Baseline clinical and treatment characteristics in a Dutch national cohort of patients with prolactinoma
I. Pelsma*a (Ms), I. Zandbergena (Ms), W. Van Furtha (Dr), N. Biermasza (Prof), . Dutch Prolactinoma Study Groupa (Prof)
a Leiden University Medical Center, Leiden, NETHERLANDS
First-line treatment for prolactinomas is pharmacological treatment using dopamine agonists (DAs), which effectively controls hyperprolactinemia, although post-withdrawal remission rates are approximately 34%. Therefore, many patients require prolonged DA treatment, while side effects negatively impact health-related quality of life (HR-QoL).
A multicenter prospective observational cohort study aimed to map standard care for all prolactinoma patients in the Netherlands. Here, we describe baseline clinical characteristics and treatment outcomes of the 325 included prolactinoma patients (mean age of 46.4±15.1 years; 210 female patients (64.6%)). At inclusion, the majority of patients were treated at a tertiary care center (N=226, 69.5%). Treatment data was available for 316 patients (treatment with DA N=206 (65.2%), surgery N=16 (5.1%), untreated N=87 (27.5%), and other treatments (i.e. hormonal supplementation or radiotherapy) N=7 (2.2%)).
Male patients had a higher mean age at inclusion (males 55.9±15.8 years, females 41.7±12.2 years, P<0.001), and were more often treated in a tertiary care center (males N=91 (83.5%), females N=134 (63.9%), P<0.001), and were more likely to have a macroprolactinoma (males N=16 (48.5%), females N=14 (20.9%), P=0.009). Lower absolute prolactin levels were observed in males (males median 11.8 µg/L (3.6 - 50.8) µg/L, females median 22.6 (10.1 - 56.4) µg/L, P=0.006), whereas patients with elevated prolactin above the gender-specific ULN (males N=32 (41.0%), females N=74 (49.0%), P=0.266) was similar between sexes. Moreover, male patients were more likely to receive DA treatment (males N=86 (80.4%), females N=120 (57.4%)), whereas female patients were more likely to not receive any treatment (males N=15 (14.0%), 72 (34.4%), P<0.001). Male patients were more likely to report hypogonadism (males N=27/81 (33.3%), females N=36/147 (24.5%), P<0.001). Female patients more often reported galactorrhea (males N=1/56 (1.8%), females N=27/108 (25.0%), P<0.001), and headache (males N=9/81 (11.1%), females N=39/149 (26.2%), P=0.007).
In this Dutch national cohort of patients with prolactinomas, the characteristics of a diverse cohort of patients with prolactinomas are described. Sex differences in clinical and treatment characteristics were observed for virtually all parameters. This study suggests that stratifying outcomes for sex should always be performed when assessing patients with prolactinoma.
The author has declared no conflict of interest.