Prolactinomas: focus on indications, outcomes and management of recurrences

Although prolactinomas are discovered at autopsy with equal frequency in women and men, they present clinically in women far more often than in men. In children, "in whom they are the most common type of adenoma, prolactinomas are seen more often in girls than in boys. In a series of nearly 400 PRL-secreting pituitary tumors operated upon by one of the authors (MHW), 321 (82%) ^Tere in female patients. This gender disparity is thought to result from differences in the manner in which such tumors are detected in vivo and referred for surgical evaluation. Presumed abnormalities in the pulsatile secretion of growth hormone-releasing hormone (GHRH) and gonadotropins precipitate a relative estrogen deficiency in patients with prolactinomas. This hypogonadal state is associated with osteoporosis in women and with both cortical and trabecular osteopenia in men. In our series, the most common presenting symptom among females was the development of secondary amenorrhea (72%); only about 50% of these patients had galactorrhea as well. Epidemiologically, approximately 5% of women with primary amenorrhea and 25%.