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Atiya et al

GWS affects 2530% of military veterans that served in the 199091 Gulf war

1 Introduction Prolactinomas (PRLomas) are the most common type of functional pituitary adenomas (PAs) ( PRL-secreting PAs are an exception among other PAs, as pharmacotherapy is the first line of treatment ( 2 Epidemiology PRLomas are the most common type of PAs and account for about 53% (39.9-66.2%) of them, with a marked female predominance ( In males, PRLomas are notably larger than those in females and, at the time of the diagnosis, are likely to be macroadenomas with high serum PRL concentration ( PRLomas are also the second most common type of pituitary carcinomas (PC), representing up to one-third of them and approximately 0.04% of all pituitary tumors ( Most often, PRL-secreting PAs occur sporadically, but up to 5% of cases develop as a component of the familial genetic syndrome, such as multiple endocrine neoplasia type 1 (MEN-1), MEN-4, Carney complex, familial isolated pituitary adenomas (FIPA) and familial pheochromocytoma/paraganglioma/pituitary adenoma (3PA) syndrome ( 3 Pathogenesis As mentioned above, PRLomas in men, in comparison to women, are usually larger, more invasive and show higher PRL concentration at the time of the diagnosis ( Histological, molecular and clinical factors differences between lactotroph tumors in women and men are summarized in Figure 1