Hyperprolactinemia and the Association with All-Cause Mortality and Cardiovascular Mortality

Krogh, Jesper; Selmer, Christian; Torp‐Pedersen, Christian; Gislason, Gunnar; Kistorp, Caroline

doi:10.1055/s-0043-107243

Cited by 22 publications

(19 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In line with this, males are diagnosed at an older age than females, possibly implying longer diagnostic delay and exposure to the consequences of hyperprolactinaemia and of related hypogonadism . Interestingly, a recent retrospective cohort study including approximately 373 individuals with hyperprolactinemia (irrespective of its primary aetiology) reported similar findings with our study . In this report, male hyperprolactinaemic patients had a higher IRR for cardiovascular and all‐cause mortality in contrast to female patients, in whom no difference was noted when compared to normoprolactinaemic controls .…”

Section: Discussionsupporting

confidence: 89%

“…Interestingly, a recent retrospective cohort study including approximately 373 individuals with hyperprolactinemia (irrespective of its primary aetiology) reported similar findings with our study . In this report, male hyperprolactinaemic patients had a higher IRR for cardiovascular and all‐cause mortality in contrast to female patients, in whom no difference was noted when compared to normoprolactinaemic controls . Of note, an older study of a case‐control design which explored prolactin levels in those who suffered a coronary artery event and controls did not find higher prolactin levels in the affected patients .…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Males with prolactinoma are at increased risk of incident cardiovascular disease

Toulis

Robbins

Reddy

et al. 2017

Clinical Endocrinology

View full text Add to dashboard Cite

SummaryObjective: To investigate whether the risk of incident cardiovascular disease (CVD) is increased in patients with prolactinoma.Design: Population-based, retrospective, open-cohort study using The Health Improvement Network (THIN) database.Patients: A total of 2233 patients with prolactinoma and 10 355 matched controls (1:5 ratio) from UK General Practices contributing to THIN were included. Sex, age, body mass index and smoking status were used as matching parameters. The primary outcome was any incident CVD, defined by Read codes suggesting myocardial infarction, angina pectoris, stroke, transient ischaemic attack or heart failure. Sex-specific-adjusted incidence rate ratios (aIRRs) were calculated with Poisson regression, using clinically relevant parameters as model covariates. Sensitivity analyses were performed to check whether a change in the initial assumptions could have an impact on the findings.Results: During the 6-year observation period, the composite CVD outcome was recorded in 54 patients with prolactinoma and 180 "nonexposed" individuals. The incidence rate was 1.8 and 14.8 per 1000 person-years for the females and males with prolactinoma, respectively. The aIRRs for CVD were estimated at 0.99 [95% confidence interval (CI): 0.61-1.61, P = .968)] in female patients and 1.94 (95% CI: 1.29-2.91, P = .001) in male patients. These findings remained robust in sensitivity analyses restricting to patients with documented record of dopamine agonist treatment and those with newly diagnosed prolactinoma. Conclusions:In contrast to females, men with prolactinoma have increased risk for incident CVD; the aetiology of this gender-specific finding remains to be elucidated. K E Y W O R D Scardiovascular disease, hyperprolactinaemia, pituitary adenoma, prolactinoma

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Males with prolactinoma are at increased risk of incident cardiovascular disease

Toulis

Robbins

Reddy

et al. 2017

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…For example, in a population-based study, pituitary tumor-related hyperprolactinemia did not show an increased risk for diabetes, vascular disease, bone fracture, and all causes of cancer and breast cancer; however, macroadenomas, drug-induced hyperprolactinemia, and idiopathic hyperprolactinemia were associated with an increased risk of death ( 48 ). Another study showed that in men, but not in women, hyperprolactinemia would be associated with higher all-cause and cardiovascular mortality ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

