Evaluation of Hyperandrogenemia in Women with Prolactinoma

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.