Treatment of hyperprolactinemia in post-menopausal women: pros
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PROS AND CONS IN ENDOCRINE PRACTICE
Treatment of hyperprolactinemia in post-menopausal women: pros D. Iacovazzo • L. De Marinis
Received: 19 June 2014 / Accepted: 1 August 2014 / Published online: 12 August 2014 Ó Springer Science+Business Media New York 2014
Abstract The incidence of hyperprolactinemia in women peaks during the 3rd–4th decade and then greatly decreases after the menopause. Apart from the effects on the hypothalamic–pituitary–gonadal axis, prolactin can act directly on bone metabolism. Hyperprolactinemia is a recognized cause of secondary osteoporosis, and treatment with dopamine agonists can lead to improved BMD. Moreover, hyperprolactinemia has been linked to weight gain and insulin resistance, which can be ameliorated following medical treatment. Although relatively rare, prolactinomas can be observed in post-menopausal women and are frequently large and invasive; dopamine agonists appear to be as effective in these patients as in younger women to induce reduction of prolactin levels and tumour shrinkage. Here, we review data potentially favouring medical treatment with dopamine agonists in post-menopausal women diagnosed with hyperprolactinemia. Keywords agonists
Hyperprolactinemia Menopause Dopamine
Introduction Hyperprolactinemia is a heterogeneous condition that recognizes different causes. It can result from autonomous secretion by pituitary lactotroph adenomas, but also from factors D. Iacovazzo L. De Marinis Endocrinology, Universita` Cattolica del Sacro Cuore, Policlinico ‘‘A. Gemelli’’, Rome, Italy D. Iacovazzo (&) Endocrinology, Barts and The London School of Medicine, Charterhouse square, London, UK e-mail: [email protected]
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interfering with hypothalamic dopamine secretion, transport or action on the lactotroph cells [1]. In some cases a cause can’t be identified (idiopathic hyperprolactinemia). Symptoms of hyperprolactinemia are mainly related to its effect on the hypothalamus–pituitary–gonadal axis and hence are gender-specific: in women it often causes oligomenorrhea or amenorrhoea, infertility and galactorrhoea; in men symptoms include erectile dysfunction and decreased libido. Hyperprolactinemia is much more frequent in females compared to males. In a series of 1607 patients with medically treated hyperprolactinemia, the prevalence of female patients has been found to be five times higher compared with male patients [2]. The incidence of medically treated hyperprolactinemia is dependent on age and sex, reaching a peak in women aged 25–34 years-old, and decreasing in post-menopausal women to levels comparable with males. This can be explained by the stimulatory effects of oestrogens on the lactotroph cells [3]. Therefore, hyperprolactinemia is not a common finding in post-menopausal women, either because of the decrease in oestrogen production or because of the lack of classical symptoms of hyperprolactinemia. Moreover, it has been reported that women with hyperprolactinemia passing through the menopause have a significant chance to normalize spontaneously t
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