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Hypoprolactinemia. Does it matter? Redefining the hypopituitarism and return from a mumpsimus

“Absence of proof is not the proof of absence”

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Abstract

Prolactin (PRL) is secreted by the lactotroph cells in the anterior pituitary gland which is under inhibitory control of dopamine. The mature human PRL has more than 300 physiological actions including lactation, reproduction, homeostasis, neuroprotection, behavior, water and electrolyte balance, immunoregulation and embryonic and fetal development. PRL is involved in the growth and development of mammary gland, preparation of the breast for lactation in the postpartum period, synthesis of milk, and maintenance of milk secretion. Abnormalities in the synthesis and secretion of PRL may result in hyperprolactinemia or hypoprolactinemia. Although hyperprolactinemia has been extensively investigated in the literature, because of the subtle or unclearly defined symptoms, hypoprolactinemia is a less-known and neglected disorder. Failure of lactation is a well-known clinical manifestation of hypoprolactinemia. Recent studies reveal that hypoprolactinemia may have some effects beyond lactation such as increased risk for metabolic abnormalities including insulin resistance, abnormal lipid profile, obesity and sexual dysfunction. Very low level of PRL is suggested to be avoided in patients receiving dopamin agonist treatment to prevent unwanted effects of hypoprolactinemia. Another important point is that hypoprolactinemia is not included in the classification of hypopituitarism. Anterior pituitary failure is traditionally classified as isolated, partial and complete (panhypopituitarism) hypopituitarism regardless of prolactin level. Therefore, there are two kinds of panhypopituitarism: panhypopituitarism with normal or high PRL level and panhypopituitarism with low PRL level. In this review, we present two personal cases, discuss the diagnosis of hypoprolactinemia, hypoprolactinemia associated clinical picture and suggest to redefine the classification of hypopituitarism.

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References

  1. Horseman ND, Yu-Lee LY. Transcriptional regulation by the helix bundle peptide hormones: growth hormone, prolactin, and hematopoietic cytokines. Endocr Rev. 1994;15:627–49. https://doi.org/10.1210/edrv-15-5-627.

    Article  CAS  PubMed  Google Scholar 

  2. Ben-Jonathan N, Mershon JL, Allen DL, Steinmetz RW. Extrapituitary prolactin: distribution, regulation, functions, and clinical aspects. Endocr Rev. 1996;17:639–69. https://doi.org/10.1210/edrv-17-6-639.

    Article  CAS  PubMed  Google Scholar 

  3. Owerbach D, Rutter WJ, Cooke NE, Martial JA, Shows TB. The prolactin gene is located on chromosome 6 in humans. Science. 1981;212:815–6. https://doi.org/10.1126/science.7221563.

    Article  CAS  PubMed  Google Scholar 

  4. Freeman ME, Kanyicska B, Lerant A, Nagy G. Prolactin: structure, function, and regulation of secretion. Physiol Rev. 2000;80:1523–631. https://doi.org/10.1152/physrev.2000.80.4.1523.

    Article  CAS  PubMed  Google Scholar 

  5. Nadine B. Prolactin. In: Pituitary. Edited by Melmed S. 4. ed: Elsevier; 2017. pp. 129–161.

  6. Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Pregnancy and pituitary disorders. Eur J Endocrinol. 2010;162:453–75. https://doi.org/10.1530/EJE-09-0923.

    Article  CAS  PubMed  Google Scholar 

  7. MacLeod RM. Regulation of prolactin secretion. In: Martini L, Ganong WF, editors. Frontiers in Neuroendocrinology. New York Raven; 1976. 169–194.

    Google Scholar 

  8. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, et al. Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction. J Sex Med. 2009;6:1457–66. https://doi.org/10.1111/j.1743-6109.2008.01206.x.

    Article  CAS  PubMed  Google Scholar 

  9. Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E, Hypopituitarism. Lancet. 2007;369:1461–70. https://doi.org/10.1016/S0140-6736(07)60673-4.

    Article  CAS  PubMed  Google Scholar 

  10. Bernard V, Young J, Binart N. Prolactin - a pleiotropic factor in health and Disease. Nat Rev Endocrinol. 2019;15:356–65. https://doi.org/10.1038/s41574-019-0194-6.

