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Endocrine

, Volume 65, Issue 3, pp 656–661 | Cite as

Hyperprolactinemia diagnosis in elderly men: a cohort of 28 patients over 65 years

  • Ilan ShimonEmail author
  • Dania Hirsch
  • Gloria Tsvetov
  • Eyal Robenshtok
  • Amit Akirov
  • Merav Fraenkel
  • Yoav Eizenberg
  • Dana Herzberg
  • Liat Barzilay-Yoseph
  • Anat Livner
  • Ilana Friedrich
  • Yossi Manisterski
  • Avraham Ishay
  • Uri Yoel
  • Hiba Masri
Original Article

Abstract

Purpose

To characterize a cohort of elderly men with prolactinomas and their response to treatment.

Methods

We have identified 28 elderly men diagnosed after the age of 65 with prolactinomas at seven different endocrine clinics in Israel. A retrospective electronic chart review identified a control group of 76 younger men with macroprolactinomas treated in one of the centers.

Results

Mean age at diagnosis was 71.3 ± 5.6 (range 65–86) years, and current age 76.6 ± 7.5 years. Initial complaints leading to diagnosis included sexual dysfunction in 17 males (61%), headaches in two patients (7%), and visual abnormalities in two (7%). Three men presented with osteoporosis. Ten patients (36%) were diagnosed incidentally following brain imaging for unrelated reasons. Seventeen patients (61%) had macroadenoma, while eleven (39%) presented with a microadenoma or no visible adenoma. Mean prolactin (PRL) at presentation was 1594 (median 382; range 50–18,329) ng/ml. Testosterone was low in 21 men. Patients were treated with cabergoline (max dose, 1.1 ± 0.5 mg/week), except for one given bromocriptine; none required pituitary surgery or radiotherapy. Treatment normalized PRL in 24 patients, and in three men PRL suppressed to <2 ULN. Fifteen men normalized testosterone, three improved without normalization, and in three the normal baseline level increased. After a mean follow-up of 5.3 years, 14/15 patients harboring a macroadenoma showed significant adenoma shrinkage. Most patients reported improvement of low libido/erectile dysfunction. In the control group 60 men (79%) achieved PRL normalization.

Conclusions

Elderly men with prolactinomas are diagnosed incidentally in 36% of cases. Long-term medical therapy is successful, achieving biochemical remission, adenoma shrinkage, and clinical improvement in almost all patients.

Keywords

Cabegoline Elderly Men Prolactinoma 

Notes

Funding

This study did not receive any specific grants from any funding agency in the public, commercial, or non-for-profit sector.

Compliance with ethical standards

Conflict of interest

Ilan Shimon, has received research grants, consulting, and lectureship fees from Novartis International AG, Medison Pharma, and Pfizer Inc. The remaining authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ilan Shimon
    • 1
    Email author
  • Dania Hirsch
    • 1
  • Gloria Tsvetov
    • 1
  • Eyal Robenshtok
    • 1
  • Amit Akirov
    • 1
  • Merav Fraenkel
    • 2
  • Yoav Eizenberg
    • 3
  • Dana Herzberg
    • 3
  • Liat Barzilay-Yoseph
    • 4
  • Anat Livner
    • 1
  • Ilana Friedrich
    • 5
  • Yossi Manisterski
    • 6
  • Avraham Ishay
    • 7
  • Uri Yoel
    • 2
  • Hiba Masri
    • 1
  1. 1.Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva: Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Endocrinology, Soroka University Medical Center; Faculty of Health SciencesBen-Gurion University of the NegevBeer ShevaIsrael
  3. 3.Tel Aviv-Jaffa District Clalit Health Services; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Endocrinology Institute, Meir Medical Center Kfar SabaClalit Health ServiceKfar SabaIsrael
  5. 5.Clalit Health ServiceNorthern IsraelIsrael
  6. 6.Maccabi Health Care ServicesTel AvivIsrael
  7. 7.Endocrinology UnitHaemek Medical CenterAfulaIsrael

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