Sex-related difference in the growth of prolactinomas : A clinical and proliferation marker study

Prolactinomas in women commonly present as small intrasellar tumors, but are usually much larger in men. This discrepancy has generally been attributed to differences in the delay before diagnosis. However, studies comparing clinical and pathological correlates of growth of these tumors in both sexe...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 1997-07, Vol.82 (7), p.2102-2107
Main Authors: DELGRANGE, E, TROUILLAS, J, MAITER, D, DONCKIER, J, TOURNIAIRE, J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Biological and medical sciences
Biomarkers - blood
Bromocriptine - therapeutic use
Cell Division
Endocrinopathies
Female
Humans
Hypothalamus. Hypophysis. Epiphysis (diseases)
Ki-67 Antigen - analysis
Male
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Pituitary Neoplasms - blood
Pituitary Neoplasms - pathology
Prolactin - blood
Prolactinoma - blood
Prolactinoma - drug therapy
Prolactinoma - pathology
Proliferating Cell Nuclear Antigen - analysis
Retrospective Studies
Sex Factors
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Summary:Prolactinomas in women commonly present as small intrasellar tumors, but are usually much larger in men. This discrepancy has generally been attributed to differences in the delay before diagnosis. However, studies comparing clinical and pathological correlates of growth of these tumors in both sexes are lacking. We conducted a retrospective study comparing 45 men and 51 women bearing prolactinoma to determine whether the predominance of large tumors in men was due to a delay in diagnosis or, rather, to a fundamental sex-related difference in tumor growth. Basal PRL levels (mean +/- SEM, 2789 +/- 573 ng/mL) and mean tumor diameter (26 +/- 2 mm) were significantly higher in men than in women (292 +/- 74 ng/mL and 10 +/- 1 mm, respectively; P < 0.001), but were not correlated to the age at diagnosis or the duration of symptoms. Giant tumors (n = 8) occurred in males only. The frequencies of bromocriptine-resistant tumors (30 vs.5%; P < 0.01) and invasive macroadenomas (52 vs.27%; P < 0.001) were significantly greater in men than those in women. Lastly, macroprolactinomas in males exhibited higher indexes of proliferating cells by Ki-67 immunoreactivity (2.6 +/- 1.1% of positive nuclei) than did similar tumors in female patients (0.4 +/- 0.2%; P = 0.08). We conclude that the predominance of large prolactinomas in men is due to a high frequency of rapidly growing tumors, which are often invasive and frequently bromocriptine resistant.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.82.7.2102