    Article  CAS  PubMed  Google Scholar 

  11. Carmichael JD. Anterior pituitary failure. In: Pituitary. Edited by Melmed S: Elsevier; 2017. pp. 329–364.

  12. Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab. 2002;87:477–85. https://doi.org/10.1210/jcem.87.2.8216.

    Article  CAS  PubMed  Google Scholar 

  13. Nagy E, Berczi I. Hypophysectomized rats depend on residual prolactin for survival. Endocrinology. 1991;128:2776–84. https://doi.org/10.1210/endo-128-6-2776.

    Article  CAS  PubMed  Google Scholar 

  14. Rastrelli G, Corona G, Maggi M. The role of prolactin in andrology: what is new? Rev Endocr Metab Disord. 2015;16:233–48. https://doi.org/10.1007/s11154-015-9322-3.

    Article  CAS  PubMed  Google Scholar 

  15. Chung TT, Koch CA, Monson JP et al. Hypopituitarism. In: Endotext. Edited by Feingold KR, Anawalt B, Boyce A,. South Dartmouth (MA): MDText.com, Inc.Copyright © 2000–2022, MDText.com, Inc.; 2000

  16. Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, et al. Hormonal replacement in hypopituitarism in adults: an endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:3888–921. https://doi.org/10.1210/jc.2016-2118.

    Article  CAS  PubMed  Google Scholar 

  17. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:364–89. https://doi.org/10.1210/jc.2015-1710.

    Article  CAS  PubMed  Google Scholar 

  18. Tanriverdi F, Dokmetas HS, Kebapcı N, Kilicli F, Atmaca H, Yarman S, et al. Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database. Endocrine. 2014;47:198–205. https://doi.org/10.1007/s12020-013-0127-4.

    Article  CAS  PubMed  Google Scholar 

  19. Drummond JB, Ribeiro-Oliveira A Jr., Soares BS et al. Non-Functioning Pituitary Adenomas. In: Endotext. Edited by Feingold KR, Anawalt B, Boyce A,. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000–2022, MDText.com, Inc.; 2000

  20. Pekic S, Miljic D, Popovic V et al. Hypopituitarism Following Cranial Radiotherapy. In: Endotext. Edited by Feingold KR, Anawalt B, Boyce A,. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000–2022, MDText.com, Inc.; 2000

  21. Tanriverdi F, Schneider HJ, Aimaretti G, Masel BE, Casanueva FF, Kelestimur F. Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach. Endocr Rev. 2015;36:305–42. https://doi.org/10.1210/er.2014-1065.

    Article  CAS  PubMed  Google Scholar 

  22. Briet C, Salenave S, Chanson P. Pituitary Apoplexy. Endocrinol Metab Clin North Am. 2015;44:199–209. https://doi.org/10.1016/j.ecl.2014.10.016.

    Article  PubMed  Google Scholar 

  23. Diri H, Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Sheehan’s syndrome: new insights into an old disease. Endocrine. 2016;51:22–31. https://doi.org/10.1007/s12020-015-0726-3.

    Article  CAS  PubMed  Google Scholar 

  24. Karaca Z, Laway BA, Dokmetas HS, Atmaca H, Kelestimur F. Sheehan syndrome. Nat Rev Dis Primers. 2016;2:16092. https://doi.org/10.1038/nrdp.2016.92.

    Article  PubMed  Google Scholar 

  25. Lichiardopol C, Albulescu DM, Pituitary stalk interruption syndrome: report of two cases and literature review.  Acta Endocrinol (Buchar). 2017;13:96–105. https://doi.org/10.4183/aeb.2017.96.

    Article  CAS  PubMed  Google Scholar 

  26. Karaca Z, Grossman A, Kelestimur F. Investigation of the Hypothalamo-pituitary-adrenal (HPA) axis: a contemporary synthesis. Rev Endocr Metab Disord. 2021;22:179–204. https://doi.org/10.1007/s11154-020-09611-3.

    Article  PubMed  Google Scholar 

  27. Arlt W, Allolio B, Adrenal insufficiency. Lancet. 2003;361:1881–93. https://doi.org/10.1016/S0140-6736(03)13492-7.

    Article  CAS  PubMed  Google Scholar 

  28. Aimaretti G, Corneli G, Razzore P, Bellone S, Baffoni C, Arvat E, et al. Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine as provocative tests for the diagnosis of GH deficiency in adults. J Clin Endocrinol Metab. 1998;83:1615–8. https://doi.org/10.1210/jcem.83.5.4837.

