高泌乳素血症在患病率、临床特征及对卡麦角林反应方面的性别差异。

Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia.

作者信息

Colao Annamaria, Sarno Antonella Di, Cappabianca Paolo, Briganti Francesco, Pivonello Rosario, Somma Carolina Di, Faggiano Antongiulio, Biondi Bernadette, Lombardi Gaetano

机构信息

Department of Molecular and Clinical Endocrinology, Federico II University of Naples, via S. Pansini 5, Italy.

出版信息

Eur J Endocrinol. 2003 Mar;148(3):325-31. doi: 10.1530/eje.0.1480325.

DOI:10.1530/eje.0.1480325

PMID:12611613

Abstract

BACKGROUND

Gender differences in tumor size are supposed to exist in hyperprolactinemia since microadenomas are more commonly found in women and macroadenomas in men. Whether this reflects only a delay in diagnosis in men or a true gender difference in tumor pathogenesis is still unclear.

OBJECTIVE

To prospectively analyze gender differences in the presentation and response to cabergoline treatment in 219 consecutive newly diagnosed patients with hyperprolactinemia.

DESIGN

An open prospective design.

SUBJECTS

Of the 219 patients of which 145 were women; 107 patients had macroprolactinoma, 97 had microprolactinoma, and 15 had non-tumoral hyperprolactinemia.

METHODS

Presenting clinical symptoms, prolactin levels and tumor size at magnetic resonance imaging were measured before and 3-6 Months after cabergoline therapy.

RESULTS

Prevalence of microprolactinomas (56% vs 22%, P=<0.0001) and non-tumoral hyperprolactinemia (10% vs 0%, P=0.01) was higher in women than in men. Men and women were of similar age (median 32 vs 29 Years; P=0.2) and a similar number had gonadal/sexual dysfunction (85 vs 83%, P=0.6); weight gain (70 vs 46%; P=<0.0001) and galactorrhea (52 vs 19%; P=<0.0001) were more common in women. Prolactin levels were higher in men than in women, whether exhibiting macro- (2848+/-2954 vs 1132+/-2351 microg/l, P=<0.0001) or microadenomas (187.8+/-51.8 vs 135.4+/-60.5 microg/l, P=0.009) and the size of the adenoma was larger in men than in women irrespective of macro- (25.8+/-12.4 vs 17.2+/-7.2 mm, P=<0.0001) or microadenoma diagnosis (8.0+/-1.4 vs 7.1+/-1.6 mm, P=0.04). After treatment, prolactin levels decreased by 89.2-96.4% in all groups, and normalized more frequently in micro- than in macroadenoma patients (86 vs 64%, P<0.0001), regardless of gender (70% vs 69%, P=0.9). Menses resumed in 82% of women, libido disturbances improved in 57% of men. Tumor size was reduced by 45+/-25% and 52+/-24% in macroprolactinoma patients and by 44+/-31 and 38+/-29% in microprolactinoma patients in women and men respectively. Visual field defects disappeared in 61% of women and in 71% of men (P=0.6).

CONCLUSIONS

Prevalence of macroprolactinomas was similar in men and women; microprolactinomas and non-tumoral hyperprolactinemia were more frequent in women. Clinical symptoms at presentation differed according to gender, with galactorrhea and weight gain more frequent in women. The successful response to cabergoline treatment for 6 Months was higher in micro- than in macroprolactinoma patients and was similar in women and men.

摘要

背景

高催乳素血症在肿瘤大小方面可能存在性别差异，因为微腺瘤在女性中更为常见，而大腺瘤在男性中更为常见。这是仅反映男性诊断延迟还是肿瘤发病机制中真正的性别差异仍不清楚。

目的

前瞻性分析219例连续新诊断的高催乳素血症患者在临床表现及对卡麦角林治疗反应方面的性别差异。

设计

开放性前瞻性设计。

研究对象

219例患者中，145例为女性；107例患有大泌乳素瘤，97例患有微泌乳素瘤，15例患有非肿瘤性高催乳素血症。

方法

在卡麦角林治疗前及治疗3 - 6个月后，测量患者的临床症状、催乳素水平及磁共振成像显示的肿瘤大小。

结果

女性微泌乳素瘤（56%对22%，P<0.0001）和非肿瘤性高催乳素血症（10%对0%，P = 0.01）的患病率高于男性。男性和女性年龄相似（中位数分别为32岁和29岁；P = 0.2），性腺/性功能障碍患者数量相似（85%对83%，P = 0.6）；体重增加（70%对46%；P<0.0001）和溢乳（52%对19%；P<0.0001）在女性中更常见。无论患有大腺瘤（2848±2954对1132±2351μg/l，P<0.0001）还是微腺瘤（187.8±51.8对135.4±60.5μg/l，P = 0.009），男性的催乳素水平均高于女性，且无论诊断为大腺瘤（25.8±12.4对17.2±7.2mm，P<0.0001）还是微腺瘤（8.0±1.4对7.1±1.6mm，P = 0.04），男性腺瘤的大小均大于女性。治疗后，所有组的催乳素水平均下降89.2 - 96.4%，微腺瘤患者催乳素水平恢复正常的频率高于大腺瘤患者（86%对64%，P<0.0001），且与性别无关（70%对69%，P = 0.9）。82%的女性月经恢复，57%的男性性欲障碍改善。大泌乳素瘤患者中，女性和男性的肿瘤大小分别缩小45±25%和52±24%；微泌乳素瘤患者中，女性和男性的肿瘤大小分别缩小44±31%和38±29%。61%的女性和71%的男性视野缺损消失（P = 0.6）。