Exploring sex-specific hematological changes and their impact on quality of life in patients with prolactinoma

Context: Despite prolactin´s (PRL) role in stimulating hematopoiesis, anemia is commonly observed in men with macroprolactinomas. However, hematological changes in men with microprolactinomas and women with prolactinomas remain unexplored, and the impact of erythropoietic alterations on quality of life (QoL) is still unclear. Objective: To explore sex-related changes in red blood cell (RBC) parameters and their potential impact on QoL at initial diagnosis of prolactinoma and after normalization of PRL under dopamine agonists. Design: Retrospective, monocentric study involving 205 patients with prolactinoma (127 women, 62%). The SF-36 QoL questionnaire was administered to 57 women and 34 men. Results: In women, no significant changes in RBC parameters were observed at diagnosis or after PRL normalization, regardless the adenoma size. Conversely, men with microprolactinoma showed a significant increase in hematocrit (HCT) and hemoglobin (Hb) levels after PRL normalization (median HCT 42.3 vs.44.0%; Hb 14.5 vs. 15.1 g/dL; both p < 0.005). Men with macroprolactinoma exhibited similar improvements (HCT 40.2 vs. 43.9%; Hb 14.0 vs. 15.1 g/dL; both p < 0.0001). In men, hypogonadism was observed in 73% of patients at baseline, and in 11% after PRL normalization. In male patients where SF-36 was administered at diagnosis and after PRL normalization, energy improvement was observed (median 50 vs. 60, p < 0.05). While changes in Hb and HCT were not significantly impacting the QoL of women and men, persistence of hypogonadism after PRL normalization, negatively impacted all the QoL scores of men. Conclusion: Patients with prolactinoma show sex-dependent changes in RBC parameters. Unlike women, men exhibit decreased HCT and Hb levels irrespective of adenoma size. Of note, the failure to recover from hypogonadism significantly affected the QoL of men.