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Petersenn S, Fleseriu M, Casanueva FF, Giustina A, Biermasz N, Biller BMK, Bronstein M, Chanson P, Fukuoka H, Gadelha M, Greenman Y, Gurnell M, Ho KKY, Honegger J, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Lodish M, Maiter D, Marcus HJ, McCormack A, Molitch M, Muir CA, Neggers S, Pereira AM, Pivonello R, Post K, Raverot G, Salvatori R, Samson SL, Shimon I, Spencer-Segal J, Vila G, Wass J, Melmed S. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat Rev Endocrinol 2023; 19:722-740. [PMID: 37670148 DOI: 10.1038/s41574-023-00886-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/07/2023]
Abstract
This Consensus Statement from an international, multidisciplinary workshop sponsored by the Pituitary Society offers evidence-based graded consensus recommendations and key summary points for clinical practice on the diagnosis and management of prolactinomas. Epidemiology and pathogenesis, clinical presentation of disordered pituitary hormone secretion, assessment of hyperprolactinaemia and biochemical evaluation, optimal use of imaging strategies and disease-related complications are addressed. In-depth discussions present the latest evidence on treatment of prolactinoma, including efficacy, adverse effects and options for withdrawal of dopamine agonist therapy, as well as indications for surgery, preoperative medical therapy and radiation therapy. Management of prolactinoma in special situations is discussed, including cystic lesions, mixed growth hormone-secreting and prolactin-secreting adenomas and giant and aggressive prolactinomas. Furthermore, considerations for pregnancy and fertility are outlined, as well as management of prolactinomas in children and adolescents, patients with an underlying psychiatric disorder, postmenopausal women, transgender individuals and patients with chronic kidney disease. The workshop concluded that, although treatment resistance is rare, there is a need for additional therapeutic options to address clinical challenges in treating these patients and a need to facilitate international registries to enable risk stratification and optimization of therapeutic strategies.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany.
- University of Duisburg-Essen, Essen, Germany.
| | | | | | - Andrea Giustina
- San Raffaele Vita-Salute University, Milan, Italy
- IRCCS Hospital San Raffaele, Milan, Italy
| | | | | | | | - Philippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Monica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yona Greenman
- Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Mark Gurnell
- University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge, UK
| | - Ken K Y Ho
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | | | | | - Ursula B Kaiser
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Maya Lodish
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ann McCormack
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Alberto M Pereira
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | - Kalmon Post
- Mount Sinai Health System, New York, NY, USA
| | - Gerald Raverot
- Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, Bron, France
| | | | | | - Ilan Shimon
- Tel Aviv University, Tel Aviv, Israel
- Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | | | - Greisa Vila
- Medical University of Vienna, Vienna, Austria
| | - John Wass
- University of Oxford, Oxford, UK
- Churchill Hospital, Oxford, UK
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Baba MS, Islam Mir SU, Bhat MH, Laway BA, Misgar RA. Gender Disparities in Prolactinomas: Unravelling Clinical Patterns, Metabolic Variations, and Treatment Responses. Cureus 2023; 15:e42911. [PMID: 37664314 PMCID: PMC10474902 DOI: 10.7759/cureus.42911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background and objective Individuals with prolactinoma exhibit elevated rates of obesity, metabolic syndrome (MS), and dyslipidemia compared to their healthy counterparts. However, there is a lack of data regarding metabolic variance between male and female prolactinoma patients. Consequently, this study aimed to investigate and compare sex-specific discrepancies in metabolic abnormalities among individuals diagnosed with prolactinoma. Methods In this prospective study, 80 treatment-naïve patients with prolactinoma (12 males and 68 females) underwent clinical assessments and laboratory investigations. The measured parameters included blood glucose, total cholesterol (TC), triglycerides (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), urea, creatinine, uric acid, and blood glucose levels. The patients were treated with cabergoline, a dopamine agonist, and reevaluated after 12 weeks. Results Forty-eight patients had microprolactinomas (all females), and 32 had macroprolactinomas (20 females, 12 males). The mean age was 28.30±7.49 years for females and 28.91±7.12 years for males (p=0.71). The median symptom duration was 12 months (range 1-72 months, IQR 4-16 months), with no significant difference between males (median 12 months, IQR 5-54 months) and females (median 12 months, IQR 10-24 months, p=0.620). The median serum prolactin (PRL) was 988 ng/mL (IQR 471-1,439) in males and 165 ng/mL (IQR 90-425) in females (p<0.05). Males showed higher HbA1c, BGF, TC, TG, LDL-C, and higher rates of obesity, MS, and diabetes mellitus. Treatment with cabergoline resulted in significant improvements in the HbA1c, BGF, TC, TG, and LDL-C levels. Conclusion Males with prolactinomas had larger tumor sizes and higher serum PRL levels than females. Additionally, males exhibited worse metabolic parameters than females. However, there was no significant difference in the duration of symptoms or age at diagnosis between the two groups.
