Estrogen-Induced Prolactinoma in a Man:

Prolactinomas can be induced in rats by large doses of estrogens. Whether prolactinomas can be induced in humans by estrogens, however, is not known. This report describes the development of a prolactinoma in a man with previously normal plasma PRL levels after the administration of pharmacological doses of estrogen. The patient, a 26-yr-old male to female transsexual, took cyproterone acetate (100 mg/day, orally) and ethinyl estradiol (100 micrograms/day, orally) for 10 months and (surrepititiously) estradiol-17-undecanoate (100 mg, twice weekly, im) for about 6 of the 10 months. Plasma PRL levels rose from 0.05 to 5.20 U/L within 10 months (normal, 0.05-0.30 U/L). A computed tomographic scan showed a pituitary mass with suprasellar extension. After all estrogen therapy was discontinued, his plasma estradiol levels gradually declined from 2.8 to 0.77 nmol/L (normal, 0.04-0.12 nmol/L), but PRL levels rose further to 6.2 U/L. Bromocriptine treatment (2.5 mg twice daily) then was given. Plasma PRL fell gradually to 0.43 U/L and a computed tomographic scan after 5 months showed reduction in tumor size. The patient then discontinued bromocriptine treatment. Four months later his plasma estradiol level was normal, while plasma PRL had risen to 4.6 U/L, indicating autonomous PRL secretion. We conclude that 1) estrogen in pharmacological doses can induce prolactinomas in man; and 2) subjects treated with high doses of estrogen must, therefore, be surveyed for the development of such tumors.