Prolactinomas Resistant to Treatment With Dopamine Agonists: Long-Term Follow-Up of Six Cases

et al. 2018

View full text Add to dashboard Cite

Introduction: Prolactinomas are preferentially treated with dopamine agonists. However, a few adenomas are resistant to this treatment.Objective: To evaluate the characteristics of patients with resistance to dopamine agonists in the long-term.Method: A retrospective study of six cases was made. Patients who did not achieve normalized prolactin blood concentrations and a reduction of more than 50% of the tumor volume with the minimum dose of 3.5 mg per week of cabergoline for 3 months or the maximum supported dose of bromocriptine for 6 months were considered resistant to dopamine agonists. Patients were followed up at the Clinic of Neurology and Endocrinology or the University Hospital of Brasilia.Results: Six patients were selected. Three patients were initially treated with bromocriptine prior to treatment with cabergoline. Four patients were men, and two were women. At the time of diagnosis, ages ranged from 9 to 62 years. Initial prolactin concentrations ranged from 430 to 14,992 ng/mL and in the last assessment ranged from 29.6 to 2,169 ng/mL. The tumor volume ranged from 0.77 to 24.0 mm3. Tumor regression occurred in all patients, ranging from 20 to 100%, but total disappearance of the adenoma with an empty sella occurred in one patient. The maximum weekly doses of cabergoline ranged from 3.0 to 4.5 mg. Follow-up time ranged from seven to 17 years. Normalization of prolactin concentrations occurred only in one woman after 17 years of treatment. Three patients also underwent surgery, but only one woman was cured of the disease.Conclusion: This study confirms that tumors resistant to dopamine agonists are more aggressive, since we did not have any microadenoma; treatment with high dose of cabergoline may reduce the size of the tumor without its disappearance, and that normalization of prolactin concentration rarely occurs. To our knowledge, this is the longest follow-up of a series of cases with resistance to dopamine agonists.

show abstract

“…In recent large cohort studies, high prolactin levels within and above the normal physiological range have been associated with increased risk of cardiovascular mortality (1, 2, 3). It is speculated whether this association is mediated through prolactin-induced increase in cardiovascular risk factors including obesity, dyslipidemia and insulin resistance (4, 5, 6, 7, 8, 9, 10).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, prolactin levels prospectively correlated with higher levels of low-density lipoprotein (LDL) in women, and with hypertension and incidence of diabetes in men (11). In two large cohort studies hyperprolactinemia was associated with increased incidence of cardiovascular disease and cardiovascular mortality in men only (2, 3). However, the association between prolactin and excess disease burden is not consistent: In a case–control study with 1204 cases of hyperprolactinemia, no increased morbidity or mortality was found (12), and in a large cohort, levels of prolactin did not differ between those participants who suffered from fatal or nonfatal coronary artery disease and those who did not (13).…”

Section: Introductionmentioning

confidence: 99%

Metabolic effects of dopamine agonists in patients with prolactinomas: a systematic review and meta-analysis

Byberg

Futtrup

Andreassen

et al. 2019

Endocrine Connections

Self Cite

View full text Add to dashboard Cite

ObjectivesRecent large cohort studies suggest an association between high plasma prolactin and cardiovascular mortality. The objective of this systematic review was to systematically assess the effect of reducing prolactin with dopamine agonist on established cardiovascular risk factors in patients with prolactinomas.DesignBibliographical search was done until February 2019 searching the following databases: PubMed, EMBASE, WHO and LILAC. Eligible studies had to include participants with verified prolactinomas where metabolic variables were assessed before and after at least 2 weeks treatment with dopamine agonists.MethodsBaseline data and outcomes were independently collected by two investigators. The study was registered with PROSPERO (registration number CRD42016046525).ResultsFourteen observational studies enrolling 387 participants were included. The pooled standardized mean difference of the primary outcome revealed a reduction of BMI and weight of −0.21 (95% CI −0.37 to −0.05; P = 0.01; I2 = 71%), after treatment. Subgroup analysis suggested that the reduction of weight was primarily driven by studies with high prolactin levels at baseline (P = 0.04). Secondary outcomes suggested a small decrease in waist circumference, a small-to-moderate decrease in triglycerides, fasting glucose levels, HOMA-IR, HbA1c and hsCRP, and a moderate decrease in LDL, total cholesterol and insulin.ConclusionThis systematic review suggests a reduction of weight as well as an improved lipid profile and glucose tolerance after treatment with dopamine agonist in patients with prolactinomas. These data are based on low-quality evidence.

show abstract

Hyperprolactinemia and the Association with All-Cause Mortality and Cardiovascular Mortality

Cited by 22 publications

References 36 publications

Males with prolactinoma are at increased risk of incident cardiovascular disease

Males with prolactinoma are at increased risk of incident cardiovascular disease

Prolactinomas Resistant to Treatment With Dopamine Agonists: Long-Term Follow-Up of Six Cases

Metabolic effects of dopamine agonists in patients with prolactinomas: a systematic review and meta-analysis

Contact Info

Product

Resources

About