Prolactinoma induced by estrogen and cyproterone acetate in a male-to-female transsexual

Objective

To report a case of a microprolactinoma in a male-to-female transsexual treated with estrogens and cyproterone acetate.

Design

Case report.

Setting

Endocrinology unit in a university hospital.

Patient(s)

A 33-year-old male-to-female transsexual with prolactin level of 10 ng/mL.

Intervention(s)

Treatment with equine-conjugated estrogens (2.5 mg/day, orally) and cyproterone acetate (100 mg/day, orally) during 6 months.

Main Outcome Measure(s)

Her levels of prolactin were repeatedly found to be elevated to a maximum of 133 ng/mL, and magnetic resonance imaging (MRI) revealed a pituitary mass of 5 × 4 × 4 mm.

Result(s)

Discontinuation of the cross-sex hormone treatment did not reduce the levels of prolactin. The use of dopaminergic-agonist therapy normalized them and reduced the size of the microadenoma. After sex-reassignment surgery, she was treated with low-dose estradiol transdermal patches and presented normal levels of prolactin and appropriate levels of 17β-estradiol and testosterone with a stable image in MRI.

Conclusion(s)

We report a case of prolactinoma after treatment with equine-conjugated estrogens and cyproterone acetate. We recommend long-term follow-up observation consisting of a periodic evaluation of prolactin levels and any symptoms suggestive of hyperprolactinemia to detect as early as possible complications derived from cross-sex hormone therapy.

Key Words: Cross-sex hormone therapy, cyproterone acetate, estrogens, hyperprolactinemia, male-to-female transsexual, prolactinoma