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.
Similar content being viewed by others
References
T. Mancini, F.F. Casanueva, A. Giustina, Hyperprolactinemia and prolactinomas. Endocrinol. Metab. Clin. North Am. 37(1), 67–99 (2008)
M. Kars, P.C. Souverein, R.M. Herings et al., Estimated age- and sex-specific incidence and prevalence of dopamine agonist-treated hyperprolactinemia. J. Clin. Endocrinol. Metab. 94(8), 2729–2734 (2009)
M.E. Lieberman, R.A. Maurer, P. Claude, J. Gorski, Prolactin synthesis in primary cultures of pituitary cells: regulation by estradiol. Mol. Cell. Endocrinol. 25(3), 277–294 (1982)
S. Karunakaran, R.C. Page, J.A. Wass, The effect of the menopause on prolactin levels in patients with hyperprolactinaemia. Clin. Endocrinol. 54(3), 295–300 (2001)
V. Dos Santos Nunes, R. El Dib, C.L. Boguszewski, C.R. Nogueira, Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and meta-analysis. Pituitary 14(3), 259–265 (2011)
M.E. Molitch, Pituitary tumors: cabergoline versus bromocriptine: a meta-analysis? Nat. Rev. Endocrinol. 7(5), 254–255 (2011)
A. Colao, A. Di Sarno, M.L. Landi et al., Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: a prospective study in 110 patients. J. Clin. Endocrinol. Metab. 85(6), 2247–2252 (2000)
F.F. Casanueva, M.E. Molitch, J.A. Schlechte et al., Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin. Endocrinol. 65(2), 265–273 (2006)
S. Melmed, F.F. Casanueva, A.R. Hoffman et al., Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(2), 273–288 (2011)
L. Vroonen, M.L. Jaffrain-Rea, P. Petrossians et al., Prolactinomas resistant to standard doses of cabergoline: a multicenter study of 92 patients. Eur. J. Endocrinol. 167(5), 651–662 (2012)
E. Delgrange, G. Raverot, M. Bex et al., Giant prolactinomas in women. Eur. J. Endocrinol. 170(1), 31–38 (2014)
I. Shimon, M.D. Bronstein, J. Shapiro, G. Tsvetov, C. Benbassat, A. Barkan, Women with prolactinomas presented at the postmenopausal period. Endocrine. (2014). doi:10.1007/s12020-014-0259-1
G. Mazziotti, T. Mancini, M. Mormando et al., High prevalence of radiological vertebral fractures in women with prolactin-secreting pituitary adenomas. Pituitary 14(4), 299–306 (2011)
D. Seriwatanachai, N. Krishnamra, J.P. van Leeuwen, Evidence for direct effects of prolactin on human osteoblasts: Inhibition of cell growth and mineralization. J. Cell. Biochem. 107(4), 677–685 (2009)
D. Seriwatanachai, K. Thongchote, N. Charoenphandhu et al., Prolactin directly enhances bone turnover by raising osteoblast-expressed receptor activator of nuclear factor kappaB ligand/osteoprotegerin ratio. Bone 42(3), 535–546 (2008)
A. Klibanski, S.L. Greenspan, Increase in bone mass after treatment of hyperprolactinemic amenorrhea. N. Engl. J. Med. 315(9), 542–546 (1986)
J. Schlechte, G. el-Khoury, M. Kathol, L. Walkner, Forearm and vertebral bone mineral in treated and untreated hyperprolactinemic amenorrhea. J. Clin. Endocrinol. Metab. 64(5), 1021–1026 (1987)
G. Mazziotti, T. Porcelli, M. Mormando et al., Vertebral fractures in males with prolactinoma. Endocrine. 39(3), 288–293 (2011)
A. Shibli-Rahhal, J. Schlechte, The effects of hyperprolactinemia on bone and fat. Pituitary 12(2), 96–104 (2009)
Y. Greenman, K. Tordjman, N. Stern, Increased body weight associated with prolactin secreting pituitary adenomas: weight loss with normalization of prolactin levels. Clin. Endocrinol. 48(5), 547–553 (1998)
C. Ling, L. Svensson, B. Oden et al., Identification of functional prolactin (PRL) receptor gene expression: PRL inhibits lipoprotein lipase activity in human white adipose tissue. J. Clin. Endocrinol. Metab. 88(4), 1804–1808 (2003)
M. Doknic, S. Pekic, M. Zarkovic et al., Dopaminergic tone and obesity: an insight from prolactinomas treated with bromocriptine. Eur. J. Endocrinol. 147(1), 77–84 (2002)
A. Tuzcu, M. Bahceci, M. Dursun, C. Turgut, S. Bahceci, Insulin sensitivity and hyperprolactinemia. J. Endocrinol. Invest. 26(4), 341–346 (2003)
S.S. Inancli, A. Usluogullari, Y. Ustu et al., Effect of cabergoline on insulin sensitivity, inflammation, and carotid intima media thickness in patients with prolactinoma. Endocrine 44(1), 193–199 (2013)
Conflict of interest
The authors have nothing to disclose and did not receive any Grant supporting the writing of this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Iacovazzo, D., De Marinis, L. Treatment of hyperprolactinemia in post-menopausal women: pros. Endocrine 48, 76–78 (2015). https://doi.org/10.1007/s12020-014-0377-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-014-0377-9