Males with prolactinoma are at increased risk of incident cardiovascular disease

Toulis, Konstantinos; Robbins, Tim; Reddy, Narendra; Kumarendran, Balachandran; Gokhale, Krishna; Wijesinghe, Haren; Cheng, Kar Keung; Karavitaki, Niki; Wass, John; Nirantharakumar, Krishnarajah

doi:10.1111/cen.13498

Cited by 28 publications

(17 citation statements)

References 33 publications

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“…Higher concentrations of several cardiac risk markers including total cholesterol, LDL, apo B, platelet count, fibrinogen, AT-III, PAI-1 and PAI-1/t-PA have been reported in patients with prolactinoma [136]. In a retrospective cohort study including 2233 individuals with prolactinoma and 10,355 matched controls, only males were at increased risk of incident cardiovascular disease (incidence rate ratio 1.94; 95% CI: 1.29-2.91, p = 0.001) [137]. However, the contribution of possible growth hormone deficiency and/or hypogonadism in these findings cannot be excluded.…”

Section: Cardiovascular Riskmentioning

confidence: 99%

Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through "stalk effect") are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.

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Section: Cardiovascular Riskmentioning

confidence: 99%

Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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“…The median age at diagnosis is 31-32 years for women and 39-48 years for men (1)(2)(3) . Data on the incidence of cardiovascular diseases in the group of patients with prolactinoma are sparse, but indicate an increased cardiovascular risk and mortality, mainly due to overlapping metabolic disorders and premature atherosclerosis (4)(5)(6)(7)(8)(9) . This is related not only to the overproduction of prolactin itself, but also to its negative effects on the activity of the hypothalamic-pituitary-gonadal axis.…”

Section: Epidemiologymentioning

confidence: 99%

Prolactinoma and cardiovascular diseases – an interdisciplinary problem

Jurek¹,

Krzesiński²,

Gielerak³

et al. 2021

Pediatr Med Rodz

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Prolactin-secreting pituitary tumour is a rare disease, in which excess prolactin causes significant functional and constitutional disorders of the whole body. Hyperprolactinaemia is associated with changes in body composition and metabolic disorders. The long-term prognosis and quality of life in patients with prolactinoma are mainly influenced by cardiovascular disorders, which, if left untreated, increase the cardiovascular risk and limit the treatment options for secondary organ complications. Cardiovascular mortality in patients with prolactinoma is several times higher than in the general population. Early diagnosis of prolactin-releasing pituitary tumour and a thorough morphological and functional cardiovascular assessment at each stage of the disease are necessary for risk stratification. Patients with prolactinoma should be put on combined treatment based on both serum prolactin control, and reduction of cardiovascular risk factors. Normalisation of prolactin levels and reduction of the tumour mass, achieved mainly through effective pharmacotherapy, reduce mortality and the risk of cardiovascular complications; therefore, the earliest possible diagnosis of prolactin pituitary tumour and implementation of appropriate treatment as well as active diagnosis and therapy of coexisting organ complications should be set as a goal in these patients. It seems that a thorough cardiological assessment of patients with prolactinoma should be obligatory, regardless of their age or the time of diagnosis. The aim of this study was to present the complexity of clinical problems in patients with prolactin secreting pituitary tumours, who require special interdisciplinary care.

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“…Excess prolactin in the setting of prolactinoma is also associated with impaired insulin sensitivity and adverse effects on lipids [ 44 ]. A role for prolactin in cardiovascular disease is supported by the association between prolactinoma and an elevated risk for incident cardiovascular disease in males compared with control subjects [ 45 ] and in CKD patients, prolactin levels have been positively associated with mortality and cardiovascular death [ 46 ].…”

Section: Other Large Uremic Toxins Linked With Cardiovascular Diseasementioning

confidence: 99%

Large uremic toxins: an unsolved problem in end-stage kidney disease

Wolley

Hutchison

2018

Nephrology Dialysis Transplantation

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Patients with end-stage kidney disease (ESKD) on maintenance hemodialysis are subject to a high burden of inflammation and cardiovascular disease, driven at least in part by retention of uremic solutes. Existing dialysis technologies using high-flux membranes offer limited clearance of solutes >15 kDa. New approaches to improve the removal of large uremic toxins include the novel medium cut-off dialysis membranes with pores larger than those in high-flux membranes. These new membranes provide the potential to improve the clearance of large middle molecules up to 50 kDa. In this review, we discuss 18 uremic toxins with molecular weights between 15 and 60 kDa that are retained in ESKD, for which there is evidence of a link to inflammation and/or cardiovascular disease. These include inflammatory proteins, cytokines, adipokines and other signaling proteins. Improved clearance of this group of difficult to remove molecules has the potential to lead to improved outcomes in dialysis patients by reducing the burden of cardiovascular disease, which now needs to be assessed in robust clinical trials.

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Males with prolactinoma are at increased risk of incident cardiovascular disease

Cited by 28 publications

References 33 publications

Hyperprolactinaemia

Hyperprolactinaemia

Prolactinoma and cardiovascular diseases – an interdisciplinary problem

Large uremic toxins: an unsolved problem in end-stage kidney disease

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