    Article  CAS  PubMed  Google Scholar 

  29. Grinspoon SK, Biller BM. Clinical review 62: Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab. 1994;79:923–31. https://doi.org/10.1210/jcem.79.4.7962298.

    Article  CAS  PubMed  Google Scholar 

  30. Karaca Z, Tanriverdi F, Atmaca H, Gokce C, Elbuken G, Selcuklu A, et al. Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic-pituitary-adrenal axis before and after pituitary Surgery? Eur J Endocrinol. 2010;163:377–82. https://doi.org/10.1530/EJE-10-0229.

    Article  CAS  PubMed  Google Scholar 

  31. Voutetakis A, Sertedaki A, Livadas S, Maniati-Christidi M, Mademtzis I, Bossis I, et al. Ovulation induction and successful pregnancy outcome in two patients with Prop1 gene mutations. Fertil Steril. 2004;82:454–7. https://doi.org/10.1016/j.fertnstert.2004.03.026.

    Article  PubMed  Google Scholar 

  32. Rasmussen KM, Kjolhede CL. Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics. 2004;113:e465–471. https://doi.org/10.1542/peds.113.5.e465.

    Article  PubMed  Google Scholar 

  33. Kirsch P, Kunadia J, Shah S, Agrawal N. Metabolic effects of prolactin and the role of dopamine agonists: a review. Front Endocrinol (Lausanne). 2022;13:1002320. https://doi.org/10.3389/fendo.2022.1002320.

    Article  PubMed  Google Scholar 

  34. Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, et al. Lactation and progression to Type 2 Diabetes Mellitus after gestational diabetes mellitus: a prospective cohort study. Ann Intern Med. 2015;163:889–98. https://doi.org/10.7326/M15-0807.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Toledano Y, Lubetsky A, Shimon I. Acquired prolactin deficiency in patients with disorders of the hypothalamic-pituitary axis. J Endocrinol Invest. 2007;30:268–73. https://doi.org/10.1007/BF03346292.

    Article  CAS  PubMed  Google Scholar 

  36. Caturegli P, Lupi I, Landek-Salgado M, Kimura H, Rose NR. Pituitary autoimmunity: 30 years later. Autoimmun Rev. 2008;7:631–7. https://doi.org/10.1016/j.autrev.2008.04.016.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Mukherjee A, Murray RD, Columb B, Gleeson HK, Shalet SM. Acquired prolactin deficiency indicates severe hypopituitarism in patients with disease of the hypothalamic-pituitary axis. Clin Endocrinol. 2003;59:743–8. https://doi.org/10.1046/j.1365-2265.2003.01916.x.

    Article  Google Scholar 

  38. Iwama S, Welt CK, Romero CJ, Radovick S, Caturegli P. Isolated prolactin deficiency associated with serum autoantibodies against prolactin-secreting cells. J Clin Endocrinol Metab. 2013;98:3920–5. https://doi.org/10.1210/jc.2013-2411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Pellegrini-Bouiller I, Bélicar P, Barlier A, Gunz G, Charvet JP, Jaquet P, et al. A new mutation of the gene encoding the transcription factor Pit-1 is responsible for combined pituitary hormone deficiency. J Clin Endocrinol Metab. 1996;81:2790–6. https://doi.org/10.1210/jcem.81.8.8768831.

    Article  CAS  PubMed  Google Scholar 

  40. Ramanbhavana VS, Vara Prasad KS. A Case Series of Craniopharyngioma: Epidemiological Study and Management Analysis at Tertiary Care Center. Asian J Neurosurg. 2019;14:1196–202. https://doi.org/10.4103/ajns.AJNS_67_19.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Shapiro MS, Bernheim J, Gutman A, Arber I, Spitz IM. Multiple abnormalities of anterior pituitary hormone secretion in association with pseudohypoparathyroidism. J Clin Endocrinol Metab. 1980;51:483–7. https://doi.org/10.1210/jcem-51-3-483.

    Article  CAS  PubMed  Google Scholar 

  42. Barbieri RL, Cooper DS, Daniels GH, Nathan D, Klibanski A, Ridgway EC. Prolactin response to thyrotropin-releasing hormone (TRH) in patients with hypothalamic-pituitary disease. Fertil Steril 1985,43:66–73. https://doi.org/10.1016/s0015-0282(16)48319-6.

