Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India.
Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India.
J Clin Endocrinol Metab. 2020 Dec 1;105(12). doi: 10.1210/clinem/dgaa650.
Data are limited regarding prevalence, predictors, and mechanisms of persistent hypogonadotropic hypogonadism (HH) in males with a macroprolactinoma who achieve normoprolactinemia on dopamine-agonist therapy. None of the previous studies provide cutoffs to predict the achievement of eugonadism.
The objective of this work is to evaluate the prevalence of persistent HH and its determinants in men with a macroprolactinoma who achieve normoprolactinemia on cabergoline monotherapy.
This retrospective study with prospective cross-sectional evaluation took place at a tertiary health care center.
Study participants included men with a macroprolactinoma and baseline HH who achieved normoprolactinemia on cabergoline monotherapy.
Outcome measures of this study included the prevalence of persistent HH and its predictors.
Thirty participants (age, 38.3 ± 10.1 years) with baseline tumor size of 4.08 ± 1.48 cm and median (interquartile range) prolactin of 2871 ng/mL (range, 1665-8425 ng/mL) were included. Eight of 30 participants achieved eugonadism after a median follow-up of 3 years. Patients with persistent HH had suppression of the luteinizing hormone (LH)-testosterone axis with sparing of other anterior pituitary hormonal axes, including follicle-stimulating hormone-inhibin B. Baseline prolactin (1674 vs 4120 ng/mL; P = .008) and maximal tumor diameter (2.55 ± 0.36 vs 4.64 ± 1.32 cm; P = .003) were lower in patients who achieved eugonadism. Baseline maximal tumor diameter less than or equal to 3.2 cm (sensitivity: 75%, specificity: 63.6%) and serum prolactin less than or equal to 2098 ng/mL (sensitivity: 87.5%, specificity: 77.3%) best predicted reversal of HH.
Recovery of the LH-testosterone axis occurred in 26.7% of men with a macroprolactinoma who achieved normoprolactinemia on cabergoline monotherapy. Higher baseline tumor size and serum prolactin predict persistent HH. Our data favor chronic functional modification of the hypothalamic-pituitary-gonadal axis over gonadotroph damage as the cause of persistent HH.
关于多巴胺激动剂治疗后催乳素正常的大泌乳素瘤男性患者中持续性促性腺激素低下性性腺功能减退症（HH）的患病率、预测因素和发病机制的数据有限。之前的研究均未提供预测性腺功能正常的截止值。
本研究旨在评估大泌乳素瘤男性患者在接受卡麦角林单药治疗后催乳素正常时，持续性 HH 的患病率及其决定因素。
这是一项回顾性研究，同时进行前瞻性横断面评估，在三级保健中心进行。
研究参与者包括基线 HH 的大泌乳素瘤男性患者，他们在接受卡麦角林单药治疗后催乳素正常。
本研究的观察指标包括持续性 HH 的患病率及其预测因素。
30 名参与者（年龄 38.3 ± 10.1 岁）基线肿瘤大小为 4.08 ± 1.48 cm，中位（四分位间距）催乳素为 2871 ng/mL（范围 1665-8425 ng/mL）。30 名参与者中有 8 名在中位随访 3 年后达到性腺功能正常。持续性 HH 患者的黄体生成素（LH）-睾丸激素轴受到抑制，但其他前叶垂体激素轴，包括卵泡刺激素-抑制素 B，受到保护。达到性腺功能正常的患者的基线催乳素（1674 与 4120 ng/mL；P =.008）和最大肿瘤直径（2.55 ± 0.36 与 4.64 ± 1.32 cm；P =.003）较低。基线最大肿瘤直径小于或等于 3.2 cm（敏感性：75%，特异性：63.6%）和血清催乳素小于或等于 2098 ng/mL（敏感性：87.5%，特异性：77.3%）可最佳预测 HH 的逆转。
在接受卡麦角林单药治疗催乳素正常的大泌乳素瘤男性患者中，有 26.7%的患者恢复了 LH-睾丸激素轴的功能。较高的基线肿瘤大小和血清催乳素预测持续性 HH。我们的数据支持下丘脑-垂体-性腺轴的慢性功能改变而不是促性腺激素损伤作为持续性 HH 的原因。