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Affiliation(s)
| | - Sajad Ul Islam Mir
- Endocrinology, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | | | - Bashir Ahmad Laway
- Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Raiz Ahmad Misgar
- Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, IND
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Baba MS, Laway BA, Misgar RA, Wani AI, Bashir MI, Bhat IA, Haq MG, Shah ZA. Metabolic Abnormalities, Inflammatory Markers and Endothelial Dysfunction in Hyperprolactinemia due to Prolactinoma before and after Normalization of Serum Prolactin: A Prospective Case Control Study. Indian J Endocrinol Metab 2023; 27:357-364. [PMID: 37867992 PMCID: PMC10586551 DOI: 10.4103/ijem.ijem_201_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/20/2022] [Accepted: 01/06/2023] [Indexed: 10/24/2023] Open
Abstract
Background Hyperprolactinemia is associated with obesity, dyslipidemia, insulin resistance, and low-grade inflammation which may promote endothelial dysfunction (EnD). Limited work has been done on EnD in prolactinomas and we, therefore, studied serum markers of inflammation and EnD in patients with prolactinomas before and after treatment with dopamine agonists. Methodology Fifty-six treatment naïve patients with prolactinomas and fifty-three (apparently healthy age and sex-matched) controls were enrolled in the study and subjected to clinical assessment and laboratory investigations including blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urea, creatinine, uric acid, erythrocyte sedimentation rate (ESR), highly sensitive C-reactive protein (hsCRP) and markers of EnD i.e., intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). Patients were treated with a dopamine agonist (cabergoline) and parameters (like ESR, hsCRP, ICAM-1, and VCAM-1) were measured at 12 weeks. Results The majority of the patients (84%) were female, more than half (52%) had metabolic syndrome and over a third (36%) were obese. Blood glucose fasting, HbA1c, lipid fractions, ESR, hsCRP, ICAM-1, and VCAM-1 were significantly higher in patients than in controls. Median ICAM-1 was 1331.95 ng/ml (IQR 803.43-1825.99) in patients vs 753.04 ng/ml (IQR 402.04-871.55) in controls, P < 0.001 and median VCAM-1in patients was 971.35 ng/ml (IQR 695.03-1285.23) as against 634.56 ng/ml (IQR 177.49-946.50) in controls, p0.001. Serum ICAM-1 and VCAM-1 correlated positively with hsCRP. On multivariate regression analysis, serum hsCRP was the only significant predictor of change in ICAM-1 and VCAM-1. Normalization of serum PRL with CAB resulted in a significant decrease in metabolic parameters, ESR, hsCRP, ICAM-1, and VCAM-1. Conclusion Hyperprolactinemia because of prolactinoma is associated with EnD secondary to systemic inflammation and metabolic abnormalities which improve after treatment with DA.
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Affiliation(s)
- Mohammad Salem Baba
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bashir Ahmad Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Raiz Ahmad Misgar
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arshad Iqbal Wani
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mir Iftikhar Bashir
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Imtiyaz Ahmad Bhat
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Malik Gawharul Haq
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Zafar Amin Shah
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Li M, Zhang J, Yang G, Zhang J, Han M, Zhang Y, Liu Y. Effects of Anterior Pituitary Adenomas' Hormones on Glucose Metabolism and Its Clinical Implications. Diabetes Metab Syndr Obes 2023; 16:409-424. [PMID: 36816815 PMCID: PMC9937076 DOI: 10.2147/dmso.s397445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Pituitary adenomas have recently become more common and their incidence is increasing yearly. Functional pituitary tumors commonly secrete prolactin, growth hormones, and adrenocorticotropic hormones, which cause diseases such as prolactinoma, acromegaly, and Cushing's disease, but rarely secrete luteinizing, follicle-stimulating, thyroid-stimulating, and melanocyte-stimulating hormones. In addition to the typical clinical manifestations of functional pituitary tumors caused by excessive hormone levels, some pituitary tumors are also accompanied by abnormal glucose metabolism. The effects of these seven hormones on glucose metabolism are important for the treatment of diabetes secondary to pituitary tumors. This review focuses on the effects of hormones on glucose metabolism, providing important clues for the diagnosis and treatment of related diseases.
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Affiliation(s)
- Mengnan Li
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jian Zhang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Guimei Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jiaxin Zhang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Minmin Han
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yi Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, People’s Republic of China
- Correspondence: Yi Zhang, Department of Pharmacology, Shanxi Medical University, Taiyuan, People’s Republic of China, Email
| | - Yunfeng Liu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- Yunfeng Liu, Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China, Tel +86 18703416196, Email
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Corona G, Rastrelli G, Comeglio P, Guaraldi F, Mazzatenta D, Sforza A, Vignozzi L, Maggi M. The metabolic role of prolactin: systematic review, meta-analysis and preclinical considerations. Expert Rev Endocrinol Metab 2022; 17:533-545. [PMID: 36447418 DOI: 10.1080/17446651.2022.2144829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Hyperprolactinemia has been proven to induce hypogonadism and metabolic derangements in both genders, while the consequences of prolactin (PRL) deficiency have been poorly investigated. AREAS COVERED To systematically review and analyze data from clinical studies focusing on the metabolic consequences of abnormally high prolactin levels (HPRL) and low prolactin levels (LPRL). In addition, data from preclinical studies about underlying pathophysiological mechanisms were summarized and discussed. EXPERT OPINION PRL contributes to providing the correct amount of energy to support the mother and the fetus/offspring during pregnancy and lactation, but it also has a homeostatic role. Pathological PRL elevation beyond these physiological conditions, but also its reduction, impairs metabolism and body composition in both genders, increasing the risk of diabetes and cardiovascular events. Hence, hypoprolactinemia should be avoided as much as possible during treatment with dopamine agonists for prolactinomas. Patients with hypoprolactinemia, because of endogenous or iatrogenic conditions, deserve, as those with hyperprolactinemia, careful metabolic assessment.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit1, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit2, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Paolo Comeglio
