ORIGINAL ARTICLE

Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization
Knosp ve Hardy Sınıflamaları, Prolaktinoması Olan Erkek Hastalarda Prolaktin Normalizasyonunu Takiben Hipogonadizminin Kalıcılığını Öngörmede Yararlıdır
Received Date : 01 Jul 2020
Accepted Date : 16 Oct 2020
Available Online : 30 Oct 2020
Doi: 10.25179/tjem.2020-77688 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:284-292
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Despite serum prolactin normalization and tumor shrinkage being obtained using dopamine agonist treatment, hypogonadism may persist in several men with prolactinomas. In this study, we evaluated the effects of tumor magnetic resonance imaging features on the persistence of hypogonadism among normoprolactinemic men with prolactinomas objectively using Knosp and Hardy grading systems. Material and Methods: The patients with prolactinomas who achieved serum prolactin normalization using cabergoline therapy were evaluated, respectively. The extent of tumor growth was evaluated on the basis of Knosp and Hardy grading systems both at diagnosis and six months of medical therapy with serum prolactin normalization. Results: A total of 28 cases (18 macro- and 10 microprolactinomas) were included. After six months of treatment with cabergoline, all microprolactinoma patients with hypogonadism at baseline showed recovery (3, 100%). Moreover, nine of 14 macroprolactinoma patients with hypogonadism at inclusion recovered at the end (group 1), and five did not (group 2). Baseline Knosp grades and Hardy numbers did not differ between groups. However, higher Knosp grades and Hardy numbers were observed in patients who consistently had low serum testosterone in the sixth month (group 2) (p=0.01, p=0.02, respectively). All patients in group 2 had invasive tumors (Hardy number III-IV) both at inclusion and the sixth month according to this classification. Conclusion: We demonstrated that macroprolactinomas with persistent hypogonadism despite serum prolactin normalization more commonly showed cavernous sinus invasion and sellar destruction. We proposed that Knosp and Hardy grading systems are useful in predicting the persistence of male hypogonadism in prolactinomas following prolactin normalization.
ÖZET
Amaç: Prolaktinoması olan erkek hastalarda, dopamin agonistleri ile tedavi sonrası serum prolaktin normalizasyonu ve tümör küçülmesi sağlanmasına rağmen hipogonadizm devam edebilir. Bu çalışmada, normoprolaktinemik erkek prolaktinoma hastalarında, Knosp ve Hardy sınıflamalarını kullanarak tümörün manyetik rezonans görüntüleme özelliklerinin, kalıcı hipogonadizm gelişimi üzerine etkisini objektif olarak değerlendiridik. Gereç ve Yöntemler: Kabergolin tedavisi ile serum prolaktin normalizasyonu sağlanan prolaktinoma hastaları retrospektif olarak değerlendirildi. Hem tanı anında hem de medikal tedavi ile serum prolaktin normalizasyonunun sağlandığı altıncı ayda tümör büyümesinin derecesi Knosp ve Hardy sınıflamaları kullanılarak değerlendirildi. Bulgular: Yirmi sekiz olgu (18 makro ve 10 mikroprolaktinoma) dâhil edildi. Altı aylık kabergolin tedavisi ile başlangıçta hipogonadizmi olan bütün mikroprolaktinoma olgularında (3, %100) hipogonadizm düzeldi. Başlangıçta hipogonadizmi olan 14 makroprolaktinoma olgusunun 9’unda hipogonadizm düzelirken (Grup 1), 5 tanesinde hipogonadizm devem etti (Grup 2). Tanı anındaki Knosp ve Hardy skorları gruplar arasında farklılık göstermedi. Bununla birlikte, altıncı ayda düşük serum testosteronu olanlarda Knosp ve Hardy skorları daha yüksek olarak bulundu (Grup 2) (sırasıyla p=0,01, p=0,02). Bu sınıflamaya göre Grup 2’deki tüm hastaların hem tanı anında hem de altıncı ayda invaziv tümörleri (Hardy III-IV) vardı. Sonuç: Serum prolaktin normalizasyonuna rağmen hipogonadizmi düzelmeyen makroprolaktinoma olgularında, kavernöz sinüs invazyonu ve sellar destrüksiyonun daha sık olduğunu gösterdik. Prolaktnoması olan hastalarda, prolaktin normalizasyonunu takiben erkek hipogonadizminin kalıcılığını öngörmede Knosp ve Hardy sınıflamalarının yardımcı olabileceğini düşünmekteyiz.
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