目的:在接受多巴胺激动剂(DA)治疗的男性泌乳素瘤中,程度,时间轴,促性腺激素轴恢复的预测因素尚不清楚。
方法:我们分析了97例接受DA治疗的男性泌乳素腺瘤(77/97大型泌乳素腺瘤)的数据。我们排除了原发性性腺功能减退症患者,DA开始后<12个月的手术,和诊断时肿瘤<5mm或催乳素<45µg/l的患者。
结果:在97例患者中,诊断时12例总睾酮正常(NT组),85例睾酮低(LT组)。在NT组中,睾丸激素在6个月时从平均13.5nmol/l上升到17.1nmol/l(n=11;p<0.05),然后在12个月时保持稳定(n=8)。在LT组中,睾丸激素从平均5.2nmol/l上升到6个月时的9.6nmol/l(n=66;p<0.001),并在12个月时进一步上升到13.1nmol/l(n=40;p<0.001),然后保持稳定。从性腺机能减退中恢复的发生率为43%,50%,54%的患者在6、12和24个月时,分别(61%,69和69%,如果催乳素正常)。12个月时与持续性性腺功能减退症独立相关的因素是在基线时存在视野缺损和较低的睾酮水平,而持续性性腺功能减退症的最显著的独立预测因子是6个月时睾酮水平<7.4nmol/l,具有91%的灵敏度和94%的特异性。
结论:少数患有泌乳素瘤的男性睾酮水平在DA治疗的第一年恢复。然而,睾酮替代可以早期考虑在患有大型和压缩性肿瘤的患者中,在DA治疗6个月后,睾酮保持在7.4nmol/l以下。
OBJECTIVE: In men with prolactinoma treated with dopamine agonists (DA), the extent, timeline, and predictive factors of gonadotropic axis recovery are still unclear.
METHODS: We analyzed data of 97 men with a prolactinoma treated with DA (77/97 macroprolactinomas). We excluded patients with primary hypogonadism, surgery < 12 months after DA initiation, and patients with tumors < 5 mm or prolactin < 45 µg/l at diagnosis.
RESULTS: Among the 97 patients, 12 had normal total testosterone (NT group) and 85 had low testosterone at diagnosis (LT group). In the NT group, testosterone rose from a mean of 13.5 nmol/l to 17.1nmol/l at 6 months (n = 11; p < 0.05) then remained stable at 12 months (n = 8). In the LT group, testosterone rose from a mean of 5.2 nmol/l to 9.6 nmol/l at 6 months (n = 66; p < 0.001) and further to 13.1nmol/l at 12 months (n = 40; p < 0.001) then remained stable. Recovery from hypogonadism occurred in 43%, 50%, and 54% of patients at 6, 12 and 24 months, respectively (61%, 69 and 69% if prolactin was normal). Factors independently associated with persistent hypogonadism at 12 months were at baseline the presence of visual field deficit and lower testosterone levels, while the most significant independent predictor of persistent hypogonadism at one year was a testosterone level < 7.4 nmol/l at 6 months, with 91% sensitivity and 94% specificity.
CONCLUSIONS: Testosterone levels recover in a small majority of men with prolactinoma mostly during the first year of DA treatment. However, testosterone replacement could be considered earlier in patients with large and compressive tumors, and in whom testosterone remains below 7.4 nmol/l after 6 months of DA treatment.