Hormones (Athens, Greece) · 2026
Gonadal recovery in men with prolactinomas on cabergoline: 6-month testosterone levels as a predictor of testosterone replacement timing.
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Fedai Neslihan Koray, Uzun Nagihan, Bostan Hayri, Kizilgul Muhammed, Demirci Taner, Cakal Erman, Ucan Bekir
Аннотация
PURPOSE: Hypogonadotropic hypogonadism is a frequent manifestation of prolactinomas in men. Dopamine agonists can restore gonadal function; however, the timeline and predictors of recovery are not well defined. This study focuses on hypogonadotropic hypogonadism exclusively among men with prolactinomas.
METHODS: We retrospectively analyzed 84 men with prolactinomas treated with cabergoline (CAB) for at least 12 months, without prior pituitary surgery or radiotherapy. Hypogonadotropic hypogonadism was defined as morning testosterone < 300 ng/dL with low or inappropriately normal luteinizing hormone (LH). Recovery was defined as testosterone ≥ 300 ng/dL.
RESULTS: At baseline, 75 patients (89.3%) had hypogonadotropic hypogonadism. Gonadal recovery was observed in 30.7% at 6 months, 44% at 12 months, and 59.5% at 24 months. Mean testosterone increased from 142 ng/dL at baseline to 352.5 ng/dL at 24 months, with continued improvement between 12 and 24 months (p < 0.001). Independent predictors of recovery at 12 months were smaller baseline tumor diameter (OR = 0.934, 95%CI: 0.894-0.977, p = 0.003) and higher baseline testosterone (OR = 1.009, 95%CI: 1.000-1.018, p = 0.042). When 6-month parameters were included, only testosterone at 6 months remained predictive (OR = 1.030, 95%CI: 1.014-1.047, p < 0.001). Optimal cut-offs for persistent hypogonadism at 12 months were tumor diameter > 2.3 cm (sensitivity 64.3%, specificity 63.6%), baseline testosterone < 144.5 ng/dL (sensitivity 63.6%, specificity 61.9%), and 6-month testosterone < 234.0 ng/dL (sensitivity 87.9%, specificity 88.1%).
CONCLUSION: Gonadal function recovers in a substantial proportion of men with prolactinomas during CAB therapy, often within the first year. Six-month testosterone levels, along with baseline tumor size, are strong predictors of recovery and may help guide testosterone replacement timing.
METHODS: We retrospectively analyzed 84 men with prolactinomas treated with cabergoline (CAB) for at least 12 months, without prior pituitary surgery or radiotherapy. Hypogonadotropic hypogonadism was defined as morning testosterone < 300 ng/dL with low or inappropriately normal luteinizing hormone (LH). Recovery was defined as testosterone ≥ 300 ng/dL.
RESULTS: At baseline, 75 patients (89.3%) had hypogonadotropic hypogonadism. Gonadal recovery was observed in 30.7% at 6 months, 44% at 12 months, and 59.5% at 24 months. Mean testosterone increased from 142 ng/dL at baseline to 352.5 ng/dL at 24 months, with continued improvement between 12 and 24 months (p < 0.001). Independent predictors of recovery at 12 months were smaller baseline tumor diameter (OR = 0.934, 95%CI: 0.894-0.977, p = 0.003) and higher baseline testosterone (OR = 1.009, 95%CI: 1.000-1.018, p = 0.042). When 6-month parameters were included, only testosterone at 6 months remained predictive (OR = 1.030, 95%CI: 1.014-1.047, p < 0.001). Optimal cut-offs for persistent hypogonadism at 12 months were tumor diameter > 2.3 cm (sensitivity 64.3%, specificity 63.6%), baseline testosterone < 144.5 ng/dL (sensitivity 63.6%, specificity 61.9%), and 6-month testosterone < 234.0 ng/dL (sensitivity 87.9%, specificity 88.1%).
CONCLUSION: Gonadal function recovers in a substantial proportion of men with prolactinomas during CAB therapy, often within the first year. Six-month testosterone levels, along with baseline tumor size, are strong predictors of recovery and may help guide testosterone replacement timing.