During the study period, 89 patients met the inclusion criteria, representing a prevalence of 36.7% among all cases of pituitary adenoma. Our study included 66 (74.1%) women, giving a sex ratio (M/F) of 0.34. The mean age of our patients was 35.6 ± 10 years, with extremes of 17 and 60 years. We found 2 cases of diabetes mellitus (2.3%), all carrying a mixed adenoma (GH + Prolactin). Hypertensive subjects accounted for 7.9% (7 cases, including 5 patients with a prolactinoma and 2 patients with a mixed adenoma).

The mean delay of consultation was 27.1 ± 29 months, with extremes of 1 and 250 months. Clinical symptoms were dominated by gonadotropic disorders, which were present in all patients (100%). These included galactorrhoea in 71 patients (79.8%), menstrual cycle disorders such as amenorrhoea in 61 patients (68.5%), spaniomenorrhoea in 5 patients (5.6%) and infertility in 31 patients (34.8%). Fifty-seven (58) patients presented with a tumour syndrome (65.2%). Among them, we noted 57 cases of headache (64%), 1 case of pituitary apoplexy (0.11%), 32 cases of visual acuity disorders (36%) and 11 cases of visual field disorders (12.4%). A dysmorphic syndrome was found in 6 patients (6.7%). Table 1 shows the distribution according to epidemiological and clinical data.

Among the 89 patients, hormonal investigations were in favour of isolated hyperprolactinaemia in 80 patients (89.9%). Nine (9) patients (10.1%) had mixed hypersecretion, including concomitant hypersecretion of growth hormone (GH) in 8 cases and ACTH in 01 patient (Table 2). We found no signs of associated hormonal hypersecretion in favour of an anteropituitary insufficiency syndrome.

All patients had undergone pituitary imaging. Thirty-eight patients (42.7%) had undergone computed tomography (CT) and sixty-seven patients (75.3%) magnetic resonance imaging (MRI). Imaging revealed a macroadenoma in 68.5% (61 patients). The adenoma had spread in 11 patients (12.4%). Table 2 shows the distribution of patients according to hormonal and morphological profile.

In the end, we found 89 cases of prolactin adenomas, including 80 cases of isolated secretion, 08 cases of mixed secretion associated with acromegaly and 01 case of mixed secretion associated with Cushing’s disease. Macroadenomas were found in 68.5% of cases, microadenomas in 31.5% and extensive adenomas in 12.4%. In our series, the factors most significantly associated with prolactinoma were young age (p < 0.001), female sex (p < 0.001), a long delay in consultation (p < 0.001) and a microadenoma (p < 0.001).

All patients had initially received medical treatment. This was mainly Cabergoline in 79 cases (88.8%) and Bromocriptine in 8 cases (8.9%). Table 3 shows the treatment of the patients. Of our patients, half had undergone surgery, in 45 cases (50.6%). The transsphenoidal approach was the most commonly used (97.8%), in 44 cases, and one patient underwent surgery via the upper approach (2.2%). Immediate post-operative complications included transient diabetes insipidus (35 cases, 77.8%) and cerebrospinal fluid leakage (9 cases, 20%). We noted 7 cases (7.9%) of death. The average age of the patients was 41.2 years. These were patients with 100% tumour syndrome, one case of mixed secretion (GH + prolactin), 6 cases of macroadenomas (85.7%), 03 cases of transsphenoidal surgery and 4 patients who did not undergo surgery. Of the 82 patients still alive, mid-term evaluation was carried out in terms of hormones in 70 patients (85.4%), morphology in 63 patients (76.8%) and ophthalmology in 82 patients (100%). Hormone secretion had normalised in 64 cases (78%). Imaging revealed no pituitary adenoma in 49 patients (59.8%). Of these, only 17 patients had undergone pituitary surgery. In terms of ophthalmology, an improvement in visual acuity was noted in 72 patients (87.8%).

This was a study of 89 cases of prolactinoma collected over 14 years, with a prevalence of 36.7%. Several studies have reported a predominance of prolactinomas among pituitary adenomas [2] [3] [6] [7] [8] [9] [10] . The prevalence was 56.26% in Cameroon [11] and 69.5% in Côte d’Ivoire [12] . Our figures for the

mean age of onset of the disease are close to the third decade reported in Pakistan [13] and Africa [14] respectively. As already widely illustrated by scientific data [13] [14] , the female sex was more representative in our series. This predominance was high, approaching 70% in most series [15] [16] . This female predominance is thought to be due to hormonal fluctuations. Indeed, it has been shown that oestrogen is involved in the development of prolactinomas [17] [18] . These results further indicate that prolactin adenomas are particularly common in young women.

In our study, the symptomatology was dominated by the amenorrhoea-galactorrhoea syndrome. This syndrome appears to be the main reason for discovery. It has been reported to be between 60% and 80% in studies carried out in France [19] . The proportion of tumour syndrome is partly explained by the high frequency of macroadenomas. However, macroadenomas appear to be more frequent in males [20] . These macroadenomas partly reflect a delay in consultation. In fact, the literature agrees on an average delay of 18 months in diagnosis in subjects with prolactinomas [1] [2] [11] [14] . In 2010, Fernandez et al. [2] reported that the delay in diagnosis was more pronounced in males because of the long insidious nature of the symptoms. In our study, all cases of microadenoma were found in women. In addition, the factors most significantly associated with prolactinoma were young age (p < 0.001), female sex (p < 0.001), a long delay in consultation (p < 0.001) and a microadenoma (p < 0.001). However and according to Nishioka et al. [21] in Japan, the high proportion of macroadenomas was rather related to a high rate of cells with high proliferativé activity.

As in our study, Kars et al. [22] in the Netherlands initially treated all their patients with dopamine antagonists. Of these, 35% required additional surgical treatment, after an average duration of 1.2 years [22] . Cabergoline remains the first-line drug [14] [23] . However, surgery is sometimes essential [14] [22] [23] . Consequently, management requires a personalised, multidisciplinary approach, taking into account each patient’s individual state of health and response to previous treatment. Under medical treatment with dopaminergic agonists, our results are similar to those of Irfan et al. [23] , who found a normalisation of prolactin levels in 73.2% and a reduction of more than 50% in tumour volume in 45.8% after two years. In the study by Kars et al. [22] in the Netherlands, prolactin normalised in 85% of patients and tumour volume was reduced in 35%; in a series evaluating the impact of medical treatment on prolactin macroadenomas, 80% of patients reported normalisation of prolactin, 87% a significant reduction in tumour volume and 68% an improvement in visual field abnormalities [24] . This reduction in tumour volume was close to 80% [25] , and even 100% in 12% and 45% of cases [20] . The results of these studies highlight the efficacy of medical treatment with Cabergoline in normalising prolactin and significantly reducing tumour size. In addition, the results of this study highlight the need for long-term monitoring of patients treated for macroprolactinomas in order to detect recurrence, regrowth of the adenoma and other complications associated with treatment. It is important to note that patients of childbearing age have regained their fertility. This recovery of fertility was observed in the majority (81%) of treated patients, contributing to an improvement in their quality of life. The results show that medical treatment not only had a positive impact on patients’ health, but also on their ability to start a family. This underlines the importance of appropriate treatment and ongoing medical monitoring in these cases.

The limitations of the study were mainly based on the fact that clinical records were sometimes incomplete, requiring additional information to be obtained from patients. In some cases, certain paraclinical examinations requested, such as a follow-up MRI, could not be carried out systematically due to a lack of financial resources.