  43. Diri H, Tanriverdi F, Karaca Z, Senol S, Unluhizarci K, Durak AC, et al. Extensive investigation of 114 patients with Sheehan’s syndrome: a continuing disorder. Eur J Endocrinol. 2014;171:311–8. https://doi.org/10.1530/EJE-14-0244.

    Article  CAS  PubMed  Google Scholar 

  44. Mukherjee A, Ryder WD, Jöstel A, Shalet SM. Prolactin deficiency is independently associated with reduced insulin-like growth factor I status in severely growth hormone-deficient adults. J Clin Endocrinol Metab. 2006;91:2520–5. https://doi.org/10.1210/jc.2005-2491.

    Article  CAS  PubMed  Google Scholar 

  45. Macotela Y, Ruiz-Herrera X, Vázquez-Carrillo DI, Ramírez-Hernandez G, de la Martínez G, Clapp C. The beneficial metabolic actions of prolactin. Front Endocrinol (Lausanne). 2022;13:1001703. https://doi.org/10.3389/fendo.2022.1001703.

    Article  PubMed  Google Scholar 

  46. Macotela Y, Triebel J, Clapp C. Time for a New Perspective on Prolactin in Metabolism. Trends Endocrinol Metab. 2020;31:276–86. https://doi.org/10.1016/j.tem.2020.01.004.

    Article  CAS  PubMed  Google Scholar 

  47. Brelje TC, Parsons JA, Sorenson RL. Regulation of islet beta-cell proliferation by prolactin in rat islets. Diabetes. 1994;43:263–73. https://doi.org/10.2337/diab.43.2.263.

    Article  CAS  PubMed  Google Scholar 

  48. Huang C, Snider F, Cross JC. Prolactin receptor is required for normal glucose homeostasis and modulation of beta-cell mass during pregnancy. Endocrinol 2009,150:1618–26. https://doi.org/10.1210/en.2008-1003.

  49. Li J, Rice MS, Huang T, Hankinson SE, Clevenger CV, Hu FB et al. Circulating prolactin concentrations and risk of type 2 diabetes in US women. Diabetologia 2018,61:2549–60. https://doi.org/10.1007/s00125-018-4733-9.

  50. Yu J, Xiao F, Zhang Q, Liu B, Guo Y, Lv Z, et al. PRLR regulates hepatic insulin sensitivity in mice via STAT5. Diabetes. 2013;62:3103–13. https://doi.org/10.2337/db13-0182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Balbach L, Wallaschofski H, Völzke H, Nauck M, Dörr M, Haring R. Serum prolactin concentrations as risk factor of metabolic syndrome or type 2 diabetes? BMC Endocr Disord. 2013;13:12. https://doi.org/10.1186/1472-6823-13-12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Wang T, Lu J, Xu Y, Li M, Sun J, Zhang J, et al. Circulating prolactin associates with Diabetes and impaired glucose regulation: a population-based study. Diabetes Care. 2013;36:1974–80. https://doi.org/10.2337/dc12-1893.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Chirico V, Cannavò S, Lacquaniti A, Salpietro V, Mandolfino M, Romeo PD, et al. Prolactin in obese children: a bridge between inflammation and metabolic-endocrine dysfunction. Clin Endocrinol. 2013;79:537–44. https://doi.org/10.1111/cen.12183.

    Article  CAS  Google Scholar 

  54. Zhang Z, Piro AL, Allalou A, Alexeeff SE, Dai FF, Gunderson EP, et al. Prolactin and maternal metabolism in women with a recent GDM pregnancy and links to future T2D: the SWIFT Study. J Clin Endocrinol Metab. 2022;107:2652–65. https://doi.org/10.1210/clinem/dgac346.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Fleenor DE, Freemark M. Prolactin induction of insulin gene transcription: roles of glucose and signal transducer and activator of transcription 5. Endocrinology. 2001;142:2805–10. https://doi.org/10.1210/endo.142.7.8267.

    Article  CAS  PubMed  Google Scholar 

  56. Zhang P, Ge Z, Wang H, Feng W, Sun X, Chu X, et al. Prolactin improves hepatic steatosis via CD36 pathway. J Hepatol. 2018;68:1247–55. https://doi.org/10.1016/j.jhep.2018.01.035.