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Federica Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Sforza
- Endocrinology Unit1, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Department of Biomedical and Neuromotor Sciences (DIBINEM)4, Alma Mater Studiorum Bologna University, Bologna, Italy; Endocrinology Unit 4, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Naz F, Malik A, Riaz M, Mahmood Q, Mehmood MH, Rasool G, Mahmood Z, Abbas M. Bromocriptine Therapy: Review of mechanism of action, safety and tolerability. Clin Exp Pharmacol Physiol 2022; 49:903-922. [DOI: 10.1111/1440-1681.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Faiza Naz
- Punjab University College of Pharmacy University of the Punjab Lahore Pakistan
| | - Abdul Malik
- College of Pharmacy University of Sargodha Sargodha Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences University of Sargodha Sargodha Pakistan
| | - Qaisar Mahmood
- College of Pharmacy University of Sargodha Sargodha Pakistan
| | - Malik Hassan Mehmood
- Department of Pharmacology, Faculty of Pharmaceutical Sciences Government College University Faisalabad Pakistan
| | - Ghulam Rasool
- Department of Allied Health Sciences University of Sargodha Sargodha Pakistan
| | - Zahed Mahmood
- Department of Biochemistry Government College University Faisalabad Pakistan
| | - Mazhar Abbas
- Department of Biochemistry College of Veterinary and Animal Sciences, University of Veterinary and Animal Sciences (Jhang Campus) Lahore Pakistan
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Lopez-Vicchi F, De Winne C, Ornstein AM, Sorianello E, Toneatto J, Becu-Villalobos D. Severe Hyperprolactinemia Promotes Brown Adipose Tissue Whitening and Aggravates High Fat Diet Induced Metabolic Imbalance. Front Endocrinol (Lausanne) 2022; 13:883092. [PMID: 35757410 PMCID: PMC9226672 DOI: 10.3389/fendo.2022.883092] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association of high serum prolactin and increased body weight is positive but controversial, therefore we hypothesized that additional factors such as diets and the impact of prolactin on brown adipose tissue may condition its metabolic effects. METHODS We used LacDrd2KO females with lifelong severe hyperprolactinemia due dopamine-D2 receptor deletion from lactotropes, and slow onset of metabolic disturbances, and compared them to their respective controls (Drd2 loxP/loxP ). Food intake, and binge eating was evaluated. We then challenged mice with a High Fat (HFD) or a Control Diet (CD) for 8 weeks, beginning at 3 months of age, when no differences in body weight are found between genotypes. At the end of the protocol brown and white adipose tissues were weighed, and thermogenic and lipogenic markers studied, using real time PCR (Ucp1, Cidea, Pgc1a, Lpl, adiponectin, Prlr) or immunohistochemistry (UCP1). Histochemical analysis of brown adipose tissue, and glucose tolerance tests were performed. RESULTS Hyperprolactinemic mice had increased food intake and binge eating behavior. Metabolic effects induced by a HFD were exacerbated in lacDrd2KO mice. Hyperprolactinemia aggravated HFD-induced body weight gain and glucose intolerance. In brown adipose tissue pronounced cellular whitening as well as decreased expression of the thermogenic markers Ucp1 and Pgc1a were observed in response to high prolactin levels, regardless of the diet, and furthermore, hyperprolactinemia potentiated the decrease in Cidea mRNA expression induced by HFD. In subcutaneous white adipose tissue hyperprolactinemia synergistically increased tissue weight, while decreasing Prlr, Adiponectin and Lpl mRNA levels regardless of the diet. CONCLUSIONS Pathological hyperprolactinemia has a strong impact in brown adipose tissue, lowering thermogenic markers and evoking tissue whitening. Furthermore, it modifies lipogenic markers in subcutaneous white adipose, and aggravates HFD-induced glucose intolerance and Cidea decrease. Therefore, severe high prolactin levels may target BAT function, and furthermore represent an adjuvant player in the development of obesity induced by high fat diets.
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Glezer A, Santana MR, Bronstein MD, Donato J, Jallad RS. The interplay between prolactin and cardiovascular disease. Front Endocrinol (Lausanne) 2022; 13:1018090. [PMID: 36704037 PMCID: PMC9871591 DOI: 10.3389/fendo.2022.1018090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Hyperprolactinemia can be caused by several conditions and its effects on the hypothalamic-pituitary-gonadal axis are understood in more detail. Nevertheless, in recent decades, other metabolic effects have been studied and data pointed to a potential increased cardiovascular disease (CVD) risk. A recent study showed a decrease in total and LDL- cholesterol only in men with prolactinoma treated with dopamine agonists (DA) supporting the previous results of a population study with increased CVD risk in men harboring prolactinoma. However, other population studies did not find a correlation between prolactin (PRL) levels and CVD risk or mortality. There is also data pointing to an increase in high-density lipoprotein levels, and decreases in triglycerides, carotid-intima-media thickness, C-reactive protein, and homocysteine levels in patients with prolactinoma on DA treatment. PRL was also implicated in endothelial dysfunction in pre and postmenopausal women. Withdrawal of DA resulted in negative changes in vascular parameters and an increase in plasma fibrinogen. It has been shown that PRL levels were positively correlated with blood pressure and inversely correlated with dilatation of the brachial artery and insulin sensitivity, increased homocysteine levels, and elevated D-dimer levels. Regarding possible mechanisms for the association between hyperprolactinemia and CVD risk, they include a possible direct effect of PRL, hypogonadism, and even effects of DA treatment, independently of changes in PRL levels. In conclusion, hyperprolactinemia seems to be associated with impaired endothelial function and DA treatment could improve CVD risk. More studies evaluating CVD risk in hyperprolactinemic patients are important to define a potential indication of treatment beyond hypogonadism.
