Gersey Zachary C, Vargas Andres F, Leung Janet H, Fazeli Pouneh K, Zenonos Georgios A, Gardner Paul A
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA.
JCEM Case Rep. 2025 Jul 7;3(8):luaf120. doi: 10.1210/jcemcr/luaf120. eCollection 2025 Aug.
The management of prolactinoma in the setting of gender-affirming hormone therapy (GAHT) is lacking in the literature. We present the case of a transgender woman who was found to have prolactinoma prior to initiating GAHT. Initially, medication effectively managed prolactin levels; however, upon starting GAHT, maintaining control of these levels became challenging. Opting to sustain GAHT without disruption and gain control over symptomatic hyperprolactinemia, the patient underwent endoscopic endonasal surgery, resulting in gross total tumor resection including the medial wall of the cavernous sinus. Postoperative assessments revealed normal prolactin levels without dopamine agonist medication, allowing uninterrupted continuation of GAHT; in the following months, prolactin has minimally increased with plans for monitoring without treatment for now due to intolerance of oral antidopaminergics and lack of visible lesion on follow-up magnetic resonance imaging.
在性别确认激素治疗（GAHT）背景下泌乳素瘤的管理在文献中较为缺乏。我们报告一例跨性别女性病例，该患者在开始GAHT之前被发现患有泌乳素瘤。最初，药物有效控制了泌乳素水平；然而，开始GAHT后，维持这些水平的控制变得具有挑战性。为了在不中断GAHT的情况下维持治疗并控制有症状的高泌乳素血症，患者接受了鼻内镜手术，实现了肿瘤全切，包括海绵窦内侧壁。术后评估显示，在未使用多巴胺激动剂药物的情况下泌乳素水平正常，从而可以不间断地继续GAHT；在接下来的几个月里，泌乳素略有升高，由于口服抗多巴胺能药物不耐受且随访磁共振成像未发现可见病变，目前计划进行监测而不进行治疗。
