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Pituitary. 2019 Apr;22(2):170-178. doi: 10.1007/s11102-019-00948-w.

Increased androgen secretion in patients with prolactinomas: the impact of altered HPA function.

Author information

1
Division of Clinical and Molecular Endocrinology, UH Cleveland Medical Center and Case Western University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
2
Division of Clinical and Molecular Endocrinology, UH Cleveland Medical Center and Case Western University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. baha.arafah@case.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Earlier studies suggested that hyperprolactinemia was associated with elevated serum DHEA-S levels. The importance of DHEA-S measurements in the diagnosis of adrenal insufficiency prompted us to assess adrenal androgen levels in hyperprolactinemic subjects with normal or impaired function.

METHODS:

Prospective study including 122 medically treated and 26 surgically patients with prolactinomas. Serum PRL, DHEA and DHEA-S levels were measured before and repeatedly after cabergoline therapy and also in the perioperative period of surgically treated patients.

RESULTS:

Serum PRL levels decreased (P < 0.001) in all 101 medically treated patients with normal HPA function from 728.3 ± 1507 reaching 29.1 ± 39 and 14.9 ± 24.4 µg/L at 3 and 12 months, respectively. Concurrently serum DHEA-S levels decreased (P < 0.001) from 245.9 ± 196 to 216.2 ± 203.3 and to 169.7 ± 121.1 µg/dl at 3 and 12 months, respectively. These effects were reversed in 19 patients who discontinued treatment and were re-demonstrated after therapy resumption. Among the 22 surgically treated patients with normal HPA, peri-operative PRL levels decreased rapidly (P < 0.001) with a parallel decline in serum DHEA-S levels (P = 0.03). Strong correlations were noted between PRL and DHEA-S decrements observed with medical or surgical therapy. Medically (n = 21) and surgically (n = 4) patients with impaired HPA function had very low DHEA-S values that were unchanged despite marked reductions in PRL secretion.

CONCLUSION:

Hyperprolactinemia is associated with a reproducible and reversible increase in serum DHEA-S that was observed in medically- and surgically-treated patients with normal HPA function. Thus, a normal age- and gender-adjusted serum DHEA-S level continues to imply normal HPA function even among hyperprolactinemic subjects.

KEYWORDS:

DHEA-S; Hypothalamic–pituitary–adrenal axis; Prolactinoma

PMID:
30798438
DOI:
10.1007/s11102-019-00948-w
[Indexed for MEDLINE]

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