scholarly journals Prolactinoma in a Male to Female Transgender Woman on Gender Affirming Hormone Therapy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A795-A795
Author(s):  
Leighton K Harned ◽  
Rene J Harper
Keyword(s):  
Pituitary Gland ◽  
Hormone Therapy ◽  
Dopamine Agonist ◽  
Brain Mri ◽  
Transgender Women ◽  
Prolactin Secretion ◽  
Reference Ranges ◽  
Agonist Therapy ◽  
Dopamine Agonist Therapy

Abstract Background: Estrogen promotes prolactin secretion and its role in prolactin secreting adenomas is still under investigation. The genesis and resolution of prolactinomas may be affected by gender affirming hormone therapy. Case Description: A 50 year old transgender female presented with new onset tunnel vision and extremity parathesias for one day. She had been taking oral estrogen for six years. Physical exam showed bilateral gynecomastia as well as galactorrhea. Her visual fields were intact by confrontation. Her brain MRI revealed a pituitary macroadenoma measuring 1.4cm x 1.3cm x 1.3cm. Laboratory studies showed prolactin 538 ng/mL (<20 ng/mL), IGF-1 89.0 (66-303 ng/ml). TSH 1.7 (0.4-4.7 mcIU/mL), Free T4 0.997 (0.58-1.76 ng/dL) and estradiol 103 pg/ml (N/A). She was treated with bromocriptine 5mg daily. Three months later galactorrhea had resolved, but gynecomastia was unchanged. The patient had a prolactin level of 3 ng/mL. Follow up brain MRI at one and three years showed no significant decrease in size of macroadenoma. Discussion: Despite this patient’s biochemical and symptomatic response to dopamine agonist therapy, her pituitary adenoma did not decrease in size over 3 years, which is a common occurrence with macroprolactinomas. However, her prolactin levels declined and her galactorrhea resolved with therapy. Research into the long term effects of gender transition therapy remains mainly in the realm of case reports and retrospective studies. Our review of the medical literature suggests that some transgender patients on estrogen therapy may have an increased risk of developing pituitary adenomas. However, guidelines have not yet been published and currently there are no recommendations for routine imaging or biochemical assessment during follow-up of these patients. While there are established reference ranges for prolactin levels for men, non-pregnant and pregnant women, no established reference ranges for prolactin levels are available for transgender women on gender affirming hormone therapy. Studies indicate that 76-86% of patients have a reduction in the size of their prolactinomas after dopamine agonist therapy. However, the same may not be true for transgender women on transfeminine hormone therapy with estrogen. Conclusion: Prolactinomas may commonly occur and be masked in transgender women on gender affirming hormone therapy due to the expected symptoms of gynecomastia, erectile dysfunction, and diminished libido from reduced testosterone levels. Estrogen promotes prolactin secretion by the pituitary gland and may have a role in development and expansion of prolactinomas. More research is needed in regards to the assessment and monitoring of the pituitary gland in transgender women on gender affirming hormone therapy with estrogen.

scholarly journals Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?

1999 ◽  
pp. 43-47 ◽  
Author(s):  
HE Turner ◽  
CB Adams ◽  
JA Wass
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
Hormone Deficiency ◽  
Serum Prolactin ◽  
Agonist Therapy ◽  
Recurrence Rates ◽  
Tertiary Referral Centre ◽  
Dopamine Agonist Therapy

AIMS: Reported cure rates following trans-sphenoidal surgery for microprolactinoma are variable and recurrence rates in some series are high. We wished to examine the cure rate of trans-sphenoidal surgery for microprolactinoma, and to assess the long-term complications and recurrence rate. DESIGN: A retrospective review of the outcome of trans-sphenoidal surgery for microprolactinoma, performed by a single neurosurgeon at a tertiary referral centre between 1976 and 1997. PATIENTS: All thirty-two patients operated on for microprolactinoma were female, with a mean age of 31 years (range 16-49). Indications for surgery were intolerance of dopamine agonists in ten (31%), resistance in six (19%) and resistance and intolerance in four (12.5%). Two patients were from countries where dopamine agonists were unavailable. RESULTS: The mean pre-operative prolactin level was 2933 mU/l (range 1125-6000). All but 1 had amenorrhoea or oligomenorrhoea, with galactorrhoea in 15 (46.9%). Twenty-five (78%) were cured by trans-sphenoidal surgery, as judged by a post-operative serum prolactin in the normal range. During a mean follow-up of 70 months (range 2 months to 16 years) there was one recurrence at 12 years. Post-operatively, one patient became LH deficient, two patients became cortisol deficient and two became TSH deficient. Out of 21 patients tested for post-operative growth hormone deficiency, 6 (28.6%) were deficient. Five patients developed post-operative diabetes insipidus which persisted for greater than 6 months. There were no other complications of surgery. The estimated cost of uncomplicated trans-sphenoidal surgery, and follow-up over 10 years, was similar to that of dopamine agonist therapy. CONCLUSION: In patients with hyperprolactinaemia due to a pituitary microprolactinoma, transsphenoidal surgery by an experienced pituitary surgeon should be considered as a potentially curative procedure. The cost of treatment over a 10 year period is similar in uncomplicated cases to long-term dopamine agonist therapy.

Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: a prospective study with 1 year follow-up

Endocrine ◽  
2018 ◽  
Vol 62 (3) ◽  
pp. 692-700 ◽  
Author(s):  
Emir Celik ◽  
Hande Mefkure Ozkaya ◽  
Burc Cagri Poyraz ◽  
Tarik Saglam ◽  
Pinar Kadioglu
Keyword(s):  
Prospective Study ◽  
Dopamine Agonist ◽  
Impulse Control ◽  
Impulse Control Disorders ◽  
Agonist Therapy ◽  
Dopamine Agonist Therapy ◽  
A Prospective Study

scholarly journals Impulse Control Disorder in a Patient with Invasive Prolactinoma on Dopamine agonist Therapy: A Case Report

2019 ◽  
Vol 3 (1) ◽  
pp. 01-03
Author(s):  
Pinaki Dutt
Keyword(s):  
Case Report ◽  
Adverse Events ◽  
Dopamine Agonist ◽  
Pituitary Adenomas ◽  
Impulse Control ◽  
Agonist Therapy ◽  
Debulking Surgery ◽  
Dopamine Agonist Therapy ◽  
Invasive Prolactinoma

Prolactinomas constitutes a major bulk of pituitary adenomas. All symptomatic prolactinomas require dopamine agonist (DA) therapy. Impulse control disorders (ICD) or pathological behaviours are rare adverse events described with use of DA. Herein we are describing a male patient with pathological gambling and doctor shopping following use of bromocriptine and higher dose of cabergoline.The pathological behaviour disappeard after debulking surgery, reduction in cabergoline dose and several sessions of counselling. Physicians prescribing DA should be aware of this potential adverse event.This should be emphasized to the patient and family members before starting DA and physician should be inquisitive for eliciting pathological behaviour on follow up.

Update Treatment for Prolactinoma

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Chávez Hernández María Margarita ◽  
Jiménez Báez María Valeria ◽  
Armijo Medina María Fernanda ◽  
Domínguez Leyva Jorge Miguel ◽  
Góngora Valencia Karen Alejandra ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Safety Profile ◽  
Pituitary Tumor ◽  
Common Type ◽  
Treatment Modalities ◽  
First Line ◽  
Agonist Therapy ◽  
Dopamine Agonist Therapy ◽  
Gonadal Dysfunction

Prolactinomas are the most common type of functional pituitary tumor. The present manuscript is an update on the treatment modalities for prolactinomas. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas; recurrence of disease after cessation of the drug may occur in patients. Its safety profile remains high, allowing its use during pregnancy.

scholarly journals EGFR/ErbB2-Targeting Lapatinib Therapy for Aggressive Prolactinomas

2020 ◽  
Author(s):  
Odelia Cooper ◽  
Vivien S Bonert ◽  
Jeremy Rudnick ◽  
Barry D Pressman ◽  
Janet Lo ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Tumor Response ◽  
Kinase Inhibitor ◽  
Growth Factor Receptor ◽  
Multicenter Trial ◽  
Tumor Diameter ◽  
Her2 Expression ◽  
Agonist Therapy ◽  
End Point ◽  
Dopamine Agonist Therapy

Abstract Context Approximately 10% to 20% of prolactinomas are resistant to dopamine agonist therapy. The ErbB signaling pathway may drive aggressive prolactinoma behavior. Objective We evaluated lapatinib, an ErbB1-epidermal growth factor receptor (EGFR)/ErbB2 or human EGFR2 (HER2) tyrosine kinase inhibitor (TKI), in aggressive prolactinomas. Design A prospective, phase 2a multicenter trial was conducted. Setting This study took place at a tertiary referral pituitary center. Patients Study participants included adults with aggressive prolactinomas showing continued tumor growth despite maximally tolerated dopamine agonist therapy. Intervention Intervention included oral lapatinib 1250 mg/day for 6 months. Main Outcome Measures The primary end point was 40% reduction in any tumor dimension assessed by magnetic resonance imaging at study end; tumor response was assessed by Response Evaluation Criteria in Solid Tumors criteria. Secondary end points included prolactin (PRL) reduction, correlation of response with EGFR/HER2 expression, and safety. Results Owing to rigorous inclusion criteria, of 24 planned participants, only 7 consented and 4 were treated. None achieved the primary end point but 3 showed stable disease, including 2 with a 6% increase and 1 with a 16.8% decrease in tumor diameter. PRL response was not always concordant with tumor response, as 2 showed 28% and 59% increases in PRL. The fourth participant had a PRL-secreting carcinoma and withdrew after 3 months of lapatinib because of imaging and PRL progression. EGFR/HER2 expression did not correlate with treatment response. Lapatinib was well tolerated overall, with reversible grade 1 transaminitis in 2 patients, grade 2 rash in 2 patients, and grade 1 asymptomatic bradycardia in 2 patients. Conclusions An oral TKI such as lapatinib may be an effective option for a difficult-to-treat patient with an aggressive prolactinoma.

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