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Affiliation(s)
- Andrea Glezer
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, SP, Brazil
- Laboratory of Cellular and Molecular Endocrinology LIM-25, University of Sao Paulo Medical School, São Paulo, SP, Brazil
- *Correspondence: Andrea Glezer,
| | - Mariana Ramos Santana
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Marcello D. Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, SP, Brazil
- Laboratory of Cellular and Molecular Endocrinology LIM-25, University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Jose Donato
- Department of Physiology and Biophysics, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Raquel Soares Jallad
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, SP, Brazil
- Laboratory of Cellular and Molecular Endocrinology LIM-25, University of Sao Paulo Medical School, São Paulo, SP, Brazil
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Andereggen L, Frey J, Andres RH, Luedi MM, Gralla J, Schubert GA, Beck J, Mariani L, Christ E. Impact of primary medical or surgical therapy on prolactinoma patients' BMI and metabolic profile over the long-term. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2021; 24:100258. [PMID: 34195008 PMCID: PMC8237353 DOI: 10.1016/j.jcte.2021.100258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
High prolactin (PRL) levels are associated with weight gain and impaired metabolic profiles. Long-term control of hyperprolactinemia can be attained by first-line surgery and medical therapy. Normalization of PRL improves patients’ BMI and fasting glucose levels. Marginal changes in patients’ metabolic profiles are noted regardless of the primary therapy. Not dopamine agonists per se, but rather the control of hyperprolactinemia plays a role in metabolic profile alterations.
Objectives High prolactin levels have been associated with weight gain and impaired metabolic profiles. While treatment with dopamine agonists (DAs) has been shown to improve these parameters, there is a lack of surgical series on its comparative effect in prolactinoma patients. Methods In this retrospective, comparative study, consecutive patients with a prolactinoma were enrolled if treated with first-line transsphenoidal surgery (TSS) or with DAs. Patients with prolactinomas of Knosp grade >2 and those with a follow-up <24 months were excluded, as were patients with missing laboratory metabolic parameters at baseline and over the long-term. Effects of either treatment on BMI and the metabolic profile were analyzed, and independent risk factors for long-term obesity were calculated. Results Primary treatment was TSS for 12 patients (40%) and DAs for 18 patients (60%). At diagnosis, no significant differences between the two cohorts were observed with regard to adenoma size, Knosp grading, baseline prolactin (PRL) levels, prevalence of hypogonadism, or laboratory metabolic parameters. Mean follow-up was 51.9 months (range, 24–158). Over the long-term, both TSS and DAs led to the control of hyperprolactinemia (92% vs. 72%) and hypogonadism (78% vs. 83%) in the majority of patients. While a significant decrease in patients’ BMI and fasting glucose were observed, changes in the lipid profile were marginal and independent of the treatment modality. At baseline, increased BMI—but not the primary treatment strategy—was an independent predictor of long-term obesity. Conclusions Over the long-term, patients’ BMI and FG improve, but changes in the metabolic profile are marginal and independent of the primary treatment. It is presumable that not DAs per se, but rather the control of hyperprolactinemia plays a role in patients’ metabolic profile alterations.
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Affiliation(s)
- Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Janine Frey
- Department of Gynecology and Obstetrics, Kantonsspital Lucerne, Lucerne, Switzerland
| | | | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jan Gralla
- Department of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Emanuel Christ
- Department of Endocrinology, Diabetes and Metabolism, University Hospital of Basel, Basel, Switzerland
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Liu J, Wang Q, Zhang L, Fu J, An Y, Meng H, Wang G. Increased Prolactin is an Adaptive Response to Protect Against Metabolic Disorders in Obesity. Endocr Pract 2021; 27:728-735. [PMID: 33637446 DOI: 10.1016/j.eprac.2021.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Prolactin (PRL) is a polypeptide hormone named for its crucial role in lactation. Recently, PRL has been recognized as a metabolic hormone that regulates energy metabolism. The current study aimed to investigate the relationship between circulating PRL and metabolic alterations in overweight/obese patients and the effect of weight loss through bariatric surgery on circulating PRL. METHODS A total of 448 overweight/obese patients aged between 18 and 40 years and 120 age- and sex-matched healthy controls with normal weight were enrolled. Among all participants, 156 obese patients underwent bariatric surgery. RESULTS Circulating PRL levels were significantly increased in the overweight (15.27 ± 9.58 μg/L) and obese (17.75 ± 9.15 μg/L) groups compared with the normal weight (13.57 ± 9.03 μg/L) group. Multiple regression analyses demonstrated that the adipose tissue insulin resistance (adipo-IR) level was an independent predictor for PRL (β = -0.451, P < .01). Despite comparable anthropometric parameters, the overweight/obese patients with a higher PRL tertile had decreased levels of triglycerides, nonesterified fatty acids, homeostasis model assessment of insulin resistance, and adipo-IR compared with the patients in the moderate and lower PRL tertiles. Serum PRL levels were significantly decreased following the alleviation of metabolic parameters after bariatric surgery (from 17.12 ± 8.27 to 13.00 ± 5.78 μg/L, P < .05), and the decrease in PRL levels was significantly greater in the lower adipo-IR group than in the higher adipo-IR group (P < .01). CONCLUSION An increased serum PRL level might be an adaptive response for protecting against metabolic disorders in obesity.
