Optimal testosterone level to improve symptoms of hypogonadism without causing dopa-testotoxicosis in male macroprolactinoma

Abstract

tBackground. – Male prolactinoma treatment by dopamine agonists (DA) restores sexual function. How-ever, excessive DA dose can lead to impulse control disorder.Objectives. – The aim of this retrospective study was to determine the level of testosterone that eliminatessymptoms and provides fertility in male macroprolactinoma, without causing these adverse effects.Materials and methods. – Twenty-seven male patients with macroprolactinoma were included. Therewere 16 macro (≥ 1–2.8 cm), 7 large macro (≥ 2.9–3.9 cm) and 4 giant (≥ 4 cm) adenomas. Prolactin (PRL)and testosterone (T) levels were evaluated. A timeline was created to analyze improvement in symptomsof hypogonadism and infertility. Testosterone levels were compared with age-matched controls.Results. – Mean PRL, basal tumor diameter and shrinkage were 2846 ± 3415 ng/mL, 27.2 ± 10.2 mmand 63.4%, respectively. Basal T levels were 1.6 ± 1.0 ng/mL for patients and 4.4 ± 1.5 ng/mL for con-trols (P < 0.001). Mean T level in the asymptomatic period was significantly lower than in controls(3.2 ± 0.4 ng/mL vs. 4.4 ± 1.5 ng/mL, respectively; P = 0.002), while mean PRL was 27.2 ng/mL. Fertility wasachieved in 6 of the patients seeking fertility, and there was no difference in T level between these patientsand controls (3.7 ± 0.8 ng/mL and 4.4 ± 1.5 ng/mL, respectively; P = 0.14); when fertility was achieved,mean PRL was 26.9 ± 23 ng/mL.Conclusion. – Patients should be carefully questioned regarding complaints at each consultation, and DAdose should not be increased unnecessarily, to avoid possible serious adverse effects.