title: Long-Term Follow-Up of Primary Medical Versus Surgical Treatment of Prolactinomas in Men: Effects on Hyperprolactinemia, Hypogonadism, and Bone Health.
abstract: OBJECTIVE
  In men with prolactinomas, impaired bone density is the principle consequence of hyperprolactinemia-induced hypogonadism. Although dopamine agonists (DAs) are the first-line approach in prolactinomas, surgery can be considered in selected cases. In this study, we aimed to investigate the long-term control of hyperprolactinemia, hypogonadism, and bone health comparing primary medical and surgical therapy in men who had not had prior DA treatment.
  
  
  METHODS
  This is a retrospective case-note study of 44 consecutive men with prolactinomas and no prior DAs managed in a single tertiary referral center. Clinical, biochemical, and radiologic response to the first-line approach were analyzed in the 2 cohorts.
  
  
  RESULTS
  Mean age at diagnosis was 47 years (range, 22-78 years). The prevalence of hypogonadism was 86%, and 27% of patients had pathologic bone density at baseline. The primary therapeutic strategy was surgery for 34% and DAs for 66% of patients. Median long-term follow-up was 63 months (range, 17-238 months). Long-term control of hyperprolactinemia required DAs in 53% of patients with primary surgical therapy, versus 90% of patients with primary medical therapy (P = 0.02). Hypogonadism was controlled in 73% of patients. The prevalence of patients with pathologic bone density was 37% at last follow-up, with no differences between the 2 therapeutic cohorts (P = 0.48).
  
  
  CONCLUSIONS
  Despite control of hyperprolactinemia and hypogonadism in most patients independent of the primary treatment modality, the prevalence of impaired bone health status remains high, and osteodensitometry should be recommended.
authors: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Lukas
authors: L
authors: Andereggen
authors: Department of Endocrinology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Janine
authors: J
authors: Frey
authors: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Robert H
authors: RH
authors: Andres
authors: Department of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Marwan
authors: M
authors: El-Koussy
authors: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Jürgen
authors: J
authors: Beck
authors: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Rolf W
authors: RW
authors: Seiler
authors: Department of Endocrinology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: emanuel.christ@insel.ch.
authors: Emanuel
authors: E
authors: Christ
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001847:Bone Diseases / Q000401:mortality* / Q000517:prevention & control; D015984:Causality; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D006966:Hyperprolactinemia / Q000401:mortality* / Q000517:prevention & control; D007006:Hypogonadism / Q000401:mortality* / Q000517:prevention & control; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D054526:Men's Health / Q000706:statistics & numerical data; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D010911:Pituitary Neoplasms / Q000401:mortality* / Q000628:therapy; D015175:Prolactinoma / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Bone health; Hypogonadism; Men; Primary medical therapy; Primary surgical therapy; Prolactinoma