title: Altered diurnal rhythm of prolactin in systemic sclerosis.
abstract: OBJECTIVE
  Mild hyperprolactinemia has been reported in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We investigated whether the elevated serum level of prolactin (Prl) detected in SSc is due to a sustained increase over 24 h and/or a shift in the diurnal rhythm, and whether Prl autoantibodies--originally described in SLE--may interfere in the assay.
  
  
  METHODS
  The serum level of Prl was measured by ELISA and compared between 73 patients with SSc and 73 age and sex matched controls (78% women, age 56 +/- 11 years). The diurnal rhythms of Prl and thyrotropin (thyroid stimulating hormone, TSH) were compared between 3 patients with SSc and 10 healthy controls. Blood was taken at 2-3, 6-7, 10-11 a.m., and 2-3, 6-7, 10-11 p.m. The serum level of Prl autoantibodies was measured by ELISA and compared between matched patients with SSc and SLE and controls (n = 42 each). Standard curves of the Prl ELISA were spiked with 10% sera containing high levels of Prl autoantibodies to test interference.
  
  
  RESULTS
  Serum levels of Prl measured in the morning (8-10 a.m.) were significantly higher in patients with SSc (17.9 +/- 7.7 ng/ml), compared with controls (9.3 +/- 4.2 ng/ml; p < 0.05). In SSc, 40% of patients had Prl levels > 20 ng/ml, but no correlation was found with Scl-70 or Prl autoantibodies. Younger patients (< 50 years, n = 23/73) showed higher serum levels of Prl than older patients (21.3 +/- 10.3 vs 16.3 +/- 6.2 ng/ml; p < 0.05). The diurnal rhythm of Prl revealed that both a sustained increase over 24 h and some shift occurred in SSc. Peaks of secretion were detected between 6 and 11 a.m., instead of 2-6 a.m. The median levels of TSH over 24 h in patients with SSc ranged within the normal limits. Nevertheless, in SSc, a significant correlation (r = 0.59, p < 0.01) was found between diurnal rhythms of Prl and TSH. The prevalence of Prl autoantibodies in serum was 8% in SSc, 27% in SLE, and < 5% in controls. However, the presence of Prl autoantibodies did not interfere with our assay.
  
  
  CONCLUSIONS
  Our data confirm that mild hyperprolactinemia occurs in a subgroup of patients with SSc, and showed that the elevated serum level of Prl is due to both a sustained increase over 24 h and a shift in the diurnal rhythm. The correlation between diurnal rhythms of Prl and TSH suggests common regulatory mechanisms.
authors.affiliation: Center for Experimental Rheumatology and Department of Rheumatology, University Hospital, Zürich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Hilty
authors.forename: P
authors.initials: P
authors.lastname: Brühlmann
authors.forename: H
authors.initials: H
authors.lastname: Sprott
authors.forename: R E
authors.initials: RE
authors.lastname: Gay
authors.forename: B A
authors.initials: BA
authors.lastname: Michel
authors.forename: S
authors.initials: S
authors.lastname: Gay
authors.forename: M
authors.initials: M
authors.lastname: Neidhart
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood*; D012595:Scleroderma, Systemic / Q000097:blood* / Q000276:immunology*; D013972:Thyrotropin / Q000097:blood
chemical_list: D001323:Autoantibodies; D011388:Prolactin; D013972:Thyrotropin