Diagnosis and management of hyperprolactinemia: results of a Brazilian multicenter study with 1234 patients.

OBJECTIVE: The aim of the study was to evaluate clinical and laboratorial features of 1234 patients with different etiologies of hyperprolactinemia, as well as the response of 388 patients with prolactinomas to dopamine agonists. DESIGN, SETTING, AND PATIENTS: A total of 1234 hyperprolactinemic patients from 10 Brazilian endocrine centers were enrolled in this retrospective study. MAIN OUTCOME MEASURE: PRL measurement, thyroid function tests, and screening for macroprolactin were conducted. RESULTS: Patients were subdivided as follows: 56.2% had prolactinomas, 14.5% drug-induced hyperprolactinemia, 9.3% macroprolactinemia, 6.6% non-functioning pituitary adenomas, 6.3% primary hypothyroidism, 3.6% idiopathic hyperprolactinemia, and 3.2% acromegaly. Clinical manifestations were similar irrespective of the etiology of the hyperprolactinemia. The highest PRL levels were observed in patients with prolactinomas but there was a great overlap in PRL values between all groups. However, PRL>500 ng/ml allowed a clear distinction between prolactinomas and the other etiologies. Cabergoline (CAB) was more effective than bromocriptine (BCR) in normalizing PRL levels (81.9% vs 67.1%, p<0.0001) and in inducing significant tumor shrinkage and complete disappearance of tumor mass. Drug resistance was observed in 10% of patients treated with CAB and in 18.4% of those that used BCR (p=0.0006). Side-effects and intolerance were also more common in BCR treated patients. CONCLUSION: Prolactinomas, drug induced hyperprolactinemia, and macroprolactinemia were the 3 most common causes of hyperprolactinemia. Although PRL levels could not reliably define the etiology of hyperprolactinemia, PRL values >500 ng/ml were exclusively seen in patients with prolactinomas. CAB was significantly more effective than BCR in terms of prolactin normalization, tumor shrinkage, and tolerability.

Body fat in men with prolactinoma.

OBJECTIVE: (a) To evaluate body fat in men with prolactinoma and healthy controls, using whole body dual energy x-ray absorptiometry (DXA), and (b) to correlate DXA results with anthropometry and clinical aspects of male prolactinomas. MATERIAL AND METHODS: A cross-sectional study was performed in two University referral centers. Eleven newly-diagnosed men with prolactinoma and 9 with normal PRL levels due to dopamine agonist treatment were submitted to DXA and blood analysis (PRL, testosterone, dihydrotestosterone, estradiol, and SHBG) by the time of their clinical evaluation. They were compared with 14 control men of similar age and body mass index distribution. RESULTS: Newly-diagnosed men with prolactinoma had higher fat percentage in the arms and the total body, when compared with patients treated with dopamine agonists and controls. The former group also presented higher fat percentage in the legs than the controls. Truncal fat percentage of the newly-diagnosed patients was lower than the dopamine agonist treated group. The 3 groups had similar android and gynoid fat contents. Fat percentage of the 6 sites correlated with PRL, testosterone, and dihydrotestosterone levels. CONCLUSION: Newly-diagnosed men with prolactinomas had higher body fat content. Body fat was linked to disease control, especially to the PRL and androgen levels. Consequently, adequate control of hyperprolactinemia should be pursued in order to reduce the risk of obesity and its metabolic complications in men with prolactinoma.