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Affiliation(s)
- Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Jing Fu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Hua Meng
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
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Yang H, Lin J, Li H, Liu Z, Chen X, Chen Q. Prolactin Is Associated With Insulin Resistance and Beta-Cell Dysfunction in Infertile Women With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:571229. [PMID: 33716958 PMCID: PMC7947819 DOI: 10.3389/fendo.2021.571229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Our study aimed to investigate if serum prolactin (PRL) levels associated with insulin resistance and beta-cell dysfunction in infertile patients with polycystic ovary syndrome (PCOS). METHODS This was a retrospective cross-sectional study performed in the reproductive medicine center of the first affiliated hospital of Wenzhou Medical University. From January 2007 to August 2018, a total of 792 PCOS and 700 non-PCOS infertile women were included. All patients' prolactin levels were in the normal range. PCOS was diagnosed according to the Rotterdam Criteria. Anthropometric parameters, blood pressure, serum prolactin levels, sex hormones, fasting lipids, fasting plasma glucose (FPG), fasting insulin (FINS) and hepatic biological parameters were measured in all subjects. RESULTS Serum prolactin levels in PCOS women were significantly decreased compared with levels in non-PCOS women after adjusting for age and BMI (P < 0.05). Moreover, we found that prolactin levels were positively associated with high-density lipoprotein cholesterol (HDL-C) and negatively associated with age, BMI, waist circumference (WC), hip circumference (HC), luteinizing hormone/follicle stimulating hormone (LH/FSH), estradiol (E2), FINS, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β (HOMA-β), triglyceride (TG) and alanine aminotransferase (ALT) (P < 0.05). After adjusting for age and BMI, multiple linear regression analysis revealed that LH, LH/FSH, E2, FINS, HOMA-IR, and HOMA-β were negatively associated with serum PRL (P < 0.05). CONCLUSIONS Low serum PRL levels within the normal range associates with a higher incidence of insulin resistance and beta-cell dysfunction in infertile women with PCOS.
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Affiliation(s)
- Haiyan Yang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Lin
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - He Li
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Zhangwei Liu
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qianqian Chen, ; Xia Chen,
| | - Qianqian Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qianqian Chen, ; Xia Chen,
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12
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Al Sabie F, Tariq Z, Erickson D, Donegan D. Association Between Prolactinoma and Body Mass Index. Endocr Pract 2020; 27:312-317. [PMID: 33720014 DOI: 10.1016/j.eprac.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Obesity is increasing worldwide, and certain endocrine disorders may contribute to weight gain. While several studies have examined the association between weight gain and prolactinomas, the results are conflicting. Therefore, this study aimed to determine if body mass index (BMI) is higher among those with prolactinomas than those without. METHODS We identified patients ≥18 years of age referred to an endocrine clinic between 2008 and 2018 with newly diagnosed prolactinomas. We extracted the relevant information, and comparative data was obtained from the 2015-2016 National Health and Nutrition Examination Survey. RESULTS In total, 34 cases met the inclusion criteria. One third of the patients described weight gain at presentation. Those with prolactinomas had a significantly higher BMI than the National Health and Nutrition Examination Survey population (median BMI, 29.8 kg/m2 vs 28.3 kg/m2, P = .0048). When stratified by sex, only men with prolactinomas had an increased BMI compared with the controls. Moreover, those with prolactinomas had a higher prevalence of class II obesity (BMI ≥ 35 kg/m2) than the survey population (35% vs 18%, P = .01). Among the prolactinoma patients, a correlation was observed between BMI and log-transformed prolactin levels (R2 = 0.4, P = .0002). CONCLUSION Weight gain can be a presenting symptom for patients with newly diagnosed prolactinomas. Those with prolactinomas have a higher BMI and an increased prevalence of class II obesity. These findings suggest that patients should be counseled regarding weight issues related to prolactinomas at presentation and should be a consideration in the investigative and treatment algorithm of prolactinomas.
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Affiliation(s)
- Farah Al Sabie
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zunera Tariq
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dana Erickson
- Division of Endocrinology Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Diane Donegan
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana; Division of Endocrinology Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota.
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Lopez-Vicchi F, De Winne C, Brie B, Sorianello E, Ladyman SR, Becu-Villalobos D. Metabolic functions of prolactin: Physiological and pathological aspects. J Neuroendocrinol 2020; 32:e12888. [PMID: 33463813 DOI: 10.1111/jne.12888] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/25/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022]
Abstract
Prolactin is named after its vital role of promoting milk production during lactation, although it has been implicated in multiple functions within the body, including metabolism and energy homeostasis. Prolactin has been hypothesised to play a key role in driving many of the adaptations of the maternal body to allow the mother to meet the physiological demands of both pregnancy and lactation, including the high energetic demands of the growing foetus followed by milk production to support the offspring after birth. Prolactin receptors are found in many tissues involved in metabolism and food intake, such as the pancreas, liver, hypothalamus, small intestine and adipose tissue. We review the literature examining the effects of prolactin in these various tissues and how they relate to changes in function in physiological states of high prolactin, such as pregnancy and lactation, and in pathological states of hyperprolactinaemia in the adult. In many cases, whether prolactin promotes healthy metabolism or leads to dysregulation of metabolic functions is highly dependent on the situation. Overall, although prolactin may not play a major role in regulating metabolism and body weight outside of pregnancy and lactation, it definitely has the ability to contribute to metabolic function.
