SAT-123 - Metabolic Changes of Prolactinoma

Metabolic Changes of Prolactinoma

Background:
Prolactinoma is the most common pituitary adenoma, with most presenting as microprolactinoma, especially in females, while macroprolactinoma is more frequent in males. Management focuses on lowering prolactin levels, shrinking tumor size, and restoring pituitary function. Dopamine agonists are the primary therapy for both tumor types, and surgery is mainly considered when medical treatment fails. Increasing evidence links prolactinoma to metabolic disturbances, highlighting the importance of evaluating metabolic outcomes. Our study examines metabolic changes in prolactinoma patients before and after medical or surgical treatment in our endocrine clinics.

Methodology:
Retrospective chart review study done at Obesity, Endocrine & Metabolic Center at King Fahad Medical City (KFMC)in Riyadh, Saudi Arabia. The duration of study included patient visits from January 2019 to December 2024. It included adults patients diagnosed with prolactinoma , received treatment of prolactinoma and continued follow up in endocrine clinics at KFMC. Data was collected directly from Epic system and it includes: Demographic data: age, sex. Anthropometric data before and after treatment :Weight , height, BMI, Clinical presentation, Treatment: medications including dopamine agonist, duration, dose, comorbidites, Investigations pre and post treatment: Hemoglobin, ALT,AST,ALP, fasting blood sugar, HbA1c, Lipid profile, calcium , phosphorus, uric acid , T4, TSH, prolactin,FSH, LH, total testosterone, estradiol. Images: Tumor size before and after treatment.

Results:
Among 180 prolactinoma patients 65% were female and mean age was 33 years. Anthropometric assessment revealed a mean weight of 86.28 and mean BMI of 31.79 kg/m², with a predominance of overweight and obese individuals. Headache and reproductive dysfunction were frequent presentations. Pharmacological therapy was the cornerstone of treatment, with cabergoline prescribed in 95.6% of cases and bromocriptine in only 5.0%. Surgical intervention (21.7%) was performed in resistant or recurrent cases. Radiotherapy was rarely used (4.4%), reflecting its role as a last-resort therapy in refractory prolactinoma. Treatment led to significant reductions in prolactin and tumor volume, with improvements in testosterone, FSH, and TSH, while BMI and metabolic indices remained largely unchanged.

Conclusion:
Cabergoline is highly effective in achieving biochemical remission and tumor shrinkage; however, persistent metabolic comorbidites highlight the need for ongoing multidisciplinary management.

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