title: Coexisting Prolactinoma and Primary Aldosteronism: Is There a Pathophysiological Link?
abstract: BACKGROUND
  Coexisting prolactinoma-primary aldosteronism (PA) is infrequently reported.
  
  
  OBJECTIVE
  The objective of the study was to identify patients with prolactinoma-PA and test the hypothesis that elevated prolactin (PRL) concentrations play a role in PA pathogenesis.
  
  
  METHODS
  Hyperprolactinemia/prolactinoma was diagnosed in PA patients from two referral centers (Munich, Germany, and Turin, Italy) and in essential hypertensive (EH) patients from one center (Turin). PRL receptor (PRLR) gene expression was determined by microarrays on aldosterone-producing adenomas and normal adrenals and validated by real-time PCR. H295R adrenal cells were incubated with 100 nM PRL, and gene expression levels were determined by real-time PCR and aldosterone production was quantified.
  
  
  RESULTS
  Seven patients with prolactinoma-PA were identified: four of 584 and three of 442 patients from the Munich and Turin PA cohorts, respectively. A disproportionate number presented with macroprolactinomas (five of seven). There were five cases of hyperprolactinemia with no cases of macroprolactinoma of 14 790 patients in a general EH cohort. In a population of PA patients case-control matched 1:3 with EH patients there were two cases of hyperprolactinemia of 270 PA patients and no cases in the EH cohort (n = 810). PRLR gene expression was significantly up-regulated in the aldosterone-producing adenomas compared with normal adrenals (1.7-fold and 1.5-fold by microarray and real-time PCR, respectively). In H295R cells, PRL treatment resulted in 1.3-fold increases in CYP11B2 expression and aldosterone production.
  
  
  CONCLUSIONS
  Elevated PRL caused by systemic hyperprolactinemia may contribute to the development of PA in those cases in which the two entities coexist.
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Tracy Ann
authors.initials: TA
authors.lastname: Williams
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Dietz
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Marily
authors.initials: M
authors.lastname: Theodoropoulou
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Riester
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Fischer
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Burrello
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Lucas
authors.initials: L
authors.lastname: Geyer
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schopohl
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulatero
authors.affiliation: Medizinische Klinik und Poliklinik IV (T.A.W., A.S.D., A.R., E.F., M.B., J.S., F.B., M.R.) and Klinische Radiologie (M.Tr., L.G.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; Division of Internal Medicine and Hypertension (T.A.W., J.B., F.V., P.M.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; and Department of Endocrinology (M.Th.), Max Planck Institute of Psychiatry, 80804 Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000328:Adult; D045744:Cell Line, Tumor; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications* / Q000235:genetics; D011388:Prolactin / Q000097:blood*; D015175:Prolactinoma / Q000097:blood / Q000150:complications* / Q000235:genetics; D011981:Receptors, Prolactin / Q000235:genetics
chemical_list: D011981:Receptors, Prolactin; D011388:Prolactin