Endocrine Abstracts

Introduction: The metabolic consequences of hyperprolactinemia and the repercussions of its treatment with dopaminergic agonists are not yet fully understood. This study aims to evaluate the metabolic profile of patients with prolactinomas (prevalence of diabetes mellitus, dyslipidaemia and obesity) and identify the potential variations after treatment with bromocriptine.

Methods: Retrospective study of patients followed between 1962 and 2013. Included 177 cases, 134♀/43♂, with 37.2±13.7 years, 54.8% (n=97) macroprolactinomas. Analysed: anthropometric data; treatment; prolactin levels, fasting glucose (FG) and lipid profile. Exclusion criteria: follow-up ≤2 years or introduction of antidiabetic and/or lipid-lowering drugs. Statistical analysis: SPSS (21).

Results: Initial evaluation: BMI: 28.1±4.7 kg/m² (obesity in 29.4%); FG: 89.8±24.4 mg/dl (diabetes in 4.5% (n=8), 50% (n=4) previously documented, and, IFG in 7.3% (n=13)); 41.2% (n=73) of the patients presented alteration of at least one lipid fraction. Median initial prolactin was 224 ng/dl. Median cumulative dose of bromocriptine administered, during 9.1±7.4 years, was 9672.5 mg. After treatment 83.1% (n=147) patients achieved normal prolactin levels. Almost half, 49.2% (n=87), of the treated patients presented weight reduction, with significant reduction of final BMI (P<0.05). Prolactin normalization constituted an independent predictive factor of weight reduction (OR=2.97, IC95%: 1.017–7.564: P<0.05). There was a reduction in FG in 18.1% (n=32) patients, and of those initially with IFG, 46% (n=6) presented normal FG after treatment. Weigh reduction sextupled the odds of reducing FG (OR: 6.33, P=0.012). About one third of patients improved at least one lipid fraction, with significant reductions of LDL-cholesterol (132.7 vs 115.3 mg/dl, P<0.01) and triglycerides (139.9 vs 110.4 mg/dl, P<0.01); and increased HDL-cholesterol (49.2 vs 55.5 mg/dl, P<0.01). Triglycerides reduction was correlated with weight reduction (r=0.285, P<0.05).

Conclusion: It was observed a high prevalence of obesity and dyslipidaemia in patients with prolactinomas and a proven benefit of hyperprolactinemia treatment. Treated patients presented weight reduction and improvement of global metabolic profile. The normalization of prolactin levels almost tripled the odds of patients lose weight, which was associated with an improvement of virtually all the evaluated parameters.