an increase in size which was accompanied with increasing prolactin level. CONCLUSIONS All microprolactinomas responded well to DA treatment. However, all adenomas larger than 30 mm was resistant to CAB or required surgery. Probability of drug resistance and requirement of second line therapy were higher in adenomas between 13.5 mm and 30 mm with invasion/extension. Doses over 2 mg/week of CAB in drug-resistant patients may not provide additional benefit. The frequency of follow-up MRI could be determined based on prolactin levels and emergence of new neurological symptoms.
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Affiliation(s)
- Ayfer Alikasifoglu
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nur Berna Celik
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Zeynep Alev Ozon
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elmas Nazli Gonc
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nurgun Kandemir
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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