    Article  CAS  PubMed  Google Scholar 

  57. Mráziková L, Neprašová B, Mengr A, Popelová A, Strnadová V, Holá L, et al. Lipidized prolactin-releasing peptide as a new potential tool to treat obesity and Type 2 Diabetes Mellitus: preclinical studies in rodent models. Front Pharmacol. 2021;12:779962. https://doi.org/10.3389/fphar.2021.779962.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Rubí B, Ljubicic S, Pournourmohammadi S, Carobbio S, Armanet M, Bartley C, et al. Dopamine D2-like receptors are expressed in pancreatic beta cells and mediate inhibition of insulin secretion. J Biol Chem. 2005;280:36824–32. https://doi.org/10.1074/jbc.M505560200.

    Article  CAS  PubMed  Google Scholar 

  59. Corona G, Wu FC, Rastrelli G, Lee DM, Forti G, O’Connor DB, et al. Low prolactin is associated with sexual dysfunction and psychological or metabolic disturbances in middle-aged and elderly men: the European Male Aging Study (EMAS). J Sex Med. 2014;11:240–53. https://doi.org/10.1111/jsm.12327.

    Article  CAS  PubMed  Google Scholar 

  60. Ufearo CS, Orisakwe OE. Restoration of normal sperm characteristics in hypoprolactinemic infertile men treated with metoclopramide and exogenous human prolactin. Clin Pharmacol Ther. 1995;58:354–9. https://doi.org/10.1016/0009-9236(95)90253-8.

    Article  CAS  PubMed  Google Scholar 

  61. Maseroli EVN, Cipriani S, Rastrelli G, Alfaroli C, Ravelli SA, Costeniero D, Scairati R, Minnetti M, Petraglia F, Auriemma RS, Nappi RE, Maggi M, Vignozzi L. Low prolactin level identifies hypoactive sexual desire disorder women with low inhibition profile. J Endocrinol Invest. 2023. https://doi.org/10.1007/s40618-023-02101-8.

    Article  PubMed  Google Scholar 

  62. Pirchio R, Graziadio C, Colao A, Pivonello R, Auriemma RS. Metabolic effects of prolactin. Front Endocrinol (Lausanne). 2022;13:1015520. https://doi.org/10.3389/fendo.2022.1015520.

    Article  PubMed  Google Scholar 

  63. Krysiak R, Kowalcze K, Okopień B. Cardiometabolic profile of young women with hypoprolactinemia. Endocrine. 2022;78:135–41. https://doi.org/10.1007/s12020-022-03145-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Krysiak R, Kowalcze K, Okopień B. Cabergoline-induced hypoprolactinemia may attenuate cardiometabolic effects of atorvastatin: a pilot study. Cardiology. 2022;147:497–506. https://doi.org/10.1159/000527333.

    Article  CAS  PubMed  Google Scholar 

  65. Krysiak R, Kowalcze K, Okopień B. Sexual function and depressive symptoms in men with hypoprolactinaemia secondary to overtreatment of prolactin excess: a pilot study. Endocrinol Diabetes Nutr (Engl Ed). 2022;69:279–88. https://doi.org/10.1016/j.endien.2021.03.004.

    Article  PubMed  Google Scholar 

  66. Moriwaki M, Welt CK. PRL mutation causing alactogenesis: insights into Prolactin structure and function relationships. J Clin Endocrinol Metab. 2021;106:e3021–6. https://doi.org/10.1210/clinem/dgab201.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Faculty of Medicine, Department of Endocrinology Kayseri, Erciyes University, Talas/Kayseri, Turkey

    Zuleyha Karaca & Kursad Unluhizarci

  2. Faculty of Medicine, Department of Endocrinology İstanbul, Yeditepe University, Ataşehir/İstanbul, Turkey

    Fahrettin Kelestimur

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ZK: Collection of data, writing of case reports and discussion, KU: writing of introduction and discussion, FK: Collection of data, writing of introduction and discussion and reappraisal of the manuscript.

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Karaca, Z., Unluhizarci, K. & Kelestimur, F. Hypoprolactinemia. Does it matter? Redefining the hypopituitarism and return from a mumpsimus. Rev Endocr Metab Disord (2023). https://doi.org/10.1007/s11154-023-09847-9

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