ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

Evaluation of Hyperandrogenemia in Women with Prolactinoma
Prolaktinomalı Kadınlarda Hiperandrojenizmin Değerlendirilmesi
Received Date : 25 Oct 2019
Accepted Date : 19 Jan 2020
Available Online : 04 Feb 2020
Doi: 10.25179/tjem.2019-72018 - Makale Dili: EN
Turk J Endocrinol Metab 2020;24:55-62
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Differential diagnosis of androgen excess disorders revealed the occurrence of hyperprolactinemia. However, an elevated level of prolactin (hyperprolactinemia) is a very infrequent cause of hyperandrogenemia in clinical practice. This study aimed to investigate the presence of hyperandrogenism/hyperandrogenemia in women with prolactinoma before and after treatment with cabergoline. Material and Methods: Twenty women diagnosed with prolactinoma in the recent past and 15 healthy women between the ages of 18 to 50 were enrolled in the study. Patients were evaluated at the baseline and after six months of cabergoline treatment. Patients were carefully noted for any signs and symptoms of hyperandrogenemia and concentration of androgen in blood. Further, adrenocorticotropin stimulation test was performed to analyze cortisol, dehydroepiandrosterone sulfate (DHEAS), androstenedione, 11-deoxycortisol (11-S), and 17-hydroxyprogesterone (17-OHP) responses. Results: A significantly higher level of prolactin compared to the control group was seen in prolactinoma patients, which reverted to normal levels after cabergoline treatment. Estradiol (E2) concentration was lower in patients with prolactinoma than control group and it did not show a significant increase after being treated with cabergoline. Patients with prolactinoma exhibited decreased sex hormone-binding globulin (SHBG) concentration in blood, which also increased significantly after the treatment. The levels of basal androstenedione, DHEAS, 17-OH progesterone, 11-S, and cortisol were found to be similar between the two groups. Basal and stimulated DHEAS and androstenedione levels decreased significantly after cabergoline treatment in prolactinoma patients. The presence of acne, hirsutism, and androgenic alopecia were similar in both groups. Pelvic ultrasonography revealed polycystic ovary (PCO) in nine patients with prolactinoma, which was significantly more frequent than in the control group. Among the 9 PCO patients, normal ovarian morphology was restored in three patients after the treatment. Conclusion: From the data, it may be suggested that hyperprolactinemia may not lead to clinically significant hyperandrogenemia and hirsutism. Moreover, the treatment of hyperprolactinemia does not lead to significant improvement in hirsutism score of the patients, if exists.
ÖZET
Amaç: Hiperprolaktinemi, androjen fazlalığı ile seyreden hastalıkların ayırıcı tanılarında araştırılması gereken durumlardandır. Ancak, klinik pratikte hiperprolaktinemi olan hastalarda nadiren hiperandrojenizm görülmektedir. Çalışmamızda, prolaktinoma tanısı almış kadınlarda kabergolin tedavisi öncesi ve sonrası hiperandrojenizmin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya yaş aralığı 18-50 yıl olan, prolaktinoma tanısı konulan 20 kadın hasta ve 15 sağlıklı kontrol dâhil edildi. Hastalar bazal ve 6 aylık kabergolin tedavisinden sonra değerlendirildi. Hiperandrojenizm belirtileri incelendi ve bazal androjen düzeyleri ölçüldü. Adrenokortikotropin stimülasyon testi ile kortizol, dehidroepiandrosteron sülfat (DHEAS) ve androstenedion, 11-deoksikortikol (11-S), 17-hidroksiprogesteron (17-OHP) cevabı değerlendirildi. Bulgular: Prolaktinomalı kadın hastalarda kontrol grubuna kıyasla PRL seviyeleri yüksekti ve kabergolin tedavisi ile geriledi. E2 seviyeleri prolaktinoma hastalarında daha düşüktü ve kabergolin sonrası anlamlı bir artış görülmedi. Seks hormon bağlayıcı globulin düzeyleri prolaktinoma hastalarında düşük olmakla beraber, tedavi ile anlamlı derecede yükseldi. Bazal androstenedion, DHEAS, 17- OH progesteron, 11-S ve kortizol düzeyleri 2 grupta benzer bulundu. Prolaktinoma hastalarında, bazal ve uyarılmış DHEAS ve androstenedion seviyeleri, kabergolin tedavisi sonrası anlamlı derece azaldı. Sivilce, hirsutizm ve androjenik alopesi 2 grupta benzer izlendi. Prolaktinomalı 9 kadın hastada kontrol grubuna göre anlamlı olarak daha sık pelvik ultrasonografide polikistik over (PKO) görüldü. Tedaviden sonra PKO olan 9 hastanın 3’ünde normal over morfolojisi görüldü ve 6 hastada hâlâ PKO vardı. Sonuç: Çalışmamızda, hiperprolaktineminin klinik olarak anlamlı hiperandrojenizm ve hirsutizme yol açmadığı izlendi. Ayrıca, hirsutizmi olan kadın hastalarda ve hirsutizm skorunda hiperprolaktinemi tedavisi sonrası anlamlı bir iyileşme gözlenmedi.
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