Analysis of Treatment Outcomes of Patients With Cystic Prolactinomas: Report of Four Cases

Background: Prolactinomas are the most common functional pituitary adenomas. Treatment with dopamine agonists is considered as first-line therapy. Cystic prolactinoma is a variant prolactinoma. . It was assumed that since cystic area does not contain dopamine receptors, cystic prolactinomas would not respond to medical treatment. However, in recent years, it has been shown that cystic prolactinomas can also be treated with dopamine agonists, and medical treatment has become more preferred than surgical treatment. In this report, we aimed to evaluate the treatment effectiveness of patients with cystic prolactinomas who treated medically in our clinic. Materials and methods: Twenty-nine prolactinoma patients who were followed up in our hospital between 2019-2020 were evaluated retrospectively. Four patients (13%) were being followed up for cystic prolactinoma. Radiological images, laboratory findings, patients records were reviewed. Results: Four patients were being followed up for cystic prolactinoma and all were women. The average age of the patients followed up for cystic prolactinoma was 36 years. 3 patients (75%) had menstrual irregularity, 2 (50%) patients had galactorrhea, and 1 patient (25%) had headache at the time of admission. Tumor size regressed with medical treatment in two patients and the tumor disappeared completely in one patient. Although the symptomatic improvement and normalization of prolactin was achieved in one of our patients, the lesion did not shrink. We continued with medical treatment in this patient since there was no indication for surgery. Discussion: There was conflicting results in the literature regarding the management of cystic prolactinomas. Recently, dopamin agonist therapy is suggested as first- line treatment option in cystic prolactinomas. A study reported male predominance for cyst formation but we observed female predominance in our report. Faje et al. also reported female predominance in their study. Presentation of our patients were not different from solid prolactinomas. And although we evaluated very limited number of patients in our report, all of our patients respond to medical treatment which was consistent with recent literature.