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Affiliation(s)
- Felicitas Lopez-Vicchi
- Instituto de Biologia y Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina
| | - Catalina De Winne
- Instituto de Biologia y Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina
| | - Belen Brie
- Instituto de Biologia y Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina
| | - Eleonora Sorianello
- Instituto de Biologia y Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina
| | - Sharon R Ladyman
- Centre for Neuroendocrinology, Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Maurice Wilkins Centre, Auckland, New Zealand
| | - Damasia Becu-Villalobos
- Instituto de Biologia y Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina
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Sexual Functioning in Hyperprolactinemic Patients Treated With Cabergoline or Bromocriptine. Am J Ther 2019; 26:e433-e440. [PMID: 29746287 DOI: 10.1097/mjt.0000000000000777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Elevated prolactin levels were found to be associated with impaired sexuality. STUDY QUESTION The aim of the study was to compare the impact of bromocriptine and cabergoline on sexual functioning in both genders. STUDY DESIGN The study enrolled 39 young women and 18 young men receiving bromocriptine treatment. In 19 women and 8 men, because of poor tolerance, bromocriptine was replaced with cabergoline, whereas the remaining ones continued bromocriptine treatment. MEASURES AND OUTCOMES Apart from measuring serum levels of prolactin and insulin sensitivity, at the beginning of the study and 16 weeks later, all included patients completed questionnaires evaluating female or male sexual functioning (Female Sexual Function Index; International Index of Erectile Function-15). RESULTS Irrespective of the gender, posttreatment prolactin levels were lower in cabergoline-treated patients than in bromocriptine-treated patients. Baseline sexual functioning did not differ between patients well and poorly tolerating bromocriptine treatment. Neither in men nor in women receiving bromocriptine, posttreatment sexual functioning differed from baseline one. In both genders, cabergoline improved sexual desire. Moreover, in men, the drug improved erectile and orgasmic function, whereas in women, it improved sexual arousal. All these effects correlated with the impact of this drug on prolactin levels and on insulin sensitivity. CONCLUSIONS Cabergoline is superior to bromocriptine in affecting male and female sexual functioning and should be preferred in hyperprolactinemic men and women with sexual dysfunction.
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15
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Byberg S, Futtrup J, Andreassen M, Krogh J. Metabolic effects of dopamine agonists in patients with prolactinomas: a systematic review and meta-analysis. Endocr Connect 2019; 8:1395-1404. [PMID: 31518995 PMCID: PMC6826167 DOI: 10.1530/ec-19-0286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/13/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Recent large cohort studies suggest an association between high plasma prolactin and cardiovascular mortality. The objective of this systematic review was to systematically assess the effect of reducing prolactin with dopamine agonist on established cardiovascular risk factors in patients with prolactinomas. DESIGN Bibliographical search was done until February 2019 searching the following databases: PubMed, EMBASE, WHO and LILAC. Eligible studies had to include participants with verified prolactinomas where metabolic variables were assessed before and after at least 2 weeks treatment with dopamine agonists. METHODS Baseline data and outcomes were independently collected by two investigators. The study was registered with PROSPERO (registration number CRD42016046525). RESULTS Fourteen observational studies enrolling 387 participants were included. The pooled standardized mean difference of the primary outcome revealed a reduction of BMI and weight of -0.21 (95% CI -0.37 to -0.05; P = 0.01; I2 = 71%), after treatment. Subgroup analysis suggested that the reduction of weight was primarily driven by studies with high prolactin levels at baseline (P = 0.04). Secondary outcomes suggested a small decrease in waist circumference, a small-to-moderate decrease in triglycerides, fasting glucose levels, HOMA-IR, HbA1c and hsCRP, and a moderate decrease in LDL, total cholesterol and insulin. CONCLUSION This systematic review suggests a reduction of weight as well as an improved lipid profile and glucose tolerance after treatment with dopamine agonist in patients with prolactinomas. These data are based on low-quality evidence.
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Affiliation(s)
- Sarah Byberg
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
- Correspondence should be addressed to S Byberg:
| | - Jesper Futtrup
- Panum Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Andreassen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Krogh
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
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Al-Nami MS, Al-Kuraishy HM, Al-Gareeb AI, Al-Mamoori F. Metabolic profile and prolactin serum levels in men with type 2 diabetes mellitus: Old-new rubric. Int J Crit Illn Inj Sci 2019; 9:120-126. [PMID: 31620350 PMCID: PMC6792395 DOI: 10.4103/ijciis.ijciis_40_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/23/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Prolactin (PRL) is involved in the regulation of glucose metabolism since high PRL serum levels are associated with low incidence of type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to assess the metabolic effects of PRL on glucose homeostasis in men with T2DM. Methods: Eighty male patients with T2DM compared with 25 male healthy controls matched with patients for age and weight were divided into four groups: Group (A): patients with T2DM on metformin (n = 29), Group (B): patients with T2DM on glyburide (n = 30), Group (C): patients with T2DM on glyburide plus metformin (n = 21), and Group (D): healthy male subjects as control (n = 25). Body mass index (BMI) and blood pressure measurements were determined. Fasting blood glucose (FBG), glycated hemoglobin, total cholesterol, triglyceride (TG), high-density lipoprotein, low-density lipoprotein, atherogenic index, fasting serum insulin, insulin resistance (IR), and β-cell function of the pancreas were determined by homeostatic model assessment-2 (HOMA-IR). Furthermore, C-reactive protein and PRL serum level were determined in patients with T2DM and healthy control men. Results: BMI of T2DM patients was higher as compared with control (P = 0.003). Combination therapy (glyburide plus metformin) in patients with T2DM showed better effect on most of glycemic indices and lipid profile than glyburide or metformin monotherapy (P < 0.05). PRL serum level was higher in patients with T2DM as compared with control (P = 0.001). PRL serum level was high in glyburide-treated patients as compared with metformin-treated patients (P = 0.002). Conclusion: This study concludes that elevated PRL serum level in patients with T2DM is associated with diabetic complications. Diabetic pharmacotherapy mainly metformin reduced PRL serum level in patients with T2DM through amelioration of IR.
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Affiliation(s)
- Marwa S Al-Nami
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Hayder M Al-Kuraishy
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Farah Al-Mamoori
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Jordan, Amman, Jordan
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Eren E, Törel Ergür A, İşgüven ŞP, Çelebi Bitkin E, Berberoğlu M, Şıklar Z, Baş F, Yel S, Baş S, Söbü E, Bereket A, Turan S, Sağlam H, Atay Z, Ercan O, Güran T, Atabek ME, Korkmaz HA, Kılınç Uğurlu A, Akıncı A, Döğer E, Şimşek E, Akbaş ED, Abacı A, Gül Ü, Acar S, Mengen Uçaktürk E, Yıldız M, Ünal E, Tarım Ö. Clinical and Laboratory Characteristics of Hyperprolactinemia in Children and Adolescents: National Survey. J Clin Res Pediatr Endocrinol 2019; 11:149-156. [PMID: 30396878 PMCID: PMC6571533 DOI: 10.4274/jcrpe.galenos.2018.2018.0206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We aimed to report the characteristics at admission, diagnosis, treatment, and follow-up of cases of pediatric hyperprolactinemia in a large multicenter study. METHODS We reviewed the records of 233 hyperprolactinemic patients, under 18 years of age, who were followed by different centers. The patients were divided as having microadenomas, macroadenomas, drug-induced hyperprolactinemia and idiopathic hyperprolactinemia. Complaints of the patients, their mode of treatment (medication and/or surgery) and outcomes were evaluated in detail. RESULTS The mean age of the patients with hyperprolactinemia was 14.5 years, and 88.4% were females. In terms of etiology, microadenomas were observed in 32.6%, macroadenomas in 27%, idiopathic hyperprolactinemia in 22.7% and drug-induced hyperprolactinemia in 6.4%. Other causes of hyperprolactinemia were defined in 11.3%. Common complaints in females (n=206) were sorted into menstrual irregularities, headaches, galactorrhea, primary or secondary amenorrhea and weight gain, whereas headache, gynecomastia, short stature and blurred vision were common in males (n=27). Median prolactin levels were 93.15 ng/mL, 241.8 ng/mL, 74.5 ng/mL, 93.2 ng/mL, and 69 ng/mL for microadenomas, macroadenomas, idiopathic hyperprolactinemia, drug-induced hyperprolactinemia, and other causes of hyperprolactinemia, respectively. Of 172 patients with hyperprolactinemia, 77.3% were treated with cabergoline and 13.4% with bromocriptine. 20.1% of the patients with pituitary adenomas underwent pituitary surgery. CONCLUSION We present the largest cohort of children and adolescents with hyperprolactinemia in the literature to date. Hyperprolactinemia is more common in females and cabergoline is highly effective and practical to use in adolescents, due to its biweekly dosing. Indications for surgery in pediatric cases need to be revised.
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Affiliation(s)
- Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey,* Address for Correspondence: Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey Phone: +90 505 768 69 47 E-mail:
| | - Ayça Törel Ergür
- Kırıkkale University Faculty of Medicine, Department of Pediatric Endocrinology, Kırıkkale, Turkey
| | - Şükriye Pınar İşgüven
- Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey
| | - Eda Çelebi Bitkin
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Firdevs Baş
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Servet Yel
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Serpil Baş
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Elif Söbü
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Halil Sağlam
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Hüseyin Anıl Korkmaz
- Balıkesir Atatürk State Hospital, Clinic of Pediatric Endocrinology, Balıkesir, Turkey
| | - Aylin Kılınç Uğurlu
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayşehan Akıncı
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Esra Döğer
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Eskişehir, Turkey
| | - Emine Demet Akbaş
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ülkü Gül
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Sezer Acar
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Eda Mengen Uçaktürk
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Melek Yıldız
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
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Aboelnaga MM, Eladawy EH, Elshafei MM, Abdullah N, Shaer ME. Different Cabergoline Effect on Metabolic and Anthropometric Parameters in Female Prolactinoma Patients Versus Idiopathic Hyperprolactinemia Patients. Endocr Metab Immune Disord Drug Targets 2019; 19:511-518. [PMID: 30806330 DOI: 10.2174/1871530319666190219103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/12/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hyperprolactinemia can lead to weight gain, insulin resistance, abnormal glucose homeostasis and dyslipidemia. Reversibility of these changes after normalization of prolactin with dopamine agonists is still controversial and needs more clarification. OBJECTIVE We aimed to: 1) evaluate and compare metabolic and anthropometric profile in female with newly diagnosed prolactin-secreting adenoma versus female idiopathic hyperprolactinemic patients; 2) compare the effects of one year cabergoline therapy on the metabolic profile and anthropometric parameters (by using visceral adiposity index as index for evaluation of adipose tissue dysfunction) in females with prolactinoma to female idiopathic hyperprolactinemic patients. PATIENTS AND METHODS We enrolled 40 female patients with newly diagnosed prolactinoma and 40 female patients with idiopathic hyperprolactinemia, who were matched according to: age; weight; BMI; waist; and prolactin levels. We enrolled the participants in this study at the time of diagnosis before therapy and they were followed up for 12 months. RESULTS Cabergoline therapy had significant favorable effects on metabolic and anthropometric parameters, visceral adiposity index and in all patients (apart from HDLc in prolactinoma patients). Cabergoline therapy was significantly more effective in patient with idiopathic hyperprolactinemia than prolactinoma patients with regard to BMI, waist circumference, HDLc and visceral adiposity index despite normalization of prolactin levels in both groups. CONCLUSION 12 months of Cabergoline treatment improved most of the anthropometric and metabolic parameters, and visceral adiposity index as a marker for adipose tissue dysfunction in both idiopathic hyperprolactinemia and prolactinoma patients. However, Cabergoline treatment was more effective in idiopathic hyperprolactinemic than prolactinoma patients.
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Affiliation(s)
- Mohamed M Aboelnaga
- Department of Endocrinology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman H Eladawy
- Department of Endocrinology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha M Elshafei
- Department of Endocrinology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nahed Abdullah
- Department of Physiology at Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - Moustafa El Shaer
- Department of Microbiology at Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
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Rasheed HA, Al-Kuraishy HM, Al-Gareeb AI, Hussien NR, Al-Nami MS. Effects of diabetic pharmacotherapy on prolactin hormone in patients with type 2 diabetes mellitus: Bane or Boon. J Adv Pharm Technol Res 2019; 10:163-168. [PMID: 31742116 PMCID: PMC6844004 DOI: 10.4103/japtr.japtr_65_19] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prolactin is a polypeptide hormone secreted from the anterior part of the pituitary gland which was implicated as a diabetogenic factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to evaluate prolactin serum levels in patients with T2DM regarding the effect of diabetic pharmacotherapy. Eighty patients with T2DM compared with 25 male healthy controls were recruited and divided into four groups: Group I - 29 patients with T2DM treated with metformin, Group II - 30 patients with T2DM treated with glyburide, Group III - 21 patients with T2DM treated with glyburide plus metformin, and Group IV - 25 control male healthy patients. Prolactin serum levels were high in patients with T2DM compared with controls (P < 0.01). Prolactin serum levels were higher in glyburide-treated patients compared with metformin-treated patients (P < 0.01). This study concludes that high prolactin levels in patients with T2DM are linked with diabetic complications and regarded as a beneficial phenomena to overcome IR and diabetic complications. Metformin but not glyburide reduced prolactin levels due to the improvement of insulin resistance.
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Affiliation(s)
- Huda Abdulbaki Rasheed
- Department of Clinical Pharmacology, Medical Faculty, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Hayder M Al-Kuraishy
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Nawar Raad Hussien
- Department of Clinical Pharmacology, Medical Faculty, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Marwa S Al-Nami
- Department of Clinical Pharmacology, Medical Faculty, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
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Abstract
Despite an increased understanding of the pathogenesis of osteoarthritis (OA) and the availability of a number of drugs designed to ameliorate its symptoms, a successful disease-modifying therapy remains elusive. Recent lines of evidence suggest that dehydroepiandrosterone (DHEA), a 19-carbon steroid hormone classified as an adrenal androgen, exerts a chondroprotective effect in OA patients, and it has been proven to be an effective DMOAD candidate that slows OA progression. However, the exact mechanisms underlying its anti-OA effect is largely unknown. This review summarizes emerging observations from studies of cell biology, preclinical animal studies, and preliminary clinical trials and describes the findings of investigations on this topic to develop an initial blueprint of the mechanisms by which DHEA slows OA progression. Presently, studies on DMOADs are increasing in importance but have met limited success. Encouragingly, the current data on DHEA are promising and may prove that DHEA-based treatment is efficacious for preventing and slowing human OA progression.
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21
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Elera-Fitzcarrald C, Ugarte-Gil MF, Gamboa-Cárdenas RV, Zevallos F, Medina M, Cucho-Venegas JM, Perich-Campos RA, Alfaro-Lozano JL, Rodriguez-Bellido Z, Alarcón GS, Pastor-Asurza CA. Prolactin levels are associated with a pro-inflammatory body mass distribution among women with systemic lupus erythematosus. Lupus 2016; 26:808-814. [PMID: 27852933 DOI: 10.1177/0961203316678673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The objective of this study was to determine whether prolactin levels are associated with a pro-inflammatory body mass distribution in women with systemic lupus erythematosus (SLE). Methods This cross-sectional study was conducted in consecutive female SLE patients seen in our rheumatology department from January 2012 to July 2015. Prolactin was measured in ng/ml. Body mass distribution was measured by dual energy x-ray absorptiometry and it was divided into subtotal (whole body excluding the head), subtotal bone mineral content, lean mass index (appendicular lean mass/height2), subtotal trunk and leg fat percentages and trunk-to-leg fat ratio. The association between prolactin levels and body mass distribution components was evaluated by univariable and multivariable linear regression models adjusting for possible confounders. Results One hundred and eighty-five patients were evaluated; their mean (SD) age at diagnosis was 34.8 (13.8) years; nearly all patients were Mestizo. Patients included in this study were comparable to the rest of the cohort in terms of age, disease duration, SLEDAI, SDI and body mass index. Disease duration was 7.3 (6.6) years. The SLEDAI was 5.2 (4.3) and the SDI 0.9 (1.3). Prolactin levels were 18.9 (16.7) ng/ml. In univariable analyses, prolactin was negatively associated with bone mineral density, bone mineral content, leg fat percentage and lean mass index, and positively associated with trunk-to-leg fat ratio. In the multivariable analyses, prolactin was negatively associated with bone mineral content and positively associated with trunk-to-leg fat ratio. Conclusions Higher prolactin levels are associated with a pro-inflammatory body mass distribution in SLE patients.
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Affiliation(s)
- C Elera-Fitzcarrald
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.,2 Universidad Científica del Sur, Lima, Perú
| | - M F Ugarte-Gil
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.,2 Universidad Científica del Sur, Lima, Perú
| | - R V Gamboa-Cárdenas
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - F Zevallos
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - M Medina
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - J M Cucho-Venegas
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - R A Perich-Campos
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.,3 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - J L Alfaro-Lozano
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Z Rodriguez-Bellido
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.,3 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - G S Alarcón
- 4 School of Medicine, The University of Alabama at Birmingham, Birmingham, USA
| | - C A Pastor-Asurza
- 1 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.,3 Universidad Nacional Mayor de San Marcos, Lima, Perú
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