Endocrine Abstracts

Introduction: Obesity is one of the most common endocrine disorders. Obesity can either be a symptom of numerous diseases or be associated with them, including cases, when patient does not have other complaints besides excess weight. This should be considered before initiating obesity treatment.

Case: A 42-year-old male visited endocrinologist, complaining of overweight. Minimum weight from his adulthood was 70 kg, maximum was for that moment–124.5 kg, BMI – 43.3 kg/m², waist circumference – 134 cm. Weight increase was gradual, for several years. Patient used to have 3 main meals, physical activity was low. He did not complain of sexual dysfunction, as he was divorced and did not live a sexual life. He did not take any medications. Headaches were infrequent: one time in six months; there was no vision impairment, no clinical features of acromegaly, no galactorrhea, however, patient’s habitus was slightly effeminate. Fasting plasma glucose level was 5.3 mmol/l, after 120 minutes OGTT – 8.53 mmol/l, HbA1c – 6.1%, insulin – 24.02, LDL-cholesterol – 3.27 mmol/l. Other parameters of biochemical blood test were within reference range. Endogenous hypercortisolism and hypothyroidism were excluded. Patient’s testosterone level was 1.88 nmol/l, LH – 0.24, FSH – 1.77, PRL – 7509 mIU/l. We performed pituitary MRI, which revealed a macroadenoma 18×16×16 mm in size, with MR-signs of subacute hemorrhage. Patient reported that he had no injuries for the whole year and the last episode of headaches was in several months ago. Perimetry revealed no vision field impairment. We started treating patient with cabergoline and advised him to adhere to a hypocaloric diet with low content of animal fats and quickly digestible carbohydrates, and everyday walking. After 3 months of treatment level of PRL was 502 mIU/l, weight decreased on 19.5 kg (from 124.5 to 105 kg), BMI estimated 35.5kg/m². There were some improvements in lab parameters: glucose after 120 minutes OGTT – 7.8 mmol/l, HbA1c – 5.8%, insulin – 16.2, LDL-cholesterol – 3.0 mmol/l. These results were achieved without any pharmacotherapy of obesity. Patient continued therapy with cabergoline and follow diet and physical activity guidelines. Repeated MRI is planned after 3 months of treatment.

Conclusion: Our case shows that despite prevalence of primary obesity, associate endocrinopathies should also be taken into consideration. In our patient, a treatment of hyperprolactinemia with cabergoline was accompanied by a decrease in body weight and metabolic parameters improvement, even without pharmacotherapy of obesity.