Hyperprolactinaemia is associated with a higher prevalence of pituitary-adrenal dysfunction in non-functioning pituitary macroadenoma.
In non-functioning pituitary macroadenoma (NFMA), hyperprolactinaemia (hyperPRL) is considered to be a sign of hypothalamic-pituitary dysregulation, but it is unknown whether hyperPRL is associated with an increased frequency of pituitary hormone deficiencies. Forty consecutive patients with histology-proven NFMA were studied and hyperPRL was defined as serum prolactin (PRL) > 200 mIU/l in men and > 600 mIU/l in women. The pituitary-adrenal axis was evaluated by measurement of urinary free cortisol (N = 38), peak cortisol to insulin-induced hypoglycaemia (IIH, N = 36) and to human corticotrophin-releasing hormone (hCRF, N = 40) and by urinary tetrahydrol 11-deoxycortisol (H4S, N = 39), plasma androstenedione increment (N = 39) and serum 11-deoxycortisol (N = 1) after metyrapone. Central hypothyroidism, gonadotrophin deficiency and growth hormone (GH) reserve were also assessed. Twenty patients had hyperPRL (serum PRL 331 (223-1120) mIU/l (median, range) in men and 932 (660-3927) mIU/l in women): urinary free cortisol excretion (p < 0.03) and peak serum cortisol in response to IIH (p < 0.02) were lower in hyperPRL than in normoPRL patients; peak serum cortisol after hCRF was not different between groups but occurred later in hyperPRL patients (at 60vs 30 min, p < 0.03); urinary H4S excretion and androstenedione response after metyrapone were lower in hyperPRL than in normoPRL patients (p < 0.05 for both): 60% of hyperPRL patients and 15% of normoPRL patients had an abnormal H4S response (p < 0.025): central hypothyroidism (overt + subclinical) was present in 74% of hyperPRL and in 60% of normoPRL patients (NS); 78% of hyperPRL and 55% of normoPRL patients had gonadotrophin deficiency (NS): growth hormone (GH) deficiency was present in 83% of hyperPRL and in 89% of normoPRL patients (NS); 73.3% of 75 evaluable pituitary hormone axes were abnormal in hyperPRL patients compared to 53.8% of 78 hormone axes in normoPRL patients (by metyrapone test to examine adrenal function, p < 0.025); and no significant differences in tumour grade and stage distribution were found between hyperPRL and normoPRL patients. It is concluded that hyper-prolactinaemia in NFMA is associated with a higher prevalence of pituitary-adrenal dysfunction, which is likely to be explained at least in part by functional hypothalamic-pituitary interruption.
Department of Endocrinology, University Hospital Groningen, The Netherlands.
G
G
Tjeerdsma
W J
WJ
Sluiter
J M
JM
Hew
W M
WM
Molenaar
W E
WE
de Lange
R P
RP
Dullaart
D000236:Adenoma / Q000097:blood* / Q000503:physiopathology* / Q000652:urine; D000328:Adult; D000368:Aged; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology; D003350:Cortodoxone / Q000031:analogs & derivatives / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D006966:Hyperprolactinemia / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000652:urine; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood* / Q000503:physiopathology* / Q000652:urine; D010913:Pituitary-Adrenal System / Q000503:physiopathology*
C009412:tetrahydro-11-deoxycortisol; D003346:Corticotropin-Releasing Hormone; D003350:Cortodoxone; D006854:Hydrocortisone