Synchronous endometrial carcinoma and a macroprolactinoma: exploring a causal relationship.
BACKGROUND
While unopposed estrogen hormone secretion is most commonly implicated in the pathogenesis of endometrial carcinoma, the role of prolactin has only recently been highlighted. The authors present a case of a synchronous endometrial carcinoma in a patient with a prolactin-secreting macroadenoma.


METHODS
A 29-year-old woman presented with a 4-year history of primary infertility, irregular periods and intermittent galactorrhea. Hormonal evaluation revealed elevated prolactin and subnormal luteinizing hormone and follicle-stimulating hormone (FSH) serum concentrations. An ultrasound of the pelvis revealed endometrial thickening. The MRI of the brain confirmed a pituitary macroadenoma. The patient underwent a resectoscopic polypectomy and dilation and curettage followed by transnasal transsphenoidal excision of the pituitary macroadenoma.


RESULTS
The biopsy of the endometrium revealed a well-differentiated endometrioid carcinoma while that of the pituitary tumor confirmed a prolactinoma.


CONCLUSIONS
An indirect causal mechanism can be postulated to explain this association. Hyperprolactinemia inhibits gonadotropin-releasing hormone leading to subnormal FSH and luteinizing hormone levels. Though the patient is hypoestrogenic, chronic anovulation with unopposed estrogen secretion can increase the risk of endometrial carcinoma. Patients with prolactinomas and irregular menstrual bleeding should undergo endometrial sampling to rule out this possibility.
Sharma
Anuradha
A
Lady Hardinge Medical College, New Delhi, India.
Sharma
Manish S
MS
De Padua
Michelle
M
Jha
Urvashi P
UP
Jha
Ajaya N
AN
D000328:Adult; D002277:Carcinoma / Q000209:etiology*; D029721:Drosophila Proteins / Q000097:blood; D004527:Egg Proteins / Q000097:blood; D016889:Endometrial Neoplasms / Q000209:etiology*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000097:blood; D006801:Humans; D009378:Neoplasms, Multiple Primary; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism; D011388:Prolactin / Q000378:metabolism; D015175:Prolactinoma / Q000150:complications* / Q000378:metabolism
D029721:Drosophila Proteins; D004527:Egg Proteins; C066329:dec-1 protein, Drosophila; D007987:Gonadotropin-Releasing Hormone; D